home-based prehabilitation for elderly patients

Conditions: Frail Elderly Syndrome

Summary: as a consequence of the increasing life expectancy hospitals are seeing a growing number of elderly patients undergoing elective surgery. these patients are likely to suffer from one or more chronic illnesses, malnutrition, reduced physical strength and mobility and sensory impairment. age related loss of resilience in combination with these conditions often results in frailty. frailty syndrome describes a reduction in weight, mobility and strength, as well as declining cognitive capacities and reduced performance in daily life activities. this decline in constitution is accompanied by an increased risk of complications and mortality in the period after surgery. frail patients are generally admitted to hospital for a longer period and are readmitted more often. a multitude of studies has demonstrated that these risks can be significantly reduced by offering frail patients a prevention program prior to their surgery. these prevention programs are often referred to as prehabilitation and combine strength and cardiovascular training with breathing exercises. despite the obvious benefits, prehabilitation programs are not yet commonly applied outside of research settings as they carry considerable costs and required additional skilled personnel. in response to the unmet need for a widely applicable, cost and personnel efficient prehabilitation program a home-based prehabilitation program has been designed. this prehabilitation allows patients to safely perform an individualised set of exercises without relying on a personal trainer or a training group. efficiency and feasibility will be evaluated in this study.

the average age of hospital patients has steadily increased with the demographic change of germany's ageing population. in 2014, more than 27 million people living in germany were older than 60 years and more than one third of this group had to undergo surgery within that year. a relevant proportion of this patient group has to be considered frail or pre-frail. over a lifetime every individual experiences a physiological reduction of functional capacity across all organ systems resulting in frailty. consequently, physical and psychological stress, such as a hospital stay and surgery cannot be readily compensated. therefore, frailty is a highly predictive pre-operative risk factor for increased post-operative morbidly and mortality, prolonged hospital stay and loss of independence. multiple studies have demonstrated post-operative outcome of frail patients can be drastically improved if these patients are identified prior to elective surgery and enrolled in a multimodal prehabilitation program. the core of prehabilitation is physical exercise next to nutritional and psychological support. the improvement of cardiovascular condition, ventilator capacity and muscle strength gained during prehabilitation resulted in a reduced incidence of complications including pneumonia, shorter hospital stays and improved quality of life. yet despite these benefits prehabilitation is not yet widely available outside of clinical studies as they carry considerable costs and demand additional skilled personnel. in order to provide prehabilitation to a larger group of patients, a pre-operative exercise program was developed, that can safely be followed by pre-frail and frail patients at home without the need of continuous instruction and supervision by a trainer or physiotherapist. efficacy and feasibility will be evaluated in this study.

Eligibility criteria:
inclusion criteria: * pre-frail or frail according to (longitudinal urban cohort ageing study) lucas-functional index * scheduled for elective surgery * planned ward admission for at least 24h after surgery exclusion criteria: * refusal of participation * presentation less than 2 weeks prior to scheduled procedure * pre-existing pronounced immobility (wheelchair bound, paresis of both arms or both legs) * minor surgical interventions such as small excisions of superficial tissues, small interventions for haemorrhoids, curettage, gastroscopy

Keywords: frailty preoperative period surgery breathing exercise postoperative complications resistance training endurance training anaesthesia activities of daily living patient reported outcome prehabilitation perioperative care elderly prevention