Frailty and Nursing Care in Orthopedic Surgery Patients

Öz

Aging is permanent and irreversible as it leads to a decrease in vital functions, organism efficiency and adaptation to environmental factors Improvements in environmental conditions, along with advancements in health and technology have extended life expectancy and led to an increase in the elderly population. Physiological changes such as osteoporosis, sarcopenia, weight loss and chronic inflammation are observed in elderly individuals, the rate of falls increases and orthopedic surgery is frequently required due to trauma. The most common orthopedic surgical intervention in elderly patients is total joint arthroplasty. Frailty is common among orthopedic surgery patients and is associated with postoperative complications. Frailty is a biological condition that occurs accompanies aging. As a geriatric syndrome, frailty leads to a decrease in physiological reserves. Frail elderly patients experience problems such as sarcopenia, weight loss, weakness, decreased tolerance to stress, and burnout. Therefore, the risk of postoperative complications increases in these patients. Physical and psychological problems such as deep vein thrombosis, surgical site infection, urinary tract infection, and delirium are the most common postoperative complications. Moreover, frailty is an important cause of morbidity and mortality in the 30- day postoperative period in elderly patients. Therefore, diagnosing frailty in elderly patients, evaluating risk factors, and providing individualized nursing care are essential. The aim of the review prepared in this direction is to provide information about the diagnosis and nursing management of frailty in elderly patients undergoing orthopedic surgery.

Anahtar Kelimeler

• Geriatrics
• nursing care
• frailty
• total joint arthroplasty.

Ortopedik Cerrahi Hastalarında Kırılganlık ve Hemşirelik Bakımı

Öz

Yaşlılık, yaşamsal fonksiyonların, organizma verimliliğinin ve çevresel faktörlere uyumun azalmasına neden olduğundan, sürekli ve geri dönüşsüzdür. Çevresel koşulların iyileşmesi, sağlık ve teknoloji alanındaki gelişmeler yaşam süresini uzatmış ve yaşlı nüfusun artmasına neden olmuştur. Yaşlı bireylerde osteoporoz, sarkopeni, kilo kaybı, kronik inflamasyon gibi fizyolojik değişiklikler görülmekte, düşme oranı artmakta ve travma nedeniyle ortopedik cerrahi girişim sık uygulanmaktadır. Yaşlı hastalarda en sık uygulanan ortopedik cerrahi girişim ise total eklem artroplastisidir. Ortopedik cerrahi hastalarında kırılganlık yaygındır ve ameliyat sonrası komplikasyonlar ile ilişkilidir. Kırılganlık, yaşlanma ile oluşan biyolojik bir durumdur. Geriatrik bir sendrom olan kırılganlık, fizyolojik rezervlerin azalmasına neden olmaktadır. Kırılgan yaşlı hastalarda sarkopeni, kilo kaybı, güçsüzlük, strese karşı toleransta azalma ve tükenmişlik gibi problemler yaşanmaktadır. Bu nedenle bu hastalarda ameliyat sonrası komplikasyon riski artmaktadır. Derin ven trombozu, cerrahi alan enfeksiyonu, idrar yolu enfeksiyonu, deliryum gibi fiziksel ve psikolojik problemler en sık görülen ameliyat sonrası komplikasyonlardır. Ayrıca kırılganlık yaşlı hastalarda ameliyat sonrası 30 günlük dönemdeki morbidite ve mortalitenin önemli bir nedenidir. Bu nedenle yaşlı hastalarda kırılganlığın tanılanması, risk faktörlerinin değerlendirilmesi ve bireyselleştirilmiş hemşirelik bakımının sağlanması gereklidir. Bu doğrultuda hazırlanan bu derlemenin amacı, ortopedik cerrahi geçiren yaşlı hastalarda kırılganlığın tanılanması ve hemşirelik yönetimi hakkında bilgi vermektir.

Anahtar Kelimeler

• Geriatri
• hemşirelik bakımı
• kırılganlık
• total eklem artroplastisi

Kaynakça

1. Word Health Organization. [Internet]. Ageing; 2022 [cited 2022 Dec 24]. Available from: https://www.who.int/health-topics/ ageing#tab=tab_1
2. Winters AM, Hartog LC, Roijen HIF, Brohet RM, Kamper AM. Relationship between clinical outcomes and Dutch frailty score among elderly patients who underwent surgery for hip fracture. Clin Interv Aging. 2018;13:2481–6.
3. Cooper Z, Rogers SO, Ngo L, Guess J, Schmitt E, Jones RN, et al. Comparison of frailty measures as predictors of outcomes after orthopedic surgery. J Am Geriatr Soc. 2016;64(12):2464–71.
4. O’Caoimh R, Sezgin D, O’Donovan MR, William Molloy D, Clegg A, Rockwood K, et al. Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies. Age Ageing. 2021;50(1):96–104.
5. Ninomiya K, Takahira N, Ikeda T, Suzuki K, Sato R, Kazuo H. Prevalence of frailty and associated factors among community-dwelling older adults after total hip arthroplasty. Hip Int. 2021;1–7.
6. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):146–56.
7. Mamtora PH, Fortier MA, Barnett SR, Schmid LN, Kain ZN. Peri-operative management of frailty in the orthopedic patient. J Orthop. 2020;22:304–7.
8. Rodríguez-Mañas L, Féart C, Mann G, Viña J, Chatterji S, Chodzko- Zajko W, et al. Searching for an operational definition of frailty: A delphi method based consensus statement: the frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci. 2013;68(1):62–7.

9. Sun X, Shen Y, Ji M, Feng S, Gao Y, Yang J, et al. Frailty is an independent risk factor of one-year mortality after elective orthopedic surgery: A prospective cohort study. Aging. 2021;13(5):7190–8.
10. Bulut Ateş E, Öztürk Kosuva Z. Ayaktan kliniğe başvuran 60 yaş üstündeki hastalarda geriatrik sendrom prevalansı. Geriatrik Bilimler Dergisi. 2018;1(1):8–13.
11. Elbi H, Cengiz Özyurt B. 65 yaş ve üstü bireylerde kırılganlığın prevalansı ve kırılganlığı etkileyen faktörler. Smyrna Tıp Dergisi. 2013;76(1):16–21.
12. Ortopedi ve Travmatoloji Hemşireleri Derneği. [Internet]. Kırılganlık kırığında hemşirelik: 2008 [cited 2022 Dec 24]. Available from: https:// www.othed.org.tr/othed/yayinlar
13. Dharmasukrit C, Chan SYS, Applegate RL, Tancredi DJ, Harvath TA, Joseph JG. Frailty, race/ethnicity, functional status, and adverse outcomes after total hip/knee arthroplasty: a moderation analysis. J Arthroplasty. 2021;36(6):1895–903.
14. Demir Korkmaz F, Arikan B. Nursing care of frail patients in cardiac surgery. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2022;11(2):806–16.
15. Choi JY, Kim JK, Kim K il, Lee YK, Koo KH, Kim CH. How does the multidimensional frailty score compare with grip strength for predicting outcomes after hip fracture surgery in older patients? A retrospective cohort study. BMC Geriatr. 2021;21(1):1–9.
16. Espinoza SE, Fried L. Risk factors for frailty in the older adult. Clin Geriatr. 2007;15(6):1–9.
17. Roopsawang I, Zaslavsky O, Thompson H, Aree-Ue S, Kwan RYC, Belza B. Frailty measurements in hospitalised orthopaedic populations age 65 and older: A scoping review. J Clin Nurs. 2022;31(9–10):1149–63.
18. Schmucker AM, Hupert N, Mandl LA. The Impact of Frailty on short-term outcomes after elective hip and knee arthroplasty in older adults: A systematic review. Geriatr Orthop Surg Rehabil. 2019;10.
19. Leng S, Chen X, Mao G. Frailty syndrome: an overview. Clin Interv Aging. 2014;9:433.
20. Beaudart C, Reginster JY, Petermans J, Gillain S, Quabron A, Locquet M, et al. Quality of life and physical components linked to sarcopenia: The SarcoPhAge study. Exp Gerontol. 2015;69:103.
21. Ondeck NT, Bovonratwet P, Ibe IK, Bohl DD, McLynn RP, Cui JJ, et al. Discriminative ability for adverse outcomes after surgical management of hip fractures: A comparison of the Charlson Comorbidity Index, Elixhauser Comorbidity Measure, and Modified Frailty Index. J Orthop Trauma. 2018;32(5):231–7.
22. Aygör Eskiizmirli H, Fadıloğlu Ç, Şahin S, Aykar FŞ, Akçiçek F. Validation of Edmonton Frail Scale into Elderly Turkish. Arch Gerontol Geriatr. 2018 May 1;76:133–7.
23. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):146–57.
24. Özsürekci C, Balcı C, Kızılarslanoğlu MC, Çalışkan H, Tuna Doğrul R, Ayçiçek GŞ, et al. An important problem in an aging country: identifying the frailty via 9 Point Clinical Frailty Scale-. Acta Clin Belg. 2020;75(3):200–4.
25. Akın S, Mumtaz, Mazıcıoglu M, Mucuk S, Gocer S, Deniz E, et al. The prevalence of frailty and related factors in community-dwelling Turkish elderly according to modified Fried Frailty Index and FRAIL scales. Aging Clin Exp Res. 2015;27:703–9.
26. Shah A, Gustafson O, Swarbrick C, King E, Shah K. Frailty in the ICU: what are we doing with all this information? Intensive Care Med. 2022;48(9):1258–9.
27. Sang WA, Durrani H, Liu H, Clark JM, Ferber L, Hagan J, et al. Frailty Score as a predictor of outcomes in geriatric patients with isolated hip fractures. Am Surg. 2021;0(0):1–6.
28. Schwartz AM, Wilson JM, Farley KX, Bradbury TL, Guild GN. Concomitant malnutrition and frailty are uncommon, but significant risk factors for mortality and complication following primary total knee arthroplasty. J Arthroplasty. 2020;35(10):2878–85.
29. Pizzonia M, Giannotti C, Carmisciano L, Signori A, Rosa G, Santolini F, et al. Frailty assessment, hip fracture and long-term clinical outcomes in older adults. Eur J Clin Invest. 2021;51(4):1–9.
30. Jorissen RN, Lang C, Visvanathan R, Crotty M, Inacio MC. The effect of frailty on outcomes of surgically treated hip fractures in older people. Bone. 2020;136.
31. Tıp Dergisi O, Kapucu S, Ünver G. Kırılgan yaşlı ve hemşirelik bakımı. Osmangazi Tıp Dergisi. 2017;39(1):122–9.
32. Lee H, Lee E, Jang IY. Frailty and comprehensive geriatric assessment. Journal of Korean Medical Sciencel. 2020;35(3):1–13.
33. Ondeck NT, Bohl DD, Bovonratwet P, McLynn RP, Cui JJ, Shultz BN, et al. Discriminative ability of commonly used indices to predict adverse outcomes after poster lumbar fusion: a comparison of demographics, ASA, the Modified Charlson Comorbidity Index, and the Modified Frailty Index. Spine J. 2018;18(1):44–52.
34. Amrock LG, Deiner S. The implication of frailty on preoperative risk assessment. Curr Opin Anaesthesiol. 2014;27(3):330–5.
35. Wilson JM, Boissonneault AR, Schwartz AM, Staley CA, Schenker ML. Frailty and malnutrition are associated with ınpatient postoperative complications and mortality in hip fracture patients. J Orthop Trauma. 2019;33(3):143–8.
36. Chan SP, Ip KY, Irwin MG. Peri-operative optimisation of elderly and frail patients: A narrative review. Anaesthesia. 2019;74 Suppl 1:80–9.
37. Aceto P, Bassi P, Sollazzi L, Racioppi M, Fortunato G, Gianfrancesco L, et al. Implementation of frailty preoperative assessment to predict outcome in patients undergoing urological surgery: A systematic review and meta-analysis. BJU Int. 2021;127(5):507–17.
38. Susano MJ, Grasfield RH, Friese M, Rosner B, Crosby G, Bader AM, et al. Brief preoperative screening for frailty and cognitive impairment predicts delirium following spine surgery. Anesthesiology. 2020;133(6):1184–90.
39. Esmaeeli S, Franco-Garcia E, Akeju O, Heng M, Zhou C, Azocar RJ, et al. Association of preoperative frailty with postoperative delirium in elderly orthopedic trauma patients. Aging Clin Exp Res. 2022;34(3):625–31.
40. Oliver D. Medical input, rehabilitation and discharge planning for patients with hip fracture: Why traditional models are not fit for purpose and how things are changing. Curr Anaesth Crit Care. 2005;16(1):11–22.
41. Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing. 2006;35(5):526–9.
42. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.