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Invited Commentary
August 2017

Frailty—Going From Measurement to Action

Author Affiliations
  • 1University of California, San Francisco
JAMA Surg. 2017;152(8):757-758. doi:10.1001/jamasurg.2017.1050

Wahl et al1 report on the Modified Frailty Index, a frailty screen modified to allow for measurement within existing surgical data collection structures. While numerous studies have documented the impact of frailty on clinical and functional outcomes after surgery, the authors should be commended for their rigorous and detailed study, which demonstrates that the Modified Frailty Index is associated with increased health care resource use after discharge including 30-day readmissions. The proportion of adults aged 65 years and older continues to grow rapidly, and elderly individuals consume a high portion of health care resources (medical and surgical). Emerging data demonstrate that preoperative comprehensive geriatric assessment and optimization reduce medical and surgical complications, reduce length of stay, and decrease the likelihood of being discharged to a higher level of dependency.2 Inpatient multicomponent delirium prevention pathways reduce delirium and prevent falls in elderly patients.3 Therefore, there is an imperative to go beyond screening to focusing on developing effective interventions to promote high-value surgical care that is efficient, safe, and allows frail older adults to achieve their treatment goals.

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