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Case 5: Frailty, Recognition, Quantification, and Management in the Context of a Patient Considering Lumbar Laminectomy

Learning Objectives
1. Recognize how to screen for frailty
2. Recognize how care goals and plans differ for the frail patient
3. Recognize how to implement appropriate care pathways for frail older adults
0.5 Credit CME

A 79-year-old man is referred to the orthopaedic spine surgeon because of increasingly severe low back pain with radiation to his right leg; he has also had weakness of the right leg. The patient is accompanied by his son who explains that his father is no longer able to drive due to the problems with his right leg. He has a history of chronic obstructive pulmonary disease (COPD) and peripheral vascular disease. He has lived alone since his wife died three months ago and is having increasing difficulty with activities of daily living (ADLs) because he is minimally mobile. He reports overall exhaustion, an unintentional 4.5-kg (10-lb) weight loss, and several episodes of urinary incontinence over the past several months. He has not had recent fevers or chills. He appears thin.

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Credit Designation Statement: The American Geriatrics Society designates this enduring continuing medical educational activity for a maximum of 0.50 AMA PRA Category 1 Credits™.

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Advisory Panel

The following members of the advisory panel had no relevant financial relationships with ineligible companies to disclose:

Ruben Azocar, MD

George Drach, MD

Sandhya Lagoo-Deenadayalan, MD, PhD

Andrew Lee, MD

Mike Malone MD

Myron Miller, MD

Arvind Nana, MD

Tom Robinson, MD

Victoria Tang MD, MAS

The following members of the advisory panel have reported relevant financial relationships with ineligible companies that have been mitigated through peer review of planning decisions by persons without relevant financial relationships and recusal from any aspect of planning and content related to the financial relationship:

Kevin Biese MD, MAT is a paid consultant for Call 9 Telemedicine Medical Advisor and Bristol Meyers Squibb/ Pfizer

Daniel Mendelson, MS, MD is a paid consultant for Point Click Care Touchscreen

Writing Panel

The following members of the writing panel had no relevant financial relationships with ineligible companies to disclose:

Tomas Griebling, MD

Joseph Hejkal, MD

Melissa Hornor, MD

Jason Johanning, MD

Sushila Murthy, MD, MPH

Tony Rosen, MD, MPH

Kate Schenning, MD, MPH

The following members of the writing panel have reported relevant financial relationships with ineligible companies that have been mitigated through peer review of content by persons without relevant financial relationships:

Charles Brown, MD is a paid consultant for and receives grants from Medtronic

Badrinath Konety, MD, MBA is a paid consultant for NxThera, and Bristol Myers Squibb, Opko and receives grant funding from Photocure, Genentech, and Genomic Health

Reviewers:

The following reviewers had no relevant financial relationships with ineligible companies to disclose:

Shamsuddin Akhtar, MD

Patrick Kortebein, MD

Joseph LoCicero, MD

Support Statement

This CME activity is supported by a grant from the John A. Hartford Foundation.

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References:
1.
Fried  LP, Tangen  CM, Walston  J,  et al.  Frailty in older adults: evidence for a phenotype.  J Geront A Bio Sci Med Sci. 2001; 56(3):M146–157. https://www.ncbi.nlm.nih.gov/pubmed/11253156Google Scholar
2.
Chow  WB, Rosenthal  RA, Merkow  RP, Ko  CY, Esnaola  NF. American College of Surgeons National Surgical Quality Improvement Program. American Geriatrics Society.  Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society.  J Am Coll Surg. 2012;215(4):453–466. http://www.journalacs.org/article/S1072-7515(12)00493-0/fulltextGoogle Scholar
3.
Mohanty  S, Rosenthal  RA, Russell  MM, Neuman  MD, Ko  Cy, Esnaola  NF.  Optimal perioperative management of the geriatric patient: A best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society.  J Am Coll Surg. 2016;222(5):930–47. http://www.journalacs.org/article/S1072-7515(15)01822-0/fulltextGoogle Scholar
4.
Robinson  TN, Eiseman  B, Wallace  JI,  et al.  Redefining geriatric preoperative assessment using frailty, disability and co-morbidity.  Ann Surg. 2009;250(3):449–455. https://www.ncbi.nlm.nih.gov/pubmed/19730176Google Scholar
5.
Makary  MA, Segev  DL, Pronovost  PJ,  et al.  Frailty as a predictor of surgical outcomes in older patients.  J Am Coll Surg. 2010;210(6):901–908. http://www.journalacs.org/article/S1072-7515(10)00059-1/fulltextGoogle Scholar
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