Articles: frailty-index.
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The incidence of spine surgery in elderly patients is increasing. Geriatric spine surgery has 3 main concerns: osteoporosis, continuing degeneration and more deformity, and comorbidities. Measures taken regarding these concerns would improve results, and elderly patients will experience much more benefit from surgery. This study reviewed the most recent literature to improve outcomes of geriatric spine surgery. ⋯ Geriatric patients pose more concerns for spine surgery. To achieve better outcomes with fewer complications, we must concentrate more on comorbidities in elderly patients. Measures to treat osteoporosis; application of enhanced recovery after surgery protocols for patient preparation; use of less invasive surgical techniques; and good postoperative rehabilitation, pain, and psychological management would help to improve the outcomes of spine surgery in geriatric patients.
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Review
Feasibility and reliability of frailty assessment in the critically ill: a systematic review.
For healthcare systems, an ageing population poses challenges in the delivery of equitable and effective care. Frailty assessment has the potential to improve care in the intensive care setting, but applying assessment tools in critical illness may be problematic. The aim of this systematic review was to evaluate evidence for the feasibility and reliability of frailty assessment in critical care. ⋯ CRD42016052073 .
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Review
Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology.
Answer questions and earn CME/CNE The concept of frailty has become increasingly recognized as one of the most important issues in health care and health outcomes and is of particular importance in patients with cancer who are receiving treatment with surgery, chemotherapy, and radiotherapy. Because both cancer itself, as well as the therapies offered, can be significant additional stressors that challenge a patient's physiologic reserve, the incidence of frailty in older patients with cancer is especially high-it is estimated that over one-half of older patients with cancer have frailty or prefrailty. Defining frailty can be challenging, however. ⋯ Still, it has been demonstrated that frail patients are at increased risk of postoperative complications, chemotherapy intolerance, disease progression, and death. Although international standardization of frailty cutoff points are needed, continued efforts by oncology physicians and surgeons to identify frailty and promote multidisciplinary decision making will help to develop more individualized management strategies and optimize care for patients with cancer. CA Cancer J Clin 2017;67:362-377. © 2017 American Cancer Society.
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Intensive care medicine · Aug 2017
Review Meta AnalysisThe impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis.
Functional status and chronic health status are important baseline characteristics of critically ill patients. The assessment of frailty on admission to the intensive care unit (ICU) may provide objective, prognostic information on baseline health. To determine the impact of frailty on the outcome of critically ill patients, we performed a systematic review and meta-analysis comparing clinical outcomes in frail and non-frail patients admitted to ICU. ⋯ Frailty is common in patients admitted to ICU and is associated with worsened outcomes. Identification of this previously unrecognized and vulnerable ICU population should act as the impetus for investigating and implementing appropriate care plans for critically ill frail patients. Registration: PROSPERO (ID: CRD42016053910).
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A best evidence topic in thoracic surgery was performed according to a structured protocol. The question addressed was the role of frailty scores in predicting outcomes of patients undergoing thoracic surgery. Seventy-one papers were found using the reported search, of which three studies and one conference abstract represented the best evidence to answer the clinical question. ⋯ Their conclusion supported the conclusions drawn from the larger studies that a single frailty measure alone did not predict an increase in morbidity or mortality, but in combination several measures may have a role in predicting postoperative outcomes. The clinical bottom line is that there is a paucity of evidence to either fully support or fully refute the use of preoperative frailty scoring as a reliable means of predicting morbidity and mortality in thoracic surgery. The evidence presented does however indicate the potentially important clinical role that frailty scores may have in the future.