Frailty of older patients ‘not being assessed in majority of hospitals'
Older patients who have surgery are not screened to assess their frailty in most hospitals, a study has suggested.
Frail patients are more likely to face longer recovery times after an operation and are at greater risk of complications, research by the Royal College of Anaesthetists (RCoA) and the University of Nottingham found.
Experts have called for all surgical patients over the age of 60 to be screened for frailty as standard practice to bolster recovery and slash extended stays in hospital.
Professor Iain Moppett, from the University of Nottingham's School of Medicine and chief investigator for the RCoA's third Sprint National Anaesthesia Project, said: 'Identifying frailty is straightforward and should lead to open and honest discussions with patients about what can be offered, what they want and what they can expect if they choose to have surgery.
'Good teamwork between the right specialists – surgeons, anaesthetists and geriatricians – helps to get patients living with frailty as fit and well as possible before surgery, make the right decisions and get the best care after surgery.'
Frailty is a medical condition that is common in older people, with symptoms such as reduced muscle strength, fatigue, slower walking pace, lower activity levels, weight loss and increased vulnerability.
Clinicians can assess how frail a patient is by using the Clinical Frailty Scale (CFS), which gives a score between one and nine based on factors such as a patient's ability to walk and manage daily tasks.
A score of more than five indicates the patient should be referred to specialist care.
The analysis includes data from 7,129 patients over five days in March 2022 across 214 NHS hospitals, and found 71 per cent were not routinely screening surgical patients aged 60 and over for frailty.
The research also highlighted the risks associated with frail patients who undergo operations.
Patients with the condition stay an average of three days longer in hospital after an operation than patients who are fit for surgery. Severely frail people stay six days longer, and are three times more likely to suffer from complications.
Frail patients are also four times more likely to experience delirium, a condition that causes confusion, and are also three times more likely to die in the first year after surgery.
Dr Claire Shannon, the RCoA's president, said: 'There is huge potential to improve patient outcomes by assessing all those over 60 for frailty as standard practice so that their care can be managed appropriately, with involvement from a geriatrician.
'With older people accounting for an increasing proportion of surgical patients, implementing effective screening for frailty is becoming evermore necessary.
'Universal adoption of frailty assessments will not only help patients recover better from surgery but also help improve efficiency by avoiding extended lengths of stay in hospital.'
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