Feature


Patient frailty and IR


The case for frailty as a geriatric diagnostic tool By Rana Rabei, MD, and Maureen P. Kohi, MD, FSIR


This article is based on a poster from SIR 2021. T


he U.S. population is rapidly aging. By 2060, 95 million people will be age 65 or older.1 This shift in demographics (is


closely mirrored in much of the Western world and has major implications for all areas of healthcare delivery, particularly in the perioperative and periprocedural setting where increased age is associated with higher risk of morbidity and mortality. This aging population is expected to increase demand for interventional radiology services,


20 IRQ | FALL 2021


particularly for palliative therapies targeted to elderly patients who are considered high-risk surgical candidates.


Despite the minimally invasive nature of IR, no procedure is without risk and a minority of our patients do experience complications, longer-than-anticipated recovery and rehabilitation, and even decreased health and death. With an increasing number of geriatric patients seeking IR services, identification of patients at higher risk for complications


will allow for improved pre-procedural counseling and patient selection, as well as targeted application of resources to improve the perioperative risk profile for select patients.


Pathophysiology of frailty Emerging data indicate that that immune and endocrine dysfunction along with malnutrition shape the stigmata of frailty. Frail patients have altered distribution of cytokines with higher proinflammatory markers, decreased sex hormones, higher levels of cortisol and vitamin D deficiency. Together, these factors result in sarcopenia, anemia, insulin resistance, decline in anabolic metabolism and leukocyte function, which all impact the patient’s risk of infection and healing abilities after surgery. Decreased muscle mass and increased adipose tissue that characterize frail body habitus alters drug metabolism, leading to higher duration of action of lipophilic drugs and higher peak plasma concentration of hydrophilic drugs. This impact, along with renal and hepatic impairments that


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