Incorporating Frailty in the Treatment Program of Elderly Patients with Gastrointestinal Disease
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Gastroenterology for Geriatric Patients (S Katz and A Afzali, Section Editors)
Incorporating Frailty in the Treatment Program of Elderly Patients with Gastrointestinal Disease C. Thompson, MD* S. Taleban, MD Address * Division of Gastroenterology and Hepatology, University of Arizona/Banner University Medical Center, Tucson, AZ, USA Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Gastroenterology for Geriatric Patients Keywords Frailty syndrome I Sarcopenia I Disability I Malnutrition I Prehabilitation Abbreviations ADLs Activities of daily living IALDs Instrumental activities of daily living IBD Inflammatory bowel _ _ disease mFI Modified Frailty Index CHS Cardiovascular Health Study SPPB Short performance physical battery _ _ _ _ CXCL-10 CXC chemokine ligand-10 ASA American Society of Anesthesiology 6MWT score, 6-min walk test LFI _ _ _ Liver Frailty Index
Abstract Purpose of review The goal of this paper is to review the utilization of frailty as a predictor of poor outcomes in gastrointestinal disease, hepatology, and gastrointestinal surgery. Recent findings The frailty syndrome has been extensively described in the geriatric population as a predictor of poor clinical outcomes and its application has proven valuable in a variety of chronic and inflammatory disease states independent of age. In hepatology and gastroenterology, frailty has been associated with worsening pre- and post-liver transplant outcomes, post-operative complications, periprocedural adverse events during colonoscopy, and even possible early disruption of the gut microbiome. In patients undergoing immunosuppression, frailty has recently been independently associated with increased risk of infection, morbidity, and mortality. Summary Frailty has been associated with a wide range of adverse health outcomes in multiple patient populations and disease states including in chronic gastrointestinal and liver disease. The standardization and routine clinical application of frailty evaluation in groups at risk for frailty progression and deleterious outcomes have been recommended. Challenges regarding translating frailty evaluation to individualized frailty treatment remain. With emerging research examining frailty in gastrointestinal and liver disease,
Gastroenterology for Geriatric Patients (S Katz and A Afzali, Section Editors) there is hope to bridge this gap to deter and ideally reverse frailty progression and its deleterious outcomes.
Introduction The term frailty was originally described in 1979 to describe the heterogeneity in mortality in individuals of the same age [1]. Subsequently, frailty gained momentum in the late 1980s and early 1990s in geriatric medicine to describe a combination of aging and chronic disease along with declining physical fitness and nutritional status [2]. The early definitions of frailty focused on elderly persons with chronic illness and the functional dependence in activities of daily living (ADL
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