The elderly patient can be challenging in the emergency setting. Comorbidities and disabilities are well established as contraindications for surgical procedures, but not rarely these patients surprise us with their outcome: the coronary-diseased nonagenarian behaves as expected for a thirty-year-old, and the middle-aged needs longer hospital stay after equal operations for the same disease.
There are studies using Fried's approach (J Gerontol A Biol Sci Med Sci. 2001) (http://biomedgerontology.oxfordjournals.org/content/56/3/M146.full.pdf) to oncological patients, but some of the measures are not easily feasible in the surgical emergency room.
What's the best method to assess and grade frailty in the surgical patients , presenting with acute abdomen?
There are several risk stratification indices available and our anaesthetists in our unit tend to use the P- Possum score - quite reliable and takes into consideration co-morbidity in addition to the present illness. However, patients continue to provide surprises (both pleasant and unpleasant) and this is perhaps, an example of where the 'science' of medicine has to be matched by the 'art' of medicine'. The value of an assessment by an experienced surgeon prior to any major emergency surgery cannot be over-emphasized.
Geriatric asessment and emergency is a difficult combination especially in acute abdomen and fractures. The only kind of theoretically assessment might be to ask questions about daily life ( " Do you leave your appartment? How many stairs can you go up? Do you prepare meals by yourself? etc.") These questions together with some questions about mental impairment ( "What day/date do we have? How old are you?" etc.) can help you to solve the problem of a frail patient in emergency unit and before the OR.
It is a very relevant question. I don't have the exact answer. One of the simplest performance scores is ECOG/WHO/Zubrod score, often used in Oncology. It is a systematic way of registering daily life activity as mentioned by Mr. Becker. I think The score could have a potential in emergency surgery combined with e.g. BMI and comorbidities (including being diagnosed with dementia).
The simplest and fastest method to assess "low resistance" to any stress is the CBC.
Specifically when anypatient is under severe stress the White Blood Cell PMN)