Fraility, Not Age Determines Surgical Outcomes

Dr. Bellal Joseph MD FACS Associate Professor of Surgery Medical Director, Southern Arizona Telemedicine and Telepresence (SATT) Program Program Director, International Research Fellowship Liaison, Multi-Specialty Surgery Clinic at UAMCMedicalResearch.com Interview with
Dr. Bellal Joseph MD FACS
Associate Professor of Surgery
Medical Director, Southern Arizona Telemedicine and Telepresence (SATT) Program
Program Director, International Research Fellowship
Liaison, Multi-Specialty Surgery Clinic at UAMC

Medical Research: What are the main findings of the study?

Dr. Joseph: Chronologic age is frequently used as the determinant of outcomes when treating elderly and treatments are tailored accordingly. However, the findings of our study challenge this dogma and suggest that it’s not the chronologic age rather frailty status of the individual that determines outcomes. We found frailty Index (quantitative measure of frailty) as a better predictor of in-hospital complications and discharge disposition in elderly compared to the chronologic age.

Medical Research: Were any of the findings unexpected?

Dr. Joseph: Frailty is a state of decreased physiological reserves to counter stressors. It is commonly presumed that ageing and frailty correlate. The results of our study refute this common notion that ageing by itself is responsible for frailty. In our study, we found no association between age and the FI. The findings of our study suggest that frailty is not merely a function of ageing, rather it is a constellation of events and stressors that an individual goes through during his life.

Medical Research: What should clinicians and patients take away from your report?

Dr. Joseph: Elderly population is the fastest growing segment of the US population, responsible for more than 20% of hospital admissions. This increasing segment is going to reflect on practice of all physicians. When assessing elderly, age should not be used as primary criterion to determine physiologic vulnerability of an individual, as “Not all 60 years old are 60 years old”. Frailty index provides an in-depth knowledge of physiologic capability and a quantitative measure of frailty status in an elderly patient. Frailty Index can be measured easily via a questionnaire, administrable in most of the clinical settings. Patients and their primary care givers should also be aware that many factors other than and including age would determine the final outcome. Improvement of the frailty status of an individual is possible and can substantially affect the outcomes.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Joseph: This study establishes the superiority of frailty index over age as a better predictor of clinical outcomes. However, the mechanism and exact physiologic changes that occur as a result of frailty need to be ascertained. Future studies should focus on genetic, immunologic, and hormonal basis of frailty. Better details about these physiologic changes will help in defining treatment strategies for frail patients.

Citation:

Superiority of Frailty Over Age in Predicting Outcomes Among Geriatric Trauma Patients: A Prospective Analysis
Joseph B, Pandit V, Zangbar B, Kulvatunyou N, Hashmi A, Green DJ, O’Keeffe T, Tang A, Vercruysse G, Fain MJ, Friese RS, Rhee P.
JAMA Surg. 2014 Aug 1;149(8):766-72. doi: 10.1001/jamasurg.2014.296.