Use frailty assessment tools such as the Flemish Triage Risk Screening Tool (fTRST) and Geriatric-8 questionnaire to identify at-risk patients.
Incorporate physical performance measures like the Timed Up and Go test to evaluate mobility and fall risk.
Engage patients in goal-setting using the Outcome Prioritization Tool (OPT) to align care with individual preferences.
Management
Implement multimodal prehabilitation programs focusing on exercise, nutritional optimization, and psychological support.
Adopt minimally invasive surgical techniques as standard to reduce tissue trauma and enhance recovery.
Apply enhanced recovery protocols tailored for older adults, integrating nutritional screening and targeted peripheral parenteral nutrition.
Provide geriatric co-management involving collaborative care between surgical and geriatric teams throughout perioperative phases.
Monitoring & Follow-up
Monitor nutritional status using tools like the Patient-Generated Subjective Global Assessment (PG-SGA) to stratify patients and guide interventions.
Assess functional recovery and complications postoperatively with attention to delirium prevention and physical function improvement.
Evaluate social support needs to address social frailty and ensure comprehensive postoperative care.
Risks
Recognize that frailty increases risk of postoperative complications, prolonged hospital stay, and functional decline.
Identify patients unable to improve functional status preoperatively as potentially at higher risk for surgical stress intolerance.
Be aware that severely malnourished or well-nourished patients may respond differently to perioperative optimization interventions.
Patient & Prescribing Data
Older adults undergoing cancer surgery, especially those aged 70 years and above
Patients with moderate nutritional compromise derive the greatest benefit from perioperative optimization; personalized interventions based on frailty and nutritional status improve outcomes.
Clinical Best Practices
Perform comprehensive frailty assessments beyond chronological age to guide surgical candidacy and perioperative planning.
Engage in shared decision-making incorporating patient goals and preferences using structured tools like the OPT.
Integrate multimodal prehabilitation early to enhance cardiopulmonary fitness, muscle strength, and functional capacity.
Prefer minimally invasive surgical approaches to minimize surgical stress and facilitate faster recovery.
Implement enhanced recovery protocols specifically adapted for older adults to reduce delirium and preserve independence.
Ensure geriatric co-management for collaborative perioperative care to reduce mortality and improve supportive services.
Assess and address social frailty through structured social support evaluations to optimize postoperative recovery.
