Cognitive impairment and frailty screening in older surgical patients: a rural tertiary care centre experience

IntroductionDespite a clear association between cognitive impairment and physical frailty and poor postoperative outcomes in older adults, preoperative rates are rarely assessed. We sought to implement a preoperative cognitive impairment and frailty screening programme to meet the unique needs of ou...

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Bibliographic Details
Published in:BMJ open quality 2022-06, Vol.11 (2), p.e001873
Main Authors: Andrew, Caroline D, Fleischer, Christina, Charette, Kristin, Goodrum, Debra, Chow, Vinca, Abess, Alexander, Briggs, Alexandra, Deiner, Stacie
Format: Article
Language:English
Subjects:
Anaesthesia
Clinics
Cognitive ability
Frailty
Older people
Perioperative care
Quality improvement
Quality Improvement Report
Surgery
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Summary:IntroductionDespite a clear association between cognitive impairment and physical frailty and poor postoperative outcomes in older adults, preoperative rates are rarely assessed. We sought to implement a preoperative cognitive impairment and frailty screening programme to meet the unique needs of our rural academic centre.MethodsThrough stakeholder interviews, we identified five primary drivers underlying screening implementation: staff education, technology infrastructure, workload impact, screening value and patient–provider communication. Based on these findings, we implemented cognitive dysfunction (AD8, Mini-Cog) and frailty (Clinical Frailty Scale) screening in our preoperative care clinic and select surgical clinics.ResultsIn the preoperative care clinic, many of our patients scored positive for clinical frailty (428 of 1231, 35%) and for cognitive impairment (264 of 1781, 14.8%). In our surgical clinics, 27% (35 of 131) and 9% (12 of 131) scored positive for clinical frailty and cognitive impairment, respectively. Compliance to screening improved from 48% to 86% 1 year later.ConclusionWe qualitatively analysed stakeholder feedback to drive the successful implementation of a preoperative cognitive impairment and frailty screening programme in our rural tertiary care centre. Preliminary data suggest that a clinically significant proportion of older adults screen positive for preoperative cognitive impairment and frailty and would benefit from tailored inpatient care.
ISSN:2399-6641
2399-6641
DOI:10.1136/bmjoq-2022-001873