Frailty and multimorbidity in perioperative care

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The UK's surgical population is ageing, resulting in increasing proportions of surgical patients living with frailty and multimorbidity. Frailty is a clinical syndrome where there is multidomain decline in physiological reserve and function resulting in an increased vulnerability to stressors. Multimorbidity is the coexistence of ≥2 long-term health conditions, including physical and mental health problems, learning disability, symptom complexes (e.g. frailty), sensory impairment and substance misuse. Surgery in high-risk older people can provide symptomatic relief or the resolution of underlying pathological problems. High-risk patients benefit from the standard surgical pathway being tailored to address their individual needs. Identifying high-risk patients via screening such as the Clinical Frailty Scale at an early stage in the surgical pathway allows this individualization of care. For older people, a surgical pathway should include the following: identification of the patient's priorities for treatment with a careful discussion of benefits, risks and alternative management options; optimization of medical co-morbidities including anaemia; management of polypharmacy; preoperative discharge planning; organization of staffing and timing of surgery to minimize risk; and postoperative destination planning. Who delivers this care varies by hospital; teams can include perioperative physicians from a variety of backgrounds, specialist nurses, allied health professionals and social workers.