{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T22:10:42Z","timestamp":1790892642919,"version":"4.1.0"},"reference-count":65,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Cognitive impairment, frailty, and malnutrition are three of the most impactful pathologies facing an aging population, having dramatic effects on morbidity and mortality across nearly all facets of medical care and intervention. By 2050, the World Health Organization estimates that the population of individuals over the age of sixty worldwide will nearly double, and the public health toll of these demographic changes cannot be understated. With these changing demographics comes a need for a sharpened focus on the care and management of this vulnerable population. The average patient presenting for surgery is getting older, and this necessitates that clinicians understand the implications of these pathologies for both their immediate medical care needs and for appropriate procedural selection and prognostication of surgical outcomes. We believe it is incumbent on clinicians to consider the frailty, nutritional status, and cognitive function of each individual patient when offering a surgical intervention, as well as consider interventions that may delay the progression of these pathologies. Unfortunately, despite excellent evidence supporting things like routine pre-operative frailty screening and nutritional optimization, many interventions that would specifically benefit this population still have not been integrated into routine practice. In this review, we will synthesize the existing literature on these topics to provide a pragmatic approach and understanding for anesthesiologists and intensivists faced with this complex population.<\/jats:p>","DOI":"10.4103\/sja.sja_532_23","type":"journal-article","created":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T03:50:18Z","timestamp":1692244218000},"page":"509-516","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["\u201cThe Big Three\u201d of geriatrics: A review of perioperative cognitive impairment, frailty and malnutrition"],"prefix":"10.4103","volume":"17","author":[{"given":"Houman","family":"Amirfarzan","sequence":"first","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Tufts University School of Medicine, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben J.","family":"Azocar","sequence":"additional","affiliation":[{"name":"Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander D.","family":"Shapeton","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Tufts University School of Medicine, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,8,18]]},"reference":[{"key":"R2-20240909","doi-asserted-by":"crossref","first-page":"4035","DOI":"10.1038\/s41598-022-25639-8","article-title":"Ageing in Saudi Arabia:New dimensions and intervention strategies","volume":"13","author":"Salam","year":"2023","journal-title":"Sci Rep"},{"key":"R3-20240909","doi-asserted-by":"crossref","first-page":"e225155","DOI":"10.1001\/jamasurg.2022.5155","article-title":"Population-based estimates of 1-year mortality after major surgery among community-living older US adults","volume":"157","author":"Gill","year":"2022","journal-title":"JAMA Surg"},{"key":"R4-20240909","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1097\/ALN.0000000000001660","article-title":"A Systematic review and meta-analysis examining the impact of incident postoperative delirium on mortality","volume":"127","author":"Hamilton","year":"2017","journal-title":"Anesthesiology"},{"key":"R5-20240909","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1007\/s00198-019-05172-7","article-title":"Association between postoperative delirium and mortality in elderly patients undergoing hip fractures surgery:A meta-analysis","volume":"31","author":"Bai","year":"2020","journal-title":"Osteoporos Int"},{"key":"R6-20240909","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1001\/jamaneurol.2020.2273","article-title":"Association of delirium with long-term cognitive decline:A meta-analysis","volume":"77","author":"Goldberg","year":"2020","journal-title":"JAMA Neurol"},{"key":"R7-20240909","doi-asserted-by":"crossref","first-page":"110496","DOI":"10.1016\/j.jclinane.2021.110496","article-title":"Association of postoperative delirium with cognitive outcomes:A meta-analysis","volume":"75","author":"Huang","year":"2021","journal-title":"J Clin Anesth"},{"key":"R8-20240909","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/j.bja.2017.11.087","article-title":"Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018","volume":"121","author":"Evered","year":"2018","journal-title":"Br J Anaesth"},{"key":"R9-20240909","first-page":"674","article-title":"American Geriatrics Society 2019 Updated AGS Beers Criteria\u00aefor Potentially Inappropriate Medication Use in Older Adults:2019 AGS Beers Criteria\u00aeUpdate Expert Panel","volume":"67","year":"2019","journal-title":"J Am Geriatr Soc"},{"key":"R10-20240909","first-page":"751","article-title":"A systematic review and meta-analysis examining the impact of age on perioperative inflammatory biomarkers","volume":"134","author":"Patel","year":"2022","journal-title":"Anesth Analg"},{"key":"R11-20240909","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1097\/ALN.0000000000001859","article-title":"Poor performance on a preoperative cognitive screening test predicts postoperative complications in older orthopedic surgical patients","volume":"127","author":"Culley","year":"2017","journal-title":"Anesthesiology"},{"key":"R12-20240909","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1213\/ANE.0000000000001277","article-title":"Preoperative cognitive stratification of older elective surgical patients:A cross-sectional study","volume":"123","author":"Culley","year":"2016","journal-title":"Anesth Analg"},{"key":"R13-20240909","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.jamcollsurg.2012.06.017","article-title":"American College of Surgeons National Surgical Quality Improvement Program;American Geriatrics Society . 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