You're Only as Old as Your Frailty Score
This syndrome of decreased physiologic reserve predicts postoperative outcomes better than chronological age.
What is frailty?
Within this time period after initiation of mechanical ventilation, tracheostomy placement should be considered.
What is 10-14 days?
This is the greatest contributor to postoperative deconditioning and functional decline.
What is bed rest?
This phrase summarizes the preferred approach to initiating most medications in older adults.
What is "Start low, go slow"?
In advanced dementia, studies show this commonly requested procedure does not improve survival or prevent aspiration pneumonia.
What is PEG tube placement?
At age 45, this quarterback led the NFL in passing yards and passing touchdowns during the 2022 season.
Who is Tom Brady?
The core components of multimodal prehabilitation programs used to improve surgical outcomes in frail or high-risk patients include exercise and walking programs, stress management, smoking cessation, pulmonary optimization, and these additional measures (3 possible).
What are nutrition optimization, glycemic control (DM/HbA1c optimization), and weight loss?
In stroke patients, early PEG tube placement is associated with this outcome.
What is increased mortality?
Three key delirium-prevention strategies include maintaining orientation, avoiding restraints, and this postoperative intervention.
What is early mobilization?
These criteria identify medications that are potentially inappropriate for older adults.
What are the Beers Criteria?
Because only 1–4% of frail patients survive to hospital discharge after in-hospital CPR, surgeons should strongly consider having this discussion preoperatively.
What is a code status/DNR discussion?
At age 43, this pitcher became the oldest player in MLB history to throw a no-hitter.
Who is Nolan Ryan?
On the FRAIL screening tool (Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight), a score of this many points or more indicates frailty.
What is 3 or more?
This is the amount of time a PEG tube must stay in place prior to removal to allow for gastro-cutaneous fistula maturation.
What is 4-6 weeks?
This syndrome is diagnosed with the Confusion Assessment Method (CAM), which requires an acute onset or fluctuating course of confusion AND inattention, as well as EITHER disorganized thinking OR an altered level of consciousness.
What is delirium?
This electrolyte abnormality can result when ACE inhibitors are combined with potassium supplements or spironolactone.
What is hyperkalemia?
Frail adults undergoing surgery experience complications, loss of independence, non-home discharge, and death at this rate compared with nonfrail patients.
What is 3 to 6 times more often?
At age 43, this golfer won the 1986 Masters Tournament, becoming the oldest Masters champion ever.
Who is Jack Nicklaus?
This simple 9-point scale ranges from "very fit" to "terminally ill" and is one of the easiest frailty tools to use clinically.
What is the Clinical Frailty Scale (CFS)?
Children with these chronic conditions may benefit from PEG tube placement to promote weight gain, reduce the risk of pulmonary complications, and increase parental satisfaction (name at least three).
What are cerebral palsy, cystic fibrosis, kidney disease, congenital heart disease, metabolic diseases, AIDS, and cancer?
Patients who fail the bedside swallow evaluation should undergo this follow-up study.
What is a fiberoptic endoscopic evaluation of swallowing (FEES)?
This anticoagulant commonly interacts with NSAIDs, macrolides, quinolones, sulfa drugs, and phenytoin.
What is warfarin?
Cognitive impairment, prior stroke, poor dentition, xerostomia, GERD, and diabetes are all risk factors for this postoperative complication.
What is aspiration?
At age 43, this NHL legend recorded 50 goals in a season, becoming the oldest player to accomplish the feat.
Who is Gordie Howe?
These are the five domains measured by the Frailty Index in phenotypic frailty.
What are weakness, weight loss, exhaustion, low physical activity, and slowness?
These unintended consequences are commonly associated with PEG tube placement in patients with advanced dementia.
What are higher risk of pressure injury, increased need for physical and pharmacologic restraints, and social isolation from loss of gustatory pleasure?
These two simple clinic-based tests can serve as surrogate measures of frailty and functional reserve.
What are the Timed Up and Go Test and the 6-Minute Walk Test?
Benzodiazepines should be used with extreme caution, but if necessary, these two short-acting Benzos are preferred.
What are lorazepam and oxazepam?
Even low-stress operations in severely frail adults may carry this shocking 90-day mortality range.
What is 25%–50%?
This baseball player hit .328 with 28 home runs at age 40 and later became the oldest player ever elected to the Hall of Fame while still active.
Who is Ted Williams?