Understanding Aging, Frailty, and Resilience

With the increasing life expectancy and ongoing medical advancements, the demand for surgical interventions is increasing among older and oldest-old adults, worldwide. Refining technical approaches progressively mitigates surgical and anesthetist complications associated with surgical stressors. Similar efforts are required to blunt and prevent surgical complications occurring in older adults living with frailty who are more vulnerable to acute health changes and poor health-related outcomes. Frailty is not a universal attribute of aging, it is a pivotal clinical syndrome in geriatric medicine, and emerges as a significant determinant of outcomes in the surgical field. Frailty is compounded by various organ alterations, and poses a challenge to the body’s resilience, resulting in heightened vulnerability and adverse events. Surgical procedures, particularly in urgent situations, act as catalysts for frailty and multimorbidity, precipitating significant and irreversible consequences. In fact, despite established surgical protocols, frail older adults face increased rates of surgical revisions, delayed functional recovery, and prolonged hospital stays, all of which contribute to physical and cognitive deterioration and functional dependence. Adding to surgical proficiency, the medical expertise for the early detection and managing of frailty could be an effective strategy to improve the opportunities for qualified surgery at any age, and better contribution to individual quality of life. Risk stratification systems have been validated in surgical settings, but they may oversimplify the risks or overlook the factors triggering or contributing to frailty. Ultimately, some of them may raise potential criticisms and prejudice in ensuring an equal supply of care among generations. In the surgical setting, early comprehensive geriatric assessment (CGA) proves indispensable for identifying frailty, discerning individual needs, and refining decision-making processes in an integrated surgical and medical fashion. Frailty acts as an effect modifier then it may under- or overestimate the effectiveness of procedures and interventions usually validated for fit older adults, on the contrary, the CGA may support the identification of the more appropriate person-centered interventions. Interdisciplinary joint care models, exemplified by orthogeriatrics for fragility fractures, demonstrate efficacy in enhancing patient outcomes and healthcare staff gratification. Orthogeriatrics, concentrating on acute care management, adeptly mitigates adverse events and streamlines the entire care pathway. Similarly, oncogeriatrics has made substantial strides in evaluating and treating older adults with cancer, curbing the risk of geriatric syndromes, and preserving overall quality of life.