Impact of Frailty on the Treatment of Pelvic Floor Disorders
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RECONSTRUCTED BLADDER FUNCTION & DYSFUNCTION (M KAUFMAN, SECTION EDITOR)
Impact of Frailty on the Treatment of Pelvic Floor Disorders Sida Niu 1 & Tomas L Griebling 1 & Casey G Kowalik 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Frailty is highly prevalent with increasing age and contributes to adverse health outcomes. Prior to medical and surgical intervention for the treatment of pelvic floor disorders (PFD), a comprehensive evaluation is necessary to evaluate frailty. Beyond a standard assessment, the care of frail patients requires consideration of additional factors including functional ability, cognitive impairment, and the role of caregivers. In this article, we review the current literature on PFD, specifically urinary and fecal incontinence and pelvic organ prolapse, in frail individuals and highlight the risks and benefits of various treatment options. Recent Findings Multiple tools are available to screen and assess for frailty in the general population. Growing evidence demonstrates that the development of functional limitations is the initial manifestation of frailty and may further translate to an increased risk of surgical complications. Summary No standardized method for screening and measurement of frailty currently exists. Independent of the individual assessment metric to measure frailty, there is an associated increased risk of adverse events related to treatments. Management of PFD in the frail population requires a tailored approach and necessitates consideration beyond objective data to the subjective, cognitive, and quality of life implications of treatment. Keywords Pelvic floor disorders . Frailty . Urinary incontinence . Fecal incontinence . Pelvic organ prolapse . Surgical outcomes
Introduction Frailty is a multidimensional syndrome manifested by a reduced ability to perform activities of daily living and diminished reserves to recover from acute, physical, psychological, and socio-economic stressors [1]. The prevalence of frailty increases with age and contributes to adverse health outcomes. It is estimated that an average of 10.7% of communitydwelling adults over 65 years of age are frail, and this increases to 26.1% for adults 85 years or older [2]. Two main definitions of frailty exist in the literature: one focusing on the This article is part of the Topical Collection on Reconstructed Bladder Function & Dysfunction * Sida Niu [email protected] Tomas L Griebling [email protected] Casey G Kowalik [email protected] 1
Department of Urology, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 3016, Kansas City, KS 66160, USA
physical phenotype of frailty versus a second expanded definition including additional components and often regarded as the multidomain phenotype. The physical phenotype was conceived by Fried and colleagues in 2001, with the identification of specific measurable frailty-defining characteristics [3]. The physical phenotype of frailty predicted poor clinical outcomes including falls, hospitalization, de
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