Abstract
BackgroundFrailty is a multidimensional condition characterized by loss of functional reserve, which results in increased vulnerability to adverse outcomes following surgery. Anesthesiologists can reduce adverse outcomes when risk factors are recognized early and dedicated care pathways are operational. As the frail elderly population is growing, we investigated the perspective on the aging population, familiarity with the frailty syndrome and current organization of perioperative care for elderly patients among Dutch anesthesiologists.MethodsA fifteen-item survey was distributed among anesthesiologists and residents during the annual meeting of the Dutch Society of Anesthesiology. The first section included questions on self-reported competence on identification of frailty, acquaintance with local protocols and attitude towards the increasing amounts of elderly patients presenting for surgery. The second part included questions on demographic features of the participant such as job position, experience and type of hospital. Answers are presented as percentages, using the total number of replies for the question per group as a denominator.ResultsA sample of 132 surveys was obtained. The increasing number of elderly patients was primarily perceived as challenging by 76% of respondents. Ninety-nine percent agreed that frailty should influence anesthetic management, while 85% of respondents claimed to feel competent to recognize frailty. Thirty-four percent of respondents reported the use of a dedicated pathway in the preoperative approach of frail elderly patients. However, only 30% of respondents reported to know where to find the frailty screening in the patient file and appointed that frailty is not consistently documented. Interestingly, only 43% of respondents reported adequate collaboration with geriatricians. This could include for example a standardized preoperative multidisciplinary approach or dedicated pathway for the elderly patient.ConclusionsThis survey demonstrated that the increasing number of frail elderly patients is perceived as important and relevant for anesthetic management. Opportunities lie in improving the organization and effectuation of perioperative care by more consistent involvement of anesthesiologists.
Highlights
Frailty is a multidimensional condition characterized by loss of functional reserve, which results in increased vulnerability to adverse outcomes following surgery
The anesthesiologist should be aware of the presence of frailty The presence of frailty should influence anesthetic management I feel competent to recognize frailty During preassessment, I report the presence of frailty in the patient file All patients > 70 years of age are screened for frailty when entering the hospital In my hospital, I know where to find the frailty screening in the patient file
The challenge lies in improving the organization and effectuation of perioperative care for elderly patients
Summary
Frailty is a multidimensional condition characterized by loss of functional reserve, which results in increased vulnerability to adverse outcomes following surgery. As the frail elderly population is growing, we investigated the perspective on the aging population, familiarity with the frailty syndrome and current organization of perioperative care for elderly patients among Dutch anesthesiologists. Frailty is a multidimensional condition characterized by loss of functional reserve, loss of homeostatic mechanisms and increased vulnerability to adverse outcomes following stressors such as surgery [1]. The number of frail elderly is growing as the population is aging. The number of frail patients presenting for specialized medical care and hospital admission will even further increase. The prevalence of frail individuals in society is estimated at 4,1-8,5% while frailty is present in 10-37% of patients in a general surgery population [3, 4]. The aging population is paralleled by increased health care costs and in the Netherlands, it is expected that in 2030 58% of the national health care budget is spent on patients over 65 years of age [5, 6]
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