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Older people represent the fastest growing segment of the peri\u2010operative population, and 25\u201350% of older surgical patients live with frailty. When frailty is present before surgery, adjusted rates of morbidity and mortality increase at least two\u2010fold; the odds of delirium and loss of independence are increased more than four\u2010 and five\u2010fold, respectively. Care of the older person with frailty presenting for emergency surgery requires individualised and evidence\u2010based care given the high\u2010risk and complex nature of their presentations. Before surgery, frailty should be assessed using a multidimensional frailty instrument (most likely the Clinical Frailty Scale), and all members of the peri\u2010operative team should be aware of each patient's frailty status. When frailty is present, pre\u2010operative care should focus on documenting and communicating individualised risk, considering advanced care directives and engaging shared decision\u2010making when feasible. Shared multidisciplinary care should be initiated. Peri\u2010operatively, analgesia that avoids polypharmacy should be provided, along with delirium prevention strategies and consideration of postoperative care in a monitored environment. After the acute surgical episode, transition out of hospital requires that adequate support be in place, along with clear discharge instructions, and review of new and existing prescription medications. Advanced care directives should be reviewed or initiated in case of readmission. Overall, substantial knowledge gaps about the optimal peri\u2010operative care of older people with frailty must be addressed through robust, patient\u2010oriented research.<\/jats:p>","DOI":"10.1111\/anae.15860","type":"journal-article","created":{"date-parts":[[2022,9,12]],"date-time":"2022-09-12T03:02:48Z","timestamp":1662951768000},"page":"1430-1438","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Frailty and emergency surgery: identification and evidence\u2010based care for vulnerable older adults"],"prefix":"10.1111","volume":"77","author":[{"given":"D.","family":"Gottesman","sequence":"first","affiliation":[{"name":"Departments of Anesthesiology and Pain Medicine University of Ottawa and Ottawa Hospita  Ottawa ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8543-1859","authenticated-orcid":false,"given":"D. 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