Frailty assessment: from clinical to radiological tools

Itay Bentov; Stephen J Kaplan; Tam N Pham; May J Reed

doi:10.1016/j.bja.2019.03.034

Frailty assessment: from clinical to radiological tools

Br J Anaesth. 2019 Jul;123(1):37-50. doi: 10.1016/j.bja.2019.03.034. Epub 2019 May 3.

Authors

Itay Bentov¹, Stephen J Kaplan², Tam N Pham³, May J Reed⁴

Affiliations

¹ Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA. Electronic address: itayb@uw.edu.
² Section of General, Thoracic, and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
³ Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA.
⁴ Division of Gerontology and Geriatric Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.

PMID: 31056240
DOI: 10.1016/j.bja.2019.03.034

Abstract

Frailty is a syndrome of cumulative decline across multiple physiological systems, which predisposes vulnerable adults to adverse events. Assessing vulnerable patients can potentially lead to interventions that improve surgical outcomes. Anaesthesiologists who care for older patients can identify frailty to improve preoperative risk stratification and subsequent perioperative planning. Numerous clinical tools to diagnose frailty exist, but none has emerged as the standard tool to be used in clinical practice. Radiological modalities, such as computed tomography and ultrasonography, are widely performed before surgery, and are therefore available to be used opportunistically to objectively evaluate surrogate markers of frailty. This review presents the importance of frailty assessment by anaesthesiologists; lists common clinical tools that have been applied; and proposes that utilising radiological imaging as an objective surrogate measure of frailty is a novel, expanding approach for which anaesthesiologists can significantly contribute to broad implementation.

Keywords: diagnostic imaging; frailty; perioperative medicine; preoperative assessment; risk assessment; sarcopenia.

Publication types

Review

MeSH terms

Aged
Aged, 80 and over
Frail Elderly*
Geriatric Assessment / methods*
Humans
Postoperative Complications / diagnosis*
Preoperative Care / methods*
Risk Assessment
Risk Factors