The Role of the Clinical Frailty Scale in Stratifying Management of Older Adults with Acute Calculous Cholecystitis and Acute Gallstone Pancreatitis.

Acute calculous cholecystitis (ACC) and acute gallstone pancreatitis (AGP) are common gallstone-related emergencies in older adults. Current guidelines emphasize early control of the acute event and definitive management when feasible, but their applicability in the older population is constrained by marked heterogeneity in physiological reserve that chronological age alone fails to capture. This narrative review examines the role of frailty in clinical decision-making for older adults with ACC and AGP, organized around two intersecting questions that recur at admission: how severe is the current acute event, and how depleted is the patient's baseline reserve. The review outlines frailty assessment tools commonly used in emergency settings and focuses on the bedside utility of the Clinical Frailty Scale (CFS) as a practical means of operationalizing the baseline-reserve question. Drawing on existing guidelines and observational evidence, we summarize how management considerations shift according to baseline reserve: patients with substantially preserved reserve generally remain candidates for standard pathways; those with borderline reserve may require bridging and iterative reassessment; and those with substantial dependency or limited recovery potential require explicit goals-of-care discussion before further invasive management is pursued. The organizing perspective and stratification presented here are intended to support clinical judgment and risk communication rather than to serve as a validated algorithm.