Objective: Frail patients in any age group are more likely to die than those that are not frail. To evaluate the impact of frailty on clinical mortality, readmission rate and length of stay for emergency surgical patients of all ages.Design, setting and participants: A multi-centre prospective cohort study was conducted on adult admissions to acute surgical units. Every patient presenting as a surgical emergency to secondary care, regardless of whether they ultimately underwent a surgical procedure. Participants were included during 2015 and 2016Intervention: Frailty as defined by the 7 point Clinical Frailty Scale Main outcomes and measures: The primary outcome was mortality at Day 90. Secondary outcomes included: Mortality at day 30, readmission at day 30 and length of stay. Results:The cohort included 2,279 patients (median age 54 years ; 56% female). Frailty was documented in patients of all ages: 1% in the under 40's to 45% of those aged 80+. We found that each incremental step of worsening frailty was associated with an 80% increase in mortality at day 90 (95% CI 1.61-2.01) supporting a linear doseresponse relative relationship. In addition, the most frail patients were increasingly likely to be readmitted, stay in hospital longer and die within 30 days. Conclusions:Worsening frailty at any age is associated with significantly poorer patient outcomes, including mortality in unselected acute surgical admissions.

Abstract Common symptoms of pandemic coronavirus disease (COVID-19) include fever and cough. We describe a 94-year-old man with well-controlled schizoaffective disorder, who presented with non-specific and atypical symptoms: delirium, low-grade pyrexia and abdominal pain. He was given antibiotics for infection of unknown source, subsequently refined to treatment for community-acquired pneumonia. Despite active treatment, he deteriorated with oxygen desaturation and tachypnoea. A repeat chest X-ray showed widespread opacification. A postmortem throat swab identified COVID-19 infection. He was treated in three wards over 5 days with no infection control precautions. This has implications for the screening, assessment and isolation of frail older people to COVID-specific clinical facilities and highlights the potential for spread among healthcare professionals and other patients.

ObjectivesMultimorbidity is the presence of 2 or more medical conditions. This increasingly used assessment has not been assessed in a surgical population. The objectives of this study were to assess the prevalence of multimorbidity and its association with common outcome measures.DesignA cross-sectional observational study.SettingA UK-based multicentre study, included participants between July and October 2014.ParticipantsConsecutive emergency (non-elective) general surgical patients admitted to hospital, aged over 65 years.Outcome measuresThe outcome measures were (1) the prevalence of multimorbidity and (2) the association between multimorbidity and frailty; the rate and severity of surgery; length of hospital stay; readmission to hospital within 30 days of discharge; and death at 30 and 90 days.ResultsData were collected on 413 participants aged 65–98 years (median 77 years, (IQR (70–84)). 51.6% (212/413) participants were women. Multimorbidity was present in 74% (95% CI 69.7% to 78.2%) of the population and increased with age (p<0.0001). Multimorbidity was associated with increasing frailty (p for trend <0.0001). People with multimorbidity underwent surgery as often as those without multimorbidity, including major surgery (p=0.03). When comparing multimorbid people with those without multimorbidity, we found no association between length of hospital stay (median 5 days, IQR (1–54), vs 6 days (1–47), (p=0.66)), readmission to hospital (64 (21.1%) vs 18 (16.8%) (p=0.35)), death at 30 days (14 (4.6%) vs 6 (5.6%) (p=0.68)) or 90-day mortality (28 (9.2%) vs 8 (7.6%) (p=0.60)).Conclusions and implicationsMultimorbidity is common. Nearly three-quarters of this older emergency general surgical population had 2 or more chronic medical conditions. It was strongly associated with age and frailty, and was not a barrier to surgical intervention. Multimorbidity showed no associations across a range of outcome measures, as it is currently defined. Multimorbidity should not be relied on as a useful clinical tool in guidelines or policies for older emergency surgical patients.

Oral iron raises haemoglobin levels in elderly people with iron deficiency anaemia by 0.35 g/dL after 4-6 weeks, but it is unclear if this results in tangible health benefits.

Consultant-led medication review (standard practice) was effective at reducing anticholinergic drug exposure in the acute setting. A system of alerting clinicians to patients prescribed anticholinergic medications further reduced anticholinergic drug exposure.