Frailty as a Growing Challenge for Anesthesiologists

Results of a Dutch National Survey

A. Bouwhuis; C. E. van den Brom; S. A. Loer; C. S. E. Bulte


BMC Anesthesiol. 2021;21(307) 

In This Article



The meeting was attended by 1394 members of the Dutch Society for Anesthesiology. In total, 132 surveys were completed, resulting in an overall response rate of 9,5%. The respondents included 65 residents (49%), 61 anesthesiologists (46%) and 6 'others' (5%) consisting of 2 physician assistants and 4 respondents with unknown profession (Figure 1).

Figure 1.

Characteristics of survey respondents. Experience level of consultants (orange, A), work environment of consultants (orange, B), total population divided by consultants in orange and residents in blue (C), experience of residents (blue, D) and work environment of residents (blue, E)

Of the consultants, 26% reported less than 5 years of experience, 21% between 5 and 15 years, and 53% over 15 years of experience (Figure 1A). Forty-two percent of consultants worked in an academic setting versus 56% in a non-academic setting (Figure 1B). Of the residents, 6% of respondents included first year residents, 20% second year, 15% third year, 22% fourth year and 29% fifth year (Figure 1D). Eighty percent of the residents worked in an academic setting versus 20% in a non-academic setting (Figure 1E). Respondents were working in 26 different hospitals in the Netherlands.

The Aging Population and the Anesthesiologist

The increasing number of elderly patients was primarily perceived as a challenge by 76% of the respondents (Figure 2). Further, 30% of the respondents perceived the increase in elderly patients as a reason for an anesthesiologist with elderly patients as subspecialty, whereas 26% of the respondents stated the increase as a problem for the society as a whole. Additionally, 13% mentioned the growing number of elderly patients to indicate a gap in their skills and knowledge regarding their perioperative management. Residents endorsed this statement twice as frequent compared to consultants (17% of residents versus 8% of consultants). For this question, multiple statements could be endorsed per respondent.

Figure 2.

Opinions of respondents on increasing number of elderly patients. In the current question multiple statements were allowed. The red bar indicates the total respondents agreeing with the statement, which were subdivided in consultants (orange bars), residents (blue bars) and others (gray bars). The number of respondents is presented within the bars, and the percentage of respondents per group is presented on the y-axis

Frailty and the Anesthesiologist

The opinions of anesthesiologists regarding frailty are summarized in Table 1. Ninety-eight percent of respondents agreed that the anesthesiologist should be aware of the presence of frailty and 99% agreed it influences perioperative anesthetic management. Furthermore, 85% claimed to feel competent to recognize frailty in elderly. However, solely 39% of respondents report the presence of frailty in the patient file during the preassessment visit (23% of residents versus 52% of consultants). Moreover, only 30% seemed aware that all patients over 70 years of age currently receive a frailty screening on hospital admission and admitted to know where to find the documented frailty screening in their hospital (14% of residents and 41% of consultants).

Organization of Multidisciplinary Geriatric Care

Regarding multidisciplinary care, 85% of respondents claimed the availability of geriatric expertise at their hospital. The majority of respondents (54%) feel that the geriatrician is considered to be in the lead. The second most common scenario, as marked by 29% of the respondents, is that the surgical specialist consults the geriatric department. Sixteen percent of respondents reported that the geriatrician is consulted by the anesthesiologist themselves. Responses concerning the manner of consultation were independent of respondents' position or work environment.

Considering collaboration with geriatric specialists and the implementation of dedicated pathways, all received inferior satisfactory rates by the respondents from academic centers compared to colleagues from non-academic hospitals (Figure 3). Due to the large portion of residents in academic work environments, comparisons were made between consultants only. Multidisciplinary dedicated care pathways for elderly patients originated from hip fracture repair procedures with high morbidity and mortality, which remain the most common performed procedure in often multimorbid complicated patients. Interestingly, only 50% of academic consultants reported the use of a dedicated pathway for elderly with a femur fracture (compared to 82% of nonacademic consultants). Similarly, only 27% of academic consultants reported a well implemented preoperative approach for elective frail elderly (compared to 53% of nonacademic consultants). The collaboration with geriatricians is reported as adequate by only 43% of all respondents. The presence of an anesthesiologist in the geriatric team is rare in both settings (3% in total; of which 12% of academic and 0% in non-academic centers).

Figure 3.

Influence of work environment on multidisciplinary geriatric care. Bars show the percentage of respondents that agree with the statement. The black bar represents all respondents; followed by consultants from academic centers (green bars) and consultants from non-academic centers (blue bars) who agree with the statement