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Feasibility and Rationale for Incorporating Frailty and Cognitive Screening Protocols in a Preoperative Anesthesia
Shawna Amini1,2,3, Samuel Crowley1, Loren Hizel1
1From the Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida.
Anesthesia and Analgesia
|August 20, 2019
Summary
Preoperative frailty and cognitive screening for older adults is feasible and identifies individuals at risk for complications. This approach aids perioperative care planning by detecting cognitive impairment and frailty before surgery.
Area of Science:
- Geriatric Medicine
- Neuroscience
- Surgical Care
Background:
- Postoperative cognitive complications are linked to advanced age, frailty, low education, and cognitive impairment.
- Implementing hospital-wide preoperative assessments for frailty and cognition in older adults is crucial for clinical practice.
- Tertiary medical centers can integrate these assessments for surgical patients.
Purpose of the Study:
- To assess the feasibility of a hospital-wide preoperative frailty and cognitive screening program for older surgical patients.
- To examine the relationship between age, education, frailty, and comorbidity with cognitive test scores.
- To estimate the prevalence of cognitive impairment and identify factors associated with hospital length of stay.
Main Methods:
- Screening of adults aged 65+ for frailty and cognition using clock-drawing and memory tests.
- Education level and comorbidity data were collected.
- Feasibility assessed through a pilot phase and a 2-month implementation phase involving all preoperative staff.
- Cognitive impairment likelihood estimated using logistic regression and Mini-Cog cut scores.
- Factors related to hospital length of stay were explored.
Main Results:
- A sample of 678 patients was included in the final implementation phase.
- Cognitive scores (clock, memory) were significantly associated with age, frailty, and education.
- Approximately 20% of the presurgical sample had cognitive impairment, irrespective of surgery type.
- Hospital length of stay correlated with preoperative comorbidity and clock-drawing test performance.
Conclusions:
- Preoperative frailty and cognitive screening are feasible and valuable for perioperative care planning.
- Challenges like staff training and administrative time are outweighed by the benefits of early identification.
- Identifying frailty and cognitive impairment in at-risk populations improves patient outcomes.
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