Multidisciplinary team assessment of frailty before major interventions
A multidisciplinary team (professionals from different disciplines) assesses a frail older adult (one with reduced reserve) to judge whether a major intervention, such as an operation, is suitable.
Remember
Frailty, meaning reduced reserve (the spare capacity of the body's systems), is what may make an older person unsuitable for a major intervention, not age or one disease alone. A multidisciplinary team looks at the whole person to judge whether the intervention is suitable.
Frailty is a risk state that builds up as deficits (health problems) accumulate. It leaves little physiological reserve, meaning the spare capacity of the body's systems to cope with a stressor. An operation is a major stress on the body, so a frail patient is likely to have a much greater drop in function and a far longer recovery. The team judges whether the patient can recover well afterwards.
A multidisciplinary team (a group of professionals from different disciplines) typically includes doctors, nurses, dietitians (nutrition experts), occupational therapists (who assess everyday tasks such as dressing and cooking) and speech and language therapists (who assess swallowing and communication). Each can assess an area that a single clinician might miss, such as nutrition, swallowing, mobility and daily living.
This holistic approach (looking at the whole person) is a form of comprehensive geriatric assessment, a process with many components that weighs medical, psychological and functional capability when building a co-ordinated care plan.
The assessment may show that the patient is too frail to recover well from certain interventions. Age, a single disease or one social factor is not decisive alone.
Key facts
- Frailty
- a state of reduced reserve that builds up as problems accumulate.
- Team members
- typically include doctors, nurses, dietitians, occupational therapists and speech and language therapists.
- Purpose of the team
- to assess multiple aspects of the patient's life and co-ordinate care decisions.
- Before an operation
- the team's combined findings show how well the patient is likely to tolerate and recover from an operation or other major treatment.
- Doctors
- remain central to care and are part of the team, which adds other professionals' skills to the medical assessment.
- Frailty score
- a higher score is linked to worse outcomes of treatment.
Exam traps
- Age on its own does not make an operation unsuitable, because people of the same age differ widely in their physiological reserve.
- Living alone does not make an operation inappropriate by itself, because the concern can be addressed with support at home.
- A frailty score guides management, but a fixed cut-off does not decide whether to offer an intervention, because the decision still depends on wishes, function and the medical picture rather than one number.
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