Frailty and anaesthesia: what we need to know

We have an ageing population with approximately 1.25 million people in the UK aged 85 yr or more and about 20% of the total UK population classified as pensioners. Estimates suggest that this patient characteristic change will continue with the older proportion of our society projected to double and treble in another 25 and 35 yr, respectively. Unsurprisingly, given this rate of population ageing, the number of older patients undergoing surgical procedures is also increasing. While surgery frequently has benefits for the older population, they also suffer from an excess of adverse postoperative outcomes when compared with younger patients. These adverse outcomes are due in part to age-related physiological change and multimorbidity but are increasingly attributed to the influence from geriatric syndromes. These syndromes can be thought of as clinical phenotypes commonly encountered in older people which do not neatly fit into a disease category or organ-specific condition, and the pathogenesis of which is often incompletely understood. Frailty, which can be thought of as decreased physiological reserve across multiple organ systems, leading to adverse outcomes in the frail individual, as a result of even seemingly minor external stressors, is a clear example of a geriatric syndrome.