Navigating the Surgical Pathway for Frail, Older Adults Undergoing Colorectal Surgery

Adults ≥ 65 years of age comprise nearly 20% of the U.S. population and over half of surgical patients. Older adults, particularly when frail, may require additional preoperative evaluation and counseling, specialized hospital care, and may experience more noticeable physical and cognitive changes than younger or healthier patients. Surgeons can assess frailty and risk using several frailty measures, as data exist demonstrating worse perioperative outcomes among patients undergoing colorectal surgery. Prehabilitation programs have not been shown to improve surgical outcomes for colorectal surgery patients but may help maintain physical function or hasten recovery to baseline around the time of surgery, particularly for frail patients. Functional decline and delirium are common postoperatively in older adult patients, particularly those who are frail at baseline, and should be discussed with at-risk older adults. Primary care physicians and geriatricians can help with in-depth evaluation of frailty and geriatric syndromes. Special attention to the risks, outcomes, and care of older adults considering or undergoing colorectal surgery can help inform decision-making, which may facilitate goal-concordant care.