Pre-habilitation: Planning for Best Outcomes After Surgery

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1 Optimizing Aging Collaborative Pre-habilitation: Planning for Best Outcomes After Surgery Kaitlin Willham, MD San Francisco VA Medical Center Division of Geriatrics, UCSF The Optimizing Aging Collaborative at UCSF is supported by the UCSF Geriatrics Workforce Enhancement Program: Health Resources and Services Administration (HRSA) Grant Number U1QHP28727.

2 What are your goals for surgery? Take care of a problem before it becomes a bigger problem Improve symptoms Speed recovery

3 Recovery of Func6on A8er Surgery Surgery Baseline Func;on Time

4 Before Surgery Surgery Baseline Func;on Time

5 Pre- habilita6on Concept: enhancing func;onal capacity before surgery to improve a person s ability to withstand an upcoming stressor An emerging area of research Pre- habilita;on includes a comprehensive assessment and crea;on of a tailored plan for older adults before surgery

6 Tradi6onal Timeline Surgery Surgical Evalua;on Anesthesiologist/PCP 30 days Short- term

7 Basic Considera6ons Before Surgery Diseases Medica;ons Risk of heart and lung disease Blood pressure control Blood sugar control Smoking

8 Importance of a Comprehensive Assessment in Older Adults Iden;fy strengths and poten;al weaknesses Predict impact of surgery Create a care plan

9 Pre- habilita6on Timeline Surgery Surgical Evalua;on Comprehensive Assessment 4-8 weeks Short Medium Long Term

10 Func;on Diseases Nutri;on Medi- ca;ons Mind

11 What is a func6on? A person s ability to maintain independence Physical abili;es Cogni;ve abili;es

12 Basic Ac6vi6es of Daily Living (ADL) Func;on Ea;ng Using the bathroom GeQng dressed GeQng out of bed or a chair Taking a bath or shower

13 Instrumental Ac6vi6es of Daily Living (IADLS) Func;on Transporta;on Managing finances Cooking Shopping Managing medica;ons Laundry Housekeeping Using the telephone

14 Mobility Func;on Falls Any falls in the past year? Walking speed Do you use any equipment for mobility?

15 A Tailored Care Plan May Include Physical and/or occupa;onal therapy assessment Exercises Adap;ve strategies Plans for leaving the hospital axer surgery

16 Exercise Walk every day before surgery Stay as ac;ve as you are able now

17 Func;on Diseases Nutri;on Medi- ca;ons Mind

18 Surgery and Nutri6on Nutri;on Good nutri;on is important to reduce risk of complica;ons and aid healing Mul;ple ways to assess for nourishment Have you had significant weight loss in the past 6 months?

19 Nourishment Nutri;on If you are at risk of undernourishment, ask to see a nutri;onist before surgery In general, ea;ng at least 3 meals a day made up of protein rich foods, whole grains, fruits, vegetables and dairy can help recovery

20 Func;on Diseases Nutri;on Medi- ca;ons Mind

21 Delirium Mind Delirium means sudden confusion Affects 5-60% of adults axer surgery Delirium is associated with worse outcomes 30-40% of delirium is PREVENTABLE!

22 Evalua6ng for the Risk of Delirium Mind Cogni;ve impairment Alcohol intake Vision or hearing problems History of delirium Medica;ons

23 Plan to Reduce Risk of Delirium Bring assis;ve devices to the hospital (hearing aids, glasses, dentures) Ask if you would benefit from a specific plan in the hospital to reduce delirium Does the hospital have an Acute Care for Elders (ACE) unit or a geriatrics consultant?

24 Mental Health Mind Depression Anxiety and coping Deep breathing

25 Be Informed and Prepare Know what to expect How will this surgery benefit me? What will recovery look like for me? What will my func;on and independence be in 6 months, 12 months? Make arrangements for help and support axer surgery

26 Inform Your Team Discuss your health goals and priori;es Update or complete your Advance Direc;ve

27 Professional Resources Primary medical and surgical team Physical therapist Occupa;onal therapist Nutri;onist Geriatrician Social worker

28 Comprehensive Pre- opera6ve Clinics Surgery Wellness Clinic at UCSF Veterans Integra;ve Periopera;ve (VIP) Clinic at the San Francisco VA

29 Planning for the best outcomes, star6ng now Work with your doctor to manage health condi;ons Stop smoking and keep alcohol intake at healthy levels Be as physically and mentally ac;ve as your abili;es and condi;ons allow!

30 Optimizing Aging Collaborative at UCSF For more information, visit us online at OptimizingAging.org or us at The Optimizing Aging Collaborative at UCSF is supported by the UCSF Geriatrics Workforce Enhancement Program: Health Resources and Services Administration (HRSA) Grant Number U1QHP28727.

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