Frailty and cognitive impairment: Unique challenges in the older emergency surgical patient

S J Moug, M Stechman, K McCarthy, L Pearce, P K Myint, J Hewitt, Older Persons Surgical Outcomes Collaboration (OPSOC)

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Introduction Older patients (>65 years of age) admitted as general surgical emergencies increasingly require improved recognition of their specific needs relative to younger patients. Two such needs are frailty and cognitive impairment. These are evolving research areas that the emergency surgeon increasingly requires knowledge of to improve short- and long-term patient outcomes. Methods This paper reviews the evidence for frailty and cognitive impairment in the acute surgical setting by defining frailty and cognitive impairment, introducing methods of diagnosis, discussing the influence on prognosis and proposing strategies to improve older patient outcomes. Results Frailty is present in 25% of the older surgical population. Using frailty-scoring tools, frailty was associated with a significantly longer hospital stay and higher mortality at 30 and 90 days after admission to an acute surgical unit. Cognitive impairment is present in a high number of older acute surgical patients (approximately 70%), whilst acute onset cognitive impairment, termed delirium, is documented in 18%. However, patients with delirium had significantly longer hospital stays and higher in-hospital mortality than those with cognitive impairment. Conclusions Improved knowledge of frailty and delirium by the emergency surgeon allows the specialised needs of older surgical patients to be taken into account. Early recognition, and consideration of minimally invasive surgery or radiological intervention alongside potentially transferable successful elective interventions such as comprehensive geriatric assessment, may help to improve short- and long-term patient outcomes in this vulnerable population.

Original languageEnglish
Pages (from-to)165-169
Number of pages5
JournalAnnals of the Royal College of Surgeons of England
Volume98
Issue number3
Early online date18 Feb 2016
DOIs
Publication statusPublished - Mar 2016

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Emergencies
Delirium
Length of Stay
Geriatric Assessment
Minimally Invasive Surgical Procedures
Cognitive Dysfunction
Vulnerable Populations
Hospital Mortality
Mortality
Research
Population

Keywords

  • frailty
  • cognitive impairment
  • older patient
  • emergency surgery

Cite this

Frailty and cognitive impairment : Unique challenges in the older emergency surgical patient. / Moug, S J; Stechman, M; McCarthy, K; Pearce, L; Myint, P K; Hewitt, J; Older Persons Surgical Outcomes Collaboration (OPSOC).

In: Annals of the Royal College of Surgeons of England, Vol. 98, No. 3, 03.2016, p. 165-169.

Research output: Contribution to journalArticle

Moug, SJ, Stechman, M, McCarthy, K, Pearce, L, Myint, PK, Hewitt, J & Older Persons Surgical Outcomes Collaboration (OPSOC) 2016, 'Frailty and cognitive impairment: Unique challenges in the older emergency surgical patient', Annals of the Royal College of Surgeons of England, vol. 98, no. 3, pp. 165-169. https://doi.org/10.1308/rcsann.2016.0087
Moug, S J ; Stechman, M ; McCarthy, K ; Pearce, L ; Myint, P K ; Hewitt, J ; Older Persons Surgical Outcomes Collaboration (OPSOC). / Frailty and cognitive impairment : Unique challenges in the older emergency surgical patient. In: Annals of the Royal College of Surgeons of England. 2016 ; Vol. 98, No. 3. pp. 165-169.
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AB - Introduction Older patients (>65 years of age) admitted as general surgical emergencies increasingly require improved recognition of their specific needs relative to younger patients. Two such needs are frailty and cognitive impairment. These are evolving research areas that the emergency surgeon increasingly requires knowledge of to improve short- and long-term patient outcomes. Methods This paper reviews the evidence for frailty and cognitive impairment in the acute surgical setting by defining frailty and cognitive impairment, introducing methods of diagnosis, discussing the influence on prognosis and proposing strategies to improve older patient outcomes. Results Frailty is present in 25% of the older surgical population. Using frailty-scoring tools, frailty was associated with a significantly longer hospital stay and higher mortality at 30 and 90 days after admission to an acute surgical unit. Cognitive impairment is present in a high number of older acute surgical patients (approximately 70%), whilst acute onset cognitive impairment, termed delirium, is documented in 18%. However, patients with delirium had significantly longer hospital stays and higher in-hospital mortality than those with cognitive impairment. Conclusions Improved knowledge of frailty and delirium by the emergency surgeon allows the specialised needs of older surgical patients to be taken into account. Early recognition, and consideration of minimally invasive surgery or radiological intervention alongside potentially transferable successful elective interventions such as comprehensive geriatric assessment, may help to improve short- and long-term patient outcomes in this vulnerable population.

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