Preoperative frailty considerations
Jul 17, 2025
Handle with care: Preoperative considerations for the frail
With an aging population, it is more pertinent than ever to ensure thorough preoperative assessment and management to best optimise patient health prior to anaesthesia for our most vulnerable patients.
Utilising evidence-based and standardised screening and assessment tools, perioperative nurses are well placed in the preoperative setting to identify and flag potential risks, and to help optimise patient health prior to anaesthesia to support positive surgical outcomes.
🔹 Screening:
Frailty screening tools should be used to identify patients with reduced reserve/capacity, weakness, and slowed or impaired mobility. This allows for early discussions regarding post-operative risks, and implementation of preventative or management strategies as soon as possible.
🔹 Physiological reserve and comorbidities:
💓 Frail patients can present with diminished cardiac output, reduced pulmonary function 🫁, limited renal and/or hepatic function. Any combination of these comorbidities results in an increased risk of morbidity and mortality during anaesthesia, including haemodynamic instability and metabolic derangements.
A comprehensive preoperative assessment will help to capture baseline function, as well as current/recent medications 💊 – which allows for optimisation of chronic conditions and medication review prior to anaesthesia.
🔹 Polypharmacy:
Frail older adults generally use multiple medications due to their comorbidities, and so present with an increased risk of drug interactions and adverse events during anaesthesia.
Preoperative nurses should identify risky medications including anticoagulants, sedatives, opioids and antihypertensives to ensure correct preoperative instructions have been followed in relation to cessation, alteration or continuation of medications.
🔹 Nutrition and Hydration:
Frail patients are at high risk for malnourishment and dehydration. Thorough assessment of nutritional and hydration status preoperatively will ensure that risks are identified and correct interventions and allied health involvement are implemented post operatively.
🔹 Education and Decision making:
The elevated perioperative risk for frail patients should be clearly communicated to them when obtaining informed consent. For patients that are cognitively impaired, it is important to ensure that family and/or guardians are involved in the decision making process and are well informed of the risks.
Perioperative nurses should be proactive in recognising frailty and implementing appropriate strategies preoperatively to optimise patient health and support positive post operative outcomes.
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References:
Richard Griffiths, Madhur Mehta, Frailty and anaesthesia: what we need to know, Continuing Education in Anaesthesia Critical Care & Pain, Volume 14, Issue 6, December 2014, Pages 273–277, https://doi.org/10.1093/bjaceaccp/mkt069
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