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Incorporating Frailty in the Treatment Program of Elderly Patients with Gastrointestinal Disease

  • Gastroenterology for Geriatric Patients (S Katz and A Afzali, Section Editors)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

The goal of this paper is to review the utilization of frailty as a predictor of poor outcomes in gastrointestinal disease, hepatology, and gastrointestinal surgery.

Recent findings

The frailty syndrome has been extensively described in the geriatric population as a predictor of poor clinical outcomes and its application has proven valuable in a variety of chronic and inflammatory disease states independent of age. In hepatology and gastroenterology, frailty has been associated with worsening pre- and post-liver transplant outcomes, post-operative complications, periprocedural adverse events during colonoscopy, and even possible early disruption of the gut microbiome. In patients undergoing immunosuppression, frailty has recently been independently associated with increased risk of infection, morbidity, and mortality.

Summary

Frailty has been associated with a wide range of adverse health outcomes in multiple patient populations and disease states including in chronic gastrointestinal and liver disease. The standardization and routine clinical application of frailty evaluation in groups at risk for frailty progression and deleterious outcomes have been recommended. Challenges regarding translating frailty evaluation to individualized frailty treatment remain. With emerging research examining frailty in gastrointestinal and liver disease, there is hope to bridge this gap to deter and ideally reverse frailty progression and its deleterious outcomes.

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Abbreviations

ADLs:

Activities of daily living

IALDs:

Instrumental activities of daily living

IBD:

Inflammatory bowel disease

CGA:

Cognitive geriatric assessment

mFI:

Modified Frailty Index

CHS:

Cardiovascular Health Study

SPPB:

Short performance physical battery

NASH:

Non-alcoholic steatohepatitis

ALD:

Alcohol-related liver disease

CRP:

Interleukin-6 (IL-6), C-reactive protein

TNF-α:

Tumor necrosis factor-α

CXCL-10:

CXC chemokine ligand-10

ASA:

American Society of Anesthesiology

6MWT:

score, 6-min walk test

LFI:

Liver Frailty Index

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  1. Division of Gastroenterology and Hepatology, University of Arizona/Banner University Medical Center, Tucson, AZ, USA

    C. Thompson MD & S. Taleban MD

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Thompson, C., Taleban, S. Incorporating Frailty in the Treatment Program of Elderly Patients with Gastrointestinal Disease. Curr Treat Options Gastro 18, 635–656 (2020). https://doi.org/10.1007/s11938-020-00310-1

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