Presentation Details
| Preoperative Nutrition and Exercise Counseling for Older Adults Experiencing Frailty Lauren J.Lee1, Bryanna De Lima2, Elizabeth Hays2, 3. 1Oregon Health & Science University, School of Medicine, Portland, OR, USA.2Oregon Health & Science University, Division of General Internal Medicine and Geriatrics, Portland, OR, USA.3Oregon Health & Science University, Department of Anesthesia and Perioperative Medicine, Portland, OR, USA |
Abstract
BACKGROUND: Frailty among older adults greatly increases postoperative risk, making surgical prehabilitation for frailty a priority. Malnutrition and weakness are dimensions of the frailty syndrome that may be addressed in the short time frame between the first preoperative visit and surgery. While the OHSU Preoperative Medicine Clinic (PMC) has established protocols for assessing frailty in geriatric patients, we have not previously acted on a diagnosis of frailty through direct patient counseling. Our goal is to impact postoperative outcomes for frail patients by improving their preoperative nutrition and strength using an evidence-based education strategy.
METHODS: We created an Epic SmartPhrase for prehabilitation targeting frail older adults which provided recommendations regarding high-protein dietary sources, exercise modalities, and nutritional supplementation to support preoperative muscle and strength optimization. PMC clinicians received written and in-person training on the tool. We tracked utilization for six weeks and gathered survey data on perceived knowledge/confidence following the presentation.
RESULTS: The SmartPhrase was used 40 times by ten different PMC clinicians in the twelve weeks after it was introduced. Seven (44%) of the PMC clinicians completed a follow-up survey. Clinicians reported their knowledge about preoperative protein, resistance exercise, and muscle building increased after the training from 2.4 to 3.8 on a 5-point scale. They reported their confidence in counseling patients about nutrition prehabilitation increased from 2.4 to 3.4 on a 4-point scale.
CONCLUSIONS: Initial implementation with brief training improved providers’ knowledge and confidence in counseling geriatric preoperative patients on nutrition and exercise. Further research is needed to assess patient perspectives and to generate more robust data to enhance preoperative care for older adults.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
METHODS: We created an Epic SmartPhrase for prehabilitation targeting frail older adults which provided recommendations regarding high-protein dietary sources, exercise modalities, and nutritional supplementation to support preoperative muscle and strength optimization. PMC clinicians received written and in-person training on the tool. We tracked utilization for six weeks and gathered survey data on perceived knowledge/confidence following the presentation.
RESULTS: The SmartPhrase was used 40 times by ten different PMC clinicians in the twelve weeks after it was introduced. Seven (44%) of the PMC clinicians completed a follow-up survey. Clinicians reported their knowledge about preoperative protein, resistance exercise, and muscle building increased after the training from 2.4 to 3.8 on a 5-point scale. They reported their confidence in counseling patients about nutrition prehabilitation increased from 2.4 to 3.4 on a 4-point scale.
CONCLUSIONS: Initial implementation with brief training improved providers’ knowledge and confidence in counseling geriatric preoperative patients on nutrition and exercise. Further research is needed to assess patient perspectives and to generate more robust data to enhance preoperative care for older adults.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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