Introduction to Frailty

What is frailty?

Frailty is a multidimensional syndrome characterized by decreased reserve and diminished resistance to stressors.^{1 2} As a syndrome most commonly associated with older people, the concept of frailty has been translated from geriatric medicine practice across many areas of acute care medicine, including into anesthesiology and perioperative medicine. Experts agree that frailty is present due to deficits related to physical performance, nutritional status, mental health and cognition.^{3 4}

Prevalence of frailty in perioperative populations

Frailty has a higher prevalence in perioperative patients than it does in the general population at the same age.⁵ The specific prevalence depends to some degree on the instrument used to define frailty (see Module 2 for an introduction to frailty instruments), as well as the specific surgical specialty. In general, clinically assessed frailty using a multidimensional instrument will define a prevalence of 25-40%, with higher prevalence tending to be in patients having oncologic or emergency surgery.⁶

Is frailty associated with outcomes?

Surgery induces substantial physiologic stress. Not surprisingly, vulnerable older people with frailty are at much higher risk of most adverse outcomes after surgery.⁷ Among older surgical patients, mortality and morbidity rates are at least two- to four-times higher in those with frailty compared to those without; rates of new disability are also approximately doubled.^7–9 Frailty predicts a four-fold increase in the risk of delirium.¹⁰ Loss of independence (i.e., decreased ability to ambulate and care for oneself) is common in older people after surgery, and the presence of frailty predicts a 5-fold increase in the risk of non-home discharge after elective surgery.^{6 11} Length of stay, costs and intensive care unit utilization rates are also significantly higher in older people with frailty.

Explore the Frailty Tool Kit

Step 2: Learn about Frailty Assessment ›

Step 3: View the Case Studies ›

Step 4: View Key Papers and References ›

Step 5: See the Infographic Guides ›

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