Frailty-Diagnostik in verschiedenen AINS-Settings

Das Vorliegen eines sog. Frailty-Syndroms („Gebrechlichkeit“) ist für den postoperativen Verlauf ein entscheidender Faktor. So kommt es, auch durch eine zunehmende Fokussierung auf die patientenzentrierte Versorgung, zu einer erhöhten Nachfrage nach Instrumenten, die den Patient*innenstatus umfassender beurteilen und Krankheitsverläufe vorhersagen können. Der Beitrag stellt die 3 führenden Modelle zur Frailty-Diagnostik vor.

Abstract

Frailty Syndrome has been recognized in several settings as a major predictor of negative outcomes. A frailty diagnosis can have important consequences for clinical decision-making and provides the opportunity to implement preventive strategies. Despite its importance, a gold standard for the diagnosis of frailty is still lacking. There are distinct frailty models and a large number of assessments are available, and they vary greatly in terms of time, training, and equipment necessary, but also on their relevance to specific outcomes. Diagnostic tools must be based on the resources available and on their relevance for the particular setting. The current review offers insights on current models and the most successful diagnostic instruments used in the anesthesia, intensive care, emergency, and palliative settings.

Kernaussagen

• Frailty korreliert in allen Bereichen der Anästhesiologie mit negativen Gesundheitsfolgen.

• Frailty kann mit einer Vielzahl an Instrumenten diagnostiziert werden, deren Auswahl je nach Setting und Ressourcen variiert.

• Die Erkennung von Frailty vermittelt einerseits einen Eindruck vom Allgemeinzustand, kann aber auch Aufschluss über genauere Problembereiche geben.

• In der Anästhesieambulanz ist der Einsatz einer Vielzahl an Testinstrumenten möglich. Die Auswahl eines Instruments sollte sich daher an der untersuchten Patient*innenklientel sowie an der gewünschten Fragestellung orientieren.

• Auf Intensivstationen ist die CFS derzeit das am weitesten verbreitete Frailty-Instrument, da sie eine Einschätzung durch Fremdanamnese ermöglicht und damit unabhängig vom aktuellen Zustand des Patient*innen einzusetzen ist.

• Auch in der Notfallmedizin ist die CFS zu empfehlen, da sie die 1-Jahres-Gesamtmortalität und die Überlebenszeit für ältere Patient*innen abgestuft für jedes CFS-Niveau prognostizieren kann.

• Allein die Diagnostik von Frailty führt zu einer zielgerechteren und auf die Bedürfnisse zugeschnittenen Behandlung dieser Patient*innen und hat damit positive Auswirkungen auf den weiteren Behandlungserfolg.

Publikationsverlauf

Artikel online veröffentlicht:
29. November 2022

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