Perioperative, Surgical, and Procedural Care for Older Adults with Frailty

Older adults have surgery more often than any other age group. Between 25% and 50% of older surgical patients live with frailty, which places them at increased risk of early postoperative adverse events such as morbidity and mortality (>twofold increase in risk), as well as disability and non-home discharge (up to fivefold increased risk). Improving outcomes for older adults with frailty considering surgery starts with frailty assessment using a multidimensional instrument. Next, clinicians should share frailty status with other member of the perioperative team, engage in shared decision making, and support deficit-informed patient optimization. In-hospital care should ideally be informed by comprehensive geriatric assessment and feature a shared care model provided by a multidisciplinary team. Multicomponent delirium reduction strategies should be employed. Promising and emerging interventions include cognitive and physical/nutritional prehabilitation and depth of anesthesia targets informed by brain monitoring.