Abstract
Background: Frail older adults undergoing elective orthopaedic surgery are at heightened risk of postoperative complications and delayed recovery. To address these risks, we co-designed a prehabilitation and perioperative care intervention tailored specifically to the needs of frail older patients, with input from both patients and healthcare professionals. This study aimed to explore the feasibility and acceptability of the intervention, focusing on the perspectives of both groups.
Approach: The intervention was co-designed through a series of workshops involving patients, healthcare professionals, and researchers, ensuring it addressed the specific needs of frail older patients. Delivered by an interdisciplinary team comprising geriatric nurses, orthopedic physiotherapists, and geriatricians, the intervention includes nutritional assessments, exercise guidance, and medication reviews. Prehabilitation begins eight weeks before surgery and continues through hospitalization.
The initial face-to-face session, involving the patient and the interdisciplinary team, identifies individual needs and preferences for follow-up. Subsequent sessions are conducted via telephone consultations. During hospitalization, perioperative care is provided in person by the geriatrician, the primary orthopedic nurse, and the physiotherapist.
A qualitative study using semi-structured interviews with both patients and healthcare professionals explored their experiences with the intervention. Descriptive analysis identified key themes relating to the intervention’s feasibility, acceptability, and adaptions.
Results: Healthcare professionals emphasized the importance of tailoring the intervention to the specific needs of frail older patients. Preoperative assessments helped identify previously overlooked issues, such as mobility difficulties and nutritional deficiencies. Involving relatives was crucial for patient adherence, and interdisciplinary collaboration among geriatric nurses, physiotherapists, and geriatricians facilitated a comprehensive and holistic care approach.
From the patients' perspective, the intervention provided both practical support and reassurance. They found the nutritional and exercise guidance beneficial, with many continuing these practices post-surgery. Patients reported feeling more prepared for both surgery and recovery, benefiting from the physical and emotional support offered throughout the intervention.
Overall, the interdisciplinary approach and the involvement of relatives were instrumental in the feasibility and acceptability of the intervention, contributing to better recovery outcomes.
Implications: This study underscores the importance of interdisciplinary collaboration and patient involvement in the design and delivery of prehabilitation interventions for frail older adults. By integrating tailored support from geriatric nurses, physiotherapists, and geriatricians, and actively involving relatives, the intervention enhanced both physical and emotional readiness for surgery. This approach not only strengthens patient adherence but also ensures more comprehensive care by addressing physical, social, and emotional needs.
Future efforts should focus on scaling such interventions to reach a broader population, ensuring that all older patients, regardless of their support system, can benefit from a coordinated, holistic approach to care.