Frailty ‘A distinctive health state related to the ageing process in which multiple body systems gradually lose their inbuilt reserves’ Fit for frailty, British Geriatric Society Some people are old but not frail Some people are frail but not old Most frailty services start at 75 years

Audit of frailty assessment in colorectal patients at uhb Sarah Biggs, CT1 Rory Spanton, ERAS Lead Nurse Jonathan Randall, Consultant Surgeon

Method Retrospective data collection 12 months of elective colorectal operations (ERAS) Frailty scores from POAC- ACS/NSQIP Frailty score. ‘Not Frail, Intermediate, Frail. Outcomes from ERAS data

Results 246 patient over 12 months 73/246 patients >70 = 29% Of the 73 patients >70 only 48 had frailty score done = 66% Frailty score Number 39 1 5 2 3

Frailty score and LOS Frailty score No. Patients Average of Length of stay (days) 8.586206897 Anterior resection 1 12 Lap anterior resection 4 21 Lap AP resection 5 Lap Hartmann's 7 Lap right hemi 16 6 Right hemi 10.5 TEMS 2 1.5 Frailty score No. Patients Average of Length of stay (days) 2   18.33333333 Lap right hemi 14 TEMS 1 27 Frailty score No. Patients Average of Length of stay (days) 3   66 Lap anterior resection 1 Frailty score No. patients Average of Length of stay (days) 1   6.2 Anterior resection 6 AP resection Lap right hemi 2 Reversal colostomy 7

Improvements Assessment Tool Timing of Assessment Intervention

Rockwood cfs

Timing of assessment and directing Fast track clinic Results clinic Specific POAC pathway? Mobility Comorbidities Nutrition Polypharmacy Cognition Social Care Needs Mood COMPREHENSIVE GERIARIC ASSESSMENT

Interventions at UH Bristol Prehabilitation Support Programme Pilot of Macmillan AHP Cancer Rehabilitation Project Exercise Plan with individual goals. Pre- and post-operative follow up calls Will feedback results to SWAG and CCG Aim of establishing a tariff for prehab within patient pathway Also School of Surgery. Directly employing prehab practitioner

HOW DO OTHERS DO IT? NORTH BRISTOL Geriatrician offers CGA pre-operatively ROYAL UNITED HOSPITALS BATH Combined surgical/anaesthetic frailty project. Starting in 2ww clinic. Though MDT into POAC with physio input.