Can Older Surgical Patients Identify Their Own Frailty? Outcomes of a Digital Self-Screening Pathway Linked to Perioperative Geriatric Care

Background: Frailty, multimorbidity and polypharmacy are associated with poorer postoperative outcomes, increased complications and loss of functional independence. National guidance recommends early frailty identification and comprehensive geriatric assessment (CGA) within surgical pathways to facilitate optimisation and informed decision-making (1). A novel digital frailty self-screening pathway was introduced across elective surgical services within Swansea Bay University Health Board, enabling patients to identify potential frailty-related concerns and trigger referral to the existing Perioperative Medicine for Older People (POPS) service at an earlier stage of their surgical journey.

Methods: A retrospective service evaluation was undertaken between November 2024 and June 2026. Patients identified through digital frailty self-screening underwent virtual assessment, with escalation to face-to-face CGA where required. Repeat attendances were removed using unique NHS numbers to provide patient-level analyses.

Results: During the evaluation period, 561 virtual and 586 face-to-face appointments were offered. Following removal of duplicate attendances, 740 unique patients were reviewed, including 402 assessed virtually and 429 face-to-face. Ninety-one patients progressed from virtual assessment to face-to-face review following identification of additional frailty, cognitive, functional or medical concerns requiring further assessment.

The pathway generated substantial optimisation activity. A total of 151 referrals were made to existing community exercise and wellbeing programmes, including the National Exercise Referral Scheme, alongside referrals to physiotherapy, falls services, memory clinics, continence services, dietetics, community therapy teams and specialist medical services. Medication review and deprescribing formed a major component of assessment. Overall, 554 patients were discharged following POPS review, indicating that a single specialist assessment was frequently sufficient to address perioperative concerns and support progression through the surgical pathway.

Importantly, 64 patients (8.6%; approximately one in twelve assessed patients) chose not to proceed with planned surgery following CGA and shared decision-making. Common contributing factors included frailty, multimorbidity, cognitive impairment, limited anticipated functional benefit and patient preference. This aligns with evidence that CGA supports realistic risk assessment and enables treatment decisions that better reflect patient goals and values (2).

Conclusions: Digital frailty self-screening successfully identified older surgical patients requiring CGA and enabled targeted deployment of POPS resources. The pathway facilitated early optimisation through referral to existing support services, medication review and multidisciplinary intervention, while enabling escalation from virtual to face-to-face assessment where additional complexity was identified. Nearly one in twelve patients elected not to proceed with surgery following assessment, highlighting the value of early frailty identification in supporting personalised, goal-oriented care and avoiding potentially non-beneficial interventions.