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Anästhesiol Intensivmed Notfallmed Schmerzther 2022; 57(11/12): 674-681
DOI: 10.1055/a-1760-8119
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Der fraile Patient: fiktives Fallbeispiel

The Frail Patient in a Fictitious Case Study
Nils Daum
,
Jörn Kiselev
,
Stefan J. Schaller
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Bei Patienten mit Gebrechlichkeitssyndrom (Frailty) kann eine Prähabilitation vor Narkose und Operationen das Risiko von Komplikationen sowie das Outcome deutlich verbessern. Hierbei ist es wichtig, ein routinemäßiges Screening zu etablieren, um ein Gebrechlichkeitssyndrom im klinischen Alltag zu erfassen und Möglichkeiten für eine Prähabilitation zu schaffen. Diese Zusammenhänge sollen anhand eines fiktiven Fallbeispiels erläutert werden.

Abstract

Various limitations in everyday life can indicate a frailty syndrome. These limitations are not always directly visible and result from a wide variety of domains. Fried et al. described these limitations of different domains as frailty syndrome. This syndrome can be acutely worsened by different influencing factors. One major risk factor is an upcoming anesthesia and surgery. Frailty is associated with a significantly increased risk of peri- and postoperative complications. To avoid acute deterioration due to anesthesia and surgery, the concept of prehabilitation was developed. The aim is to specifically address the respective deficits and to develop an individual training concept together with the patient. Prehabilitation can significantly improve the risk of complications and the outcome of frail patients. In this context, it is important to establish routine screening in order to detect a frailty syndrome in everyday clinical practice and to create opportunities for prehabilitation.

Kernaussagen

  • Es ist wichtig, ein Bewusstsein für das Frailty-Syndrom zu entwickeln.

  • Ein Frailty-Screening sollte v. a. bei älteren Patienten Teil der täglichen Routine sein.

  • Defizite im Frailty-Screening sollten erfasst und ein gemeinsames Konzept zusammen mit dem Patienten erarbeitet werden.

  • Eine Prähabilitation ist eine Maßnahme, die den Patienten bereits präoperativ unterstützt und erfasste Defizite verbessern kann.

  • Ein Frailty-Screening zusammen mit einer Prähabilitation senkt das Komplikationsrisiko des Patienten und verbessert insgesamt das Outcome.

Schlüsselwörter

Gebrechlichkeit - Prähabilitation - Anästhesiologie - Intensivmedizin

Keywords

frailty - prehabilitation - anaesthesia - intensive care


Publication History

Article published online:
29 November 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Fried LP, Tangen CM, Walston J. et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146-M156
    CrossrefPubMedSearch in Google Scholar
  • 2 Drewniok N, Mörgeli R, Eckardt-Felmberg R. Frailty-Diagnostik in verschiedenen Settings. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57: 682-696
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Collard RM, Boter H, Schoevers RA. et al. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 2012; 60: 1487-1492
    CrossrefPubMedSearch in Google Scholar
  • 4 Fuchs J, Scheidt-Nave C, Gaertner B. et al. Frailty in Germany: status and perspectives : Results from a workshop of the German Society for Epidemiology. Z Gerontol Geriatr 2016; 49: 734-742
    CrossrefPubMedSearch in Google Scholar
  • 5 Scheidt-Nave C, Kamtsiuris P, Gößwald A. et al. German health interview and examination survey for adults (DEGS) – design, objectives and implementation of the first data collection wave. BMC Public Health 2012; 12: 730
    CrossrefPubMedSearch in Google Scholar
  • 6 Saum KU, Dieffenbach AK, Müller H. et al. Frailty prevalence and 10-year survival in community-dwelling older adults: results from the ESTHER cohort study. Eur J Epidemiol 2014; 29: 171-179
    CrossrefPubMedSearch in Google Scholar
  • 7 Kiselev J. Interventions for Assisting Geriatric Patients with Frailty Before Surgery. Anasthesiol Intensivmed Notfallmed Schmerzther 2017; 52: 777-783
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Lauven PM, Stoeckel H, Ebeling BJ. Perioperative morbidity and mortality of geriatric patients. A retrospective study of 3905 cases. Anasth Intensivther Notfallmed 1990; 25 (Suppl. 01) 3-9
    PubMedSearch in Google Scholar
  • 9 Leung JM, Tsai TL, Sands LP. Brief report: preoperative frailty in older surgical patients is associated with early postoperative delirium. Anesth Analg 2011; 112: 1199-1201
    CrossrefPubMedSearch in Google Scholar
  • 10 Beggs T, Sepehri A, Szwajcer A. et al. Frailty and perioperative outcomes: a narrative review. Can J Anaesth 2015; 62: 143-157
    CrossrefPubMedSearch in Google Scholar
  • 11 Inouye SK. Delirium in older persons. N Engl J Med 2006; 354: 1157-1165
    CrossrefPubMedSearch in Google Scholar
  • 12 Revenig LM, Canter DJ, Kim S. et al. Report of a Simplified Frailty Score Predictive of Short-Term Postoperative Morbidity and Mortality. J Am Coll Surg 2015; 220: 904-911.e1
    CrossrefPubMedSearch in Google Scholar
  • 13 Schaller SJ, Anstey M, Blobner M. et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet 2016; 388: 1377-1388
    CrossrefPubMedSearch in Google Scholar
  • 14 Hall DE, Arya S, Schmid KK. et al. Association of a Frailty Screening Initiative With Postoperative Survival at 30, 180, and 365 Days. JAMA Surg 2017; 152: 233-240
    CrossrefPubMedSearch in Google Scholar
  • 15 de Labra C, Guimaraes-Pinheiro C, Maseda A. et al. Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials. BMC Geriatr 2015; 15: 154
    CrossrefPubMedSearch in Google Scholar
  • 16 Hulzebos EHJ, Van Meeteren NLU. Making the elderly fit for surgery. Br J Surg 2016; 103: e12-e15
    CrossrefPubMedSearch in Google Scholar
  • 17 Birkelbach O, Mörgeli R, Balzer F. et al. Why and How Should I Assess Frailty? A Guide for the Preoperative Anesthesia Clinic. Anasthesiol Intensivmed Notfallmed Schmerzther 2017; 52: 765-776
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Kristensen SD, Knuuti J, Saraste A. et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur J Anaesthesiol 2014; 31: 517-573
    CrossrefPubMedSearch in Google Scholar
  • 19 Deschodt M, Braes T, Flamaing J. et al. Preventing delirium in older adults with recent hip fracture through multidisciplinary geriatric consultation. J Am Geriatr Soc 2012; 60: 733-739
    CrossrefPubMedSearch in Google Scholar
  • 20 Friedman SM, Mendelson DA, Bingham KW. et al. Impact of a comanaged Geriatric Fracture Center on short-term hip fracture outcomes. Arch Intern Med 2009; 169: 1712-1717
    CrossrefPubMedSearch in Google Scholar
  • 21 Gustafson Y, Brännström B, Berggren D. et al. A geriatric-anesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures. J Am Geriatr Soc 1991; 39: 655-662
    CrossrefPubMedSearch in Google Scholar
  • 22 Moyce Z, Rodseth RN, Biccard BM. The efficacy of peri-operative interventions to decrease postoperative delirium in non-cardiac surgery: a systematic review and meta-analysis. Anaesthesia 2014; 69: 259-269
    CrossrefPubMedSearch in Google Scholar
  • 23 Vogt S, Decke S, de Las Heras Gala T. et al. Prospective association of vitamin D with frailty status and all-cause mortality in older adults: Results from the KORA-Age Study. Prev Med 2015; 73: 40-46
    CrossrefPubMedSearch in Google Scholar