Interventionen zur präoperativen Unterstützung geriatrischer Patienten mit Frailty

Zusammenfassung

Der stetig zu beobachtende demografische Wandel geht mit veränderten Anforderungen an die Patientenbetreuung einher. Ältere Patienten weisen häufig einen erhöhten Behandlungsbedarf und eine höhere Komplexität des klinischen Gesamtbildes auf. Dieser Umstand ist – abgesehen von der Routineversorgung – besonders dann zu beachten, wenn eine angedachte Intervention zu schweren und potenziell lebensbedrohlichen Komplikationen führen kann.

Abstract

Frailty is a complex syndrome leading to a higher vulnerability in elderly patients, especially during and after surgery. It is characterized by the simultaneous presence of at least three of five phenotypical symptoms: unintentional weight loss, exhaustion, muscle weakness, slow walking speed, and low activity levels. The presence of two of these symptoms is often labelled as pre-frailty.

By identifying these symptoms of frailty, medical teams can plan and perform suitable interventions prior to a planned surgery in order to lower these risk factors and to avoid complications, such as delir, hospital re-admission, loss of independence, and increased mortality. Examples for these interventions are pre-surgery rehabilitation and Delirium Management Units (DMU).

This article describes the frailty syndrome and its associated consequences for complications during and after surgery. Additionally, clinical assessments for identifying frailty symptoms as well as pre- and post-surgical interventions to reduce these risk factors are presented.

Kernaussagen

• Gebrechlichkeit (eng. Frailty) ist ein komplexes Syndrom, welches mit einer erhöhten Vulnerabilität der betroffenen Patienten einhergeht.

• Patienten mit Frailty weisen erhöhte Risiken für peri- und postoperative Komplikationen auf.

• Mithilfe der Fried-Kriterien kann das Vorliegen einer Gebrechlichkeit diagnostiziert werden.

• Trainingstherapie kann dazu genutzt werden, identifizierte Faktoren der Gebrechlichkeit vor der Durchführung einer Operation zu behandeln und dadurch das Risiko von Komplikationen zu verringern.

• Die Einrichtung von DMUs für besonders vulnerable Patienten kann postoperativ zur Vermeidung langfristiger Probleme führen.

Schlüsselwörter

Frailty - Gebrechlichkeit - perioperatives Management - präoperatives Management - geriatrische Patienten

Key words

frailty - perioperative management - preoperative management - geriatric patients

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