Lin Hui-Shan, McBride Rebecca L, Hubbard Ruth E
Centre for Research in Geriatric Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia,
PA-Southside Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia,
Local Reg Anesth. 2018 Oct 5;11:61-73. doi: 10.2147/LRA.S142996. eCollection 2018.
Frailty is a state of decreased physiologic reserve and resistance to stressors. Its prevalence increases with age and is estimated to be 26% in those aged above 85 years. As the population ages, frailty will be increasingly seen in surgical patients receiving anesthesia. Here, we evaluate the instruments which have been developed and validated for measuring frailty in surgical patients and summarize frailty tools used in 110 studies linking frailty status with adverse outcomes post-surgery. Frail older people are vulnerable to geriatric syndromes, and complications such as postoperative cognitive dysfunction and delirium are explored. This review also considers how frailty, with its decline of organ function, affects the metabolism of anesthetic agents and may influence the choice of anesthetic technique in an older person. Optimal perioperative care includes the identification of frailty, a multisystem and multidisciplinary evaluation preoperatively, and discussion of treatment goals and expectations. We conclude with an overview of the emerging evidence that Comprehensive Geriatric Assessment can improve postoperative outcomes and a discussion of the models of care that have been developed to improve preoperative assessment and enhance the postoperative recovery of older surgical patients.
衰弱是一种生理储备减少和对应激源抵抗力下降的状态。其患病率随年龄增长而增加，据估计，85岁以上人群的患病率为26%。随着人口老龄化，接受麻醉的外科手术患者中衰弱的情况将越来越常见。在此，我们评估已开发并验证用于测量外科手术患者衰弱程度的工具，并总结110项将衰弱状态与术后不良结局相关联的研究中使用的衰弱评估工具。衰弱的老年人易患老年综合征，本文还探讨了术后认知功能障碍和谵妄等并发症。本综述还考虑了衰弱及其器官功能衰退如何影响麻醉药物的代谢，并可能影响老年人麻醉技术的选择。最佳的围手术期护理包括识别衰弱、术前进行多系统和多学科评估，以及讨论治疗目标和期望。我们最后概述了综合老年评估可改善术后结局的新证据，并讨论了为改善术前评估和促进老年外科手术患者术后恢复而开发的护理模式。
