Advancing Perioperative Medicine for Frail Older Adults in Thailand: A Strategic Perspective from Anesthesiology

Jitsupa  Nithiuthai; Arunotai  Siriussawakul; Patchareya  Nivatpumin; Orawan  Pongraweewan; Weerasak  Muangpaisan; Thammawat  Parakonthun; Piyapat  Dajpratham; Varalak  Srinonprasert

doi:10.33192/smj.v77i10.276435

Authors

Jitsupa Nithiuthai Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Arunotai Siriussawakul Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Patchareya Nivatpumin Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Orawan Pongraweewan Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Weerasak Muangpaisan Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Thammawat Parakonthun Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Piyapat Dajpratham Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Varalak Srinonprasert Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33192/smj.v77i10.276435

Keywords:

Anesthesiologist role, Frail, Elder, Perioperative care, Prehabilitation

Abstract

Thailand has officially entered an aged-society phase: people ≥ 65 years already constitute > 14% of the population. This demographic transition strains surgical services; frail older adults face disproportionately high perioperative morbidity, prolonged recovery, and functional decline. Yet, perioperative care delivery in Thailand remains fragmented, with sporadic frailty screening, inconsistent multidisciplinary collaboration, and rudimentary transitional care pathways. Using the Business Model Canvas to map current service gaps, this review delineates strategic levers for reform. At high-volume centers such as Siriraj Hospital, nearly 40% of surgical patients are aged ≥ 65 years, positioning anesthesiologists to champion frailty screening, preoperative risk optimization, and postoperative recovery planning. Inspired by models from Singapore, the UK, and the US, we propose a four-phase, anesthesiologist-led perioperative care model spanning pre- to post-surgery. Prioritizing safety, recovery, and continuity of care, it is supported by workforce development and policy action. To manage implementation costs, a Business Model Canvas is recommended. This scalable strategy aims to enhance perioperative care for Thailand’s aging population.

References

Lertkovit S, Siriussawakul A, Suraarunsumrit P, Lertpipopmetha W, Manomaiwong N, Wivatdechakul W, et al. Polypharmacy in Older Adults Undergoing Major Surgery: Prevalence, Association With Postoperative Cognitive Dysfunction and Potential Associated Anesthetic Agents. Front Med (Lausanne). 2022;9:811954.

Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210(6):901-8.

Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752-62.

Robinson TN, Walston JD, Brummel NE, Deiner S, Brown CHt, Kennedy M, et al. Frailty for Surgeons: Review of a National Institute on Aging Conference on Frailty for Specialists. J Am Coll Surg. 2015;221(6):1083-92.

George EL, Hall DE, Youk A, Chen R, Kashikar A, Trickey AW, et al. Association Between Patient Frailty and Postoperative Mortality Across Multiple Noncardiac Surgical Specialties. JAMA Surgery. 2021;156(1):e205152-e.

Deiner SG, Marcantonio ER, Trivedi S, Inouye SK, Travison TG, Schmitt EM, et al. Comparison of the frailty index and frailty phenotype and their associations with postoperative delirium incidence and severity. Journal of the American Geriatrics Society. 2024;72(6):1781-92.

Parakonthun T, Sirisut B, Nampoolsuksan C, Gonggetyai G, Swangsri J, Methasate A. Factors associated with complication after gastrectomy for gastric or esophagogastric cancer compared among surgical purpose, surgical extent, and patient age: Retrospective study from a high volume center in Thailand. Annals of Medicine and Surgery. 2022;78:103902.

Parakonthun T, Nampoolsuksan C, Swangsri J, Yiengpruksawan A, Methasate A. Retrospective analysis of the outcomes in elderly patients with adenocarcinoma of the stomach and esophagogastric junction following three different treatments. Siriraj Medical Journal. 2019;71(6):457-65.

Osterwalder A, Pigneur Y. Business model generation: a handbook for visionaries, game changers, and challengers: John Wiley & Sons; 2010.

Chia CL, Mantoo SK, Tan K. ‘Start to finish trans‐institutional transdisciplinary care’: a novel approach improves colorectal surgical results in frail elderly patients. Colorectal Disease. 2016;18(1):O43-O50.

Lodge ME, Dhesi J, Shipway DJ, Braude P, Meilak C, Partridge J, et al. Core elements of the perioperative medicine for older people undergoing surgery (POPS) model of care. European Geriatric Medicine. 2025;16(2):435-46.

Wingfield SA, McDonald SR. Geriatric Models of Care: Perioperative Optimization of Senior Health (POSH). In: Malone ML, Boltz M, Macias Tejada J, White H, editors. Geriatrics Models of Care: Bringing 'Best Practice' to an Aging America. Cham: Springer International Publishing; 2024. p. 377-82.

Phannarus H, Chansaengpetch S, Virojskulchai T, Pengsorn N, Chaopanitwet P, Wong-ekkabut J, et al. Prevalence of Geriatric Syndromes and Satisfaction of Service in Older People Receiving Annual Health Screening at the Check-up Clinic, Siriraj Hospital. Siriraj Medical Journal. 2025;77(1):51-63.

Wolfe JD, Wolfe NK, Rich MW. Perioperative care of the geriatric patient for noncardiac surgery. Clinical Cardiology. 2020;43(2):127-36.

Thillainadesan J, Hilmer SN, Fleury AM, Naganathan V. New horizons in the perioperative care of older adults. Age and ageing. 2022;51(2):afab245.

Olotu C, Weimann A, Bahrs C, Schwenk W, Scherer M, Kiefmann R. The perioperative care of older patients: time for a new, interdisciplinary approach. Deutsches Ärzteblatt International. 2019;116(5):63.

Aceto P, Antonelli Incalzi R, Bettelli G, Carron M, Chiumiento F, Corcione A, et al. Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus. Aging Clin Exp Res. 2020;32(9):1647-73.

Lasocki S, Krauspe R, Von Heymann C, Mezzacasa A, Chainey S, Spahn DR. PREPARE: the prevalence of perioperative anaemia and need for patient blood management in elective orthopaedic surgery: a multicentre, observational study. European Journal of Anaesthesiology| EJA. 2015;32(3):160-7.

Somnuke P, Pongraweewan O, Siriussawakul A. Optimizing Perioperative Care for Elderly Surgical Patients: A Review of Strategies and Evidence-Based Practices. Siriraj Medical Journal. 2024;76(7):465-72.

Sieber F, McIsaac DI, Deiner S, Azefor T, Berger M, Hughes C, et al. 2025 American Society of Anesthesiologists Practice Advisory for Perioperative Care of Older Adults Scheduled for Inpatient Surgery. Anesthesiology. 2025;142(1):22-51.

Centre for Perioperative Care BGS, and Royal College of Anaesthetists,. Guideline for perioperative care for people living with frailty undergoing elective and emergency surgery. London: Centre for Perioperative Care; 2021.

Thompson A, Fleischmann KE, Smilowitz NR, de Las Fuentes L, Mukherjee D, Aggarwal NR, et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline for perioperative cardiovascular management for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2024;84(19):1869-969.

Jirakulsawat A, Noocharoen N, Somnuke P. Prehabilitation in Clinical Practice: A Review of Concepts and Implementation in Enhancing Postoperative Outcomes. Siriraj Medical Journal. 2024;76(9):646-54.

Wong HMK, Qi D, Ma BHM, Hou PY, Kwong CKW, Lee A, et al. Multidisciplinary prehabilitation to improve frailty and functional capacity in high-risk elective surgical patients: a retrospective pilot study. Perioperative Medicine. 2024;13(1):6.