title: Frailty and cognitive impairment: Unique challenges in the older emergency surgical patient.
abstract: BACKGROUND
  Older patients (>65 years of age) admitted as general surgical emergencies increasingly require improved recognition of their specific needs relative to younger patients. Two such needs are frailty and cognitive impairment. These are evolving research areas that the emergency surgeon increasingly requires knowledge of to improve short- and long-term patient outcomes.
  
  
  METHODS
  This paper reviews the evidence for frailty and cognitive impairment in the acute surgical setting by defining frailty and cognitive impairment, introducing methods of diagnosis, discussing the influence on prognosis and proposing strategies to improve older patient outcomes.
  
  
  RESULTS
  Frailty is present in 25% of the older surgical population. Using frailty-scoring tools, frailty was associated with a significantly longer hospital stay and higher mortality at 30 and 90 days after admission to an acute surgical unit. Cognitive impairment is present in a high number of older acute surgical patients (approximately 70%), whilst acute onset cognitive impairment, termed delirium, is documented in 18%. However, patients with delirium had significantly longer hospital stays and higher in-hospital mortality than those with cognitive impairment.
  
  
  CONCLUSIONS
  Improved knowledge of frailty and delirium by the emergency surgeon allows the specialised needs of older surgical patients to be taken into account. Early recognition, and consideration of minimally invasive surgery or radiological intervention alongside potentially transferable successful elective interventions such as comprehensive geriatric assessment, may help to improve short- and long-term patient outcomes in this vulnerable population.
authors.affiliation: Royal Alexandra Hospital , Paisley , UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Moug
authors.affiliation: University Hospital of Wales , Cardiff , UK.
authors.forename: M
authors.initials: M
authors.lastname: Stechman
authors.affiliation: North Bristol NHS Trust , UK.
authors.forename: K
authors.initials: K
authors.lastname: McCarthy
authors.affiliation: Manchester Royal Infirmary , UK.
authors.forename: L
authors.initials: L
authors.lastname: Pearce
authors.affiliation: University of Aberdeen; Aberdeen Royal Infirmary , UK.
authors.forename: P K
authors.initials: PK
authors.lastname: Myint
authors.affiliation: University Hospital Llandough , Cardiff , UK.|on behalf of The Older Persons Surgical Outcomes Collaboration (OPSOC).
authors.forename: J
authors.initials: J
authors.lastname: Hewitt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders; D004636:Emergency Service, Hospital; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D013514:Surgical Procedures, Operative
keywords: Cognitive impairment; Emergency surgery; Frailty; Older patient