Frailty in orthopaedics: is age relevant?

Area of Science:

• Orthopaedic surgery
• Geriatric medicine
• Trauma care

Background:

• National guidelines and Best Practice Tariffs (BPT) improved care for hip fracture patients over 60.
• Frail patients of all ages with fragility fractures historically had poorer outcomes and lacked dedicated care pathways.
• Current guidelines are expanding to include more patients, straining NHS resources and creating inconsistencies.

Purpose of the Study:

• To advocate for the Clinical Frailty Scale (CFS) to supersede age in determining clinical priority and Best Practice Tariffs for vulnerable trauma patients.
• To address the need for consistent guidelines for frail trauma patients.
• To highlight the benefits of comprehensive geriatric care for frail trauma patients.

Main Methods:

• Review of existing national guidelines and Best Practice Tariffs (BPT).
• Analysis of the increasing recognition of frailty as a predictor of outcomes across medical fields.
• Examination of the adoption of the Clinical Frailty Scale (CFS) in major trauma settings.

Main Results:

• Frailty is a recognized global indicator of patient outcomes, irrespective of age.
• Frail trauma patients benefit significantly from comprehensive geriatric care and prompt surgical intervention.
• Current BPT criteria (age >60) lack strong evidence for trauma prognosis compared to frailty assessment.

Conclusions:

• The Clinical Frailty Scale (CFS) should be prioritized over chronological age for clinical decision-making and Best Practice Tariffs in trauma care.
• Further research is needed to fully understand frailty-related outcomes in trauma and the impact of care bundles on frail orthopaedic patients.
• Implementing CFS-based guidelines can lead to more consistent and effective care for vulnerable trauma patients.