Escort of older people into the operating room: A feasibility study.

BACKGROUND: While special care is given to perioperative risk assessment and management of older people undergoing surgery, psychological aspects have been largely neglected. Escort presence in the operating room (OR) is common practice in the surgical paediatric and obstetric populations and may be beneficial in older people. OBJECTIVES: This study explored the feasibility of family member escort of older people into the OR and their presence until induction of anaesthesia. METHODS: Prospective observational study of older people (>70 years) undergoing surgery, who were offered an escort into the OR. The primary end point was the proportion of relatives who completed the intervention without feeling dizzy or fainting. Secondary end points related to patient, escort and medical and nursing staff perception of the process. RESULTS: Forty-four sets of patients and escorts completed the process. The primary objective assessing feasibility was concluded successfully. Secondary objectives assessed (1) satisfaction, where 93% of escorts and 75% of patients would support a repeat of this process; (2) anxiolysis, where 61% of patients reported a reduced level of anxiety; (3) although 68% of anaesthesiologists agreed this process improved patients' well-being, most nurses and anaesthesiologists believed this should not become routine practice. Interestingly, most staff support parents escorting a paediatric patient into OR. CONCLUSIONS: This is the first study exploring the feasibility of escorting older people into the OR. It shows a unique insight into patient- and family-centred care of the surgical older person. Escort presence may help alleviate anxiety and increase satisfaction. The medical and nursing staff objections must be looked at further.

Frailty and anesthesia.

PURPOSE OF REVIEW: This review will deliberate on contemporary concepts regarding the frailty syndrome and its association with the perioperative period. Frailty syndrome and its relevance to organ systems, scoring tools and intervention measures will be discussed in detail. RECENT FINDINGS: Frail patients have a reduced ability to respond to physical stress, similar to a decreased physiological reserve in the perioperative period. Frailty assessment is gaining popularity as a tool to guide medical interventions in the elderly population. Various measurement tools for preoperative frailty assessment were developed and show promising ability to predict perioperative morbidity, mortality and possibly to guide patient selection and intervention. Preoperative optimization for the frail patient shows mixed results. SUMMARY: Preoperative frailty is associated with significant morbidity and mortality. Recently, frailty assessment tools have been developed and show good ability to predict postoperative adverse events. These tools might become a preoperative routine, as they set the ground for patient's selection, guide perioperative interventions for the frail elderly population and thus may influence patient's outcome.