Editing Frailty


An aging-related syndrome of physiological decline, characterised by marked vulnerability to adverse health outcomes.

== Prevalence ==

* About 4-16% in patients >65yo
* Pre-frailty - 28-44% in >65yo

== Definitions ==

* Physical frailty - encompasses representative signs and symptoms
* Deficit accumulation frailty/index frailty - a conceptual framework that identifies frail and vulnerable people through cumulative comorbidities and illnesses

== Pathophysiology ==

* Related to dysregulated stress responses and energy response systems, along with age-related molecular changes, chronic environmental exposures, and specific disease states
* Sarcopenia

== Diagnosis and classification ==

* Dalhousie Clinical Frailty Scale

* FRAIL scale (1 point for each, and frail = 3 or more)
** F atigue (most/all of the past month)
** R esistance (to climbing a flight of stairs)
** A mbulation (difficulty walking one block)
** I llnesses (HTN, T2DM, cancer, MI, CCF, angina, arthritis, stroke, CKD)
** L oss of weight (>5% in past year)

== Differential diagnosis ==

* Depression
* Malignancy - lymphoma, MM, occult solid tumours
* Rheumatologic disease
* Endocrine - thyroid, DM
* Cardiovascular - HTN, CCF, IHD, PVD
* CKD
* Haematologic - myelodysplasia, iron deficiency, pernicious anaemia
* Nutritional deficiencies
* Neurologic disease - PD, vascular dementia, serial lacunar infarcts'

== Investigation ==

* FBE
* UEC
* LFT
* B12
* Vitamin D
* TSH
* HbA1c

== Management considerations ==

* Establish goals of care
* Exercise programs
* Geriatrician involvement
* OT
* Nutritional supplementation
* Medication review
* Palliative care

== Risk calculators (emergency laparotomy) ==

* NELA
** Estimated 30-day mortality risk
** Created using data entered in the UK National Emergency Laparotomy Audit between 2016 and 2019
** Originally released 2020, with 2023 update
** More accurate than P-POSSUM in the UK
** Available on app or <nowiki>https://data.nela.org.uk/riskcalculator/</nowiki>
* NSQIP (National Surgical Quality Improvement Program)
** Based on American data 
** Granular information on risk of specific complications and predicted length of stay
** Emergency or elective, and procedure-specific
** <nowiki>https://riskcalculator.facs.org/RiskCalculator/PatientInfo.jsp</nowiki>
* P-POSSUM
** Now a bit outdated, and not as good as NELA/NSQIP
** Tends to overestimate mortality

[[Category:Peri-op medicine]]