Authors: Alvarado Mora M, Alvarado Fernández M, Apuy Rodríguez F, et al.
Cureus 17(7): e89174. doi:10.7759/cureus.89174
As the aging global population increases the proportion of elderly surgical patients, traditional preoperative anesthesia assessments often fail to account for age-specific vulnerabilities such as frailty and cognitive impairment. These factors are strong predictors of postoperative complications, including delirium, functional decline, and mortality. This review emphasizes the need for integrating frailty and cognitive assessments into routine preoperative evaluations using validated tools like the Clinical Frailty Scale, Fried Phenotype, and Comprehensive Geriatric Assessment (CGA).
Evidence supports that frailty significantly increases postoperative risks, yet remains underassessed in clinical practice. Cognitive frailty—coexisting physical frailty and cognitive impairment—further elevates the risk of adverse outcomes. Interventions such as prehabilitation (exercise, nutritional support, cognitive training) show promise in improving postoperative recovery, although the strength of evidence varies.
Current guidelines from organizations like ASA and ESAIC recommend early, multidisciplinary assessments, but widespread implementation is lacking. Frailty screening tools can help triage high-risk patients for full CGA and tailored perioperative strategies. Early identification allows for interventions aimed at enhancing physiological reserve and mitigating postoperative complications. Future research should focus on standardizing frailty screening protocols and evaluating cognitive prehabilitation’s impact on surgical outcomes.
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Thank you to Cureus for allowing us to summarize this article and for their contributions to advancing perioperative care.