None listed
Conditions
Brief summary
Four in five (80%) older Australians report having one or more long-term health condition. Older frail patients who undergo cardiac surgery have poorer postoperative outcomes. There is some evidence that multidisciplinary prehabilitation may reduce the number of postoperative complications in older patients undergoing abdominal cancer surgery. There is a need for the current pilot study to demonstrate the feasibility of the multidisciplinary prehabilitation program in frail older persons and to investigate any potential risk, adverse events, compliance to exercise program and satisfaction in this patient population who has higher likelihood of unwanted postoperative outcome after cardiac surgery.
Interventions
Geriatricians will review: comorbid conditions and optimisation of management in advance of surgery; review of medications and plan for management in the perioperative period; goals and limits of care and advance care plans; assessment of cognition and plan to minimise risk of delirium in the perioperative period; anticipating change in function and associated care needs at home in advance of the surgical procedure; discharge planning in advance of the procedure; and Comprehensive Geriatric Asse
Geriatricians will review: comorbid conditions and optimisation of management in advance of surgery; review of medications and plan for management in the perioperative period; goals and limits of care and advance care plans; assessment of cognition and plan to minimise risk of delirium in the perioperative period; anticipating change in function and associated care needs at home in advance of the surgical procedure; discharge planning in advance of the procedure; and Comprehensive Geriatric Assessment. Duration of the review: 45min to 1 hour Frequency: one consultation and follow-up as determined by the geriatrician Geriatric consultation will take place prior to patients' surgery Physiotherapist will provide home exercises. The first exercise session will be conducted by the study physiotherapist at Liverpool hospital. The first exercise session will be approximately 40-60minutes in duration depending on participants. The study physiotherapist will conduct telehealth twice per week for 3 weeks (for a total of 2 telehealth sessions per week) to monitor participant’s progress in exercise program and adjust the intensity of the training according to participant’s reported perceived exertion (RPE) and symptoms if need. All participants will be provided with exercise diary which includes images of exercises to be conducted, log of completion of exercises (day and specific exercises) and breathing exercises An example of exercise prescription: 5-10 minutes of warm up and cool down Aerobic training (mainly walking, steps and cycle) Frequency: 3 times per week, 30 minutes per session Resistance training: light to moderate 10-15 repetitions involving 6-8 groups of skeletal muscles, at least twice a week, using resistance bands
Sponsors
UNSW
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Age: 65 years and older Clinical Frailty Score (CFS) 3-7 as assessed by Cardiothoracic surgery clinical nurse specialist (CNC), cardiologist, cardiothoracic surgeon or study personnel, at the time of agreeing to surgery at the surgeons’ rooms (including private rooms) or heart team meeting or at preadmission clinic. Elective cardiac interventions include: elective coronary artery bypass graft surgery (CABG); aortic valve repair/replacement; mitral valve repair/replacement or combined coronary artery bypass/valve procedure, Bentall’s and transcatheter aortic valve implantation (TAVI). Participants with an estimated 2 or more weeks of surgical waiting list time. Ability to provide informed consent for participation and able to communicate in English. A family member is encouraged to be present for any participant who is performing aerobic training at home.
Exclusion criteria
Participants with unstable or recently unstable cardiac syndrome/haemodynamic instability (New York Heart Association Class IV, critical left main coronary artery disease, acute coronary syndrome (ACS) before phone interview). Participants with severe aortic or mitral stenosis whom cardiac surgeons and/or cardiologist advise not to participate in this study/exercise programs. Such participants may be referred to see a geriatrician and/or a dietitian as indicated separately to the study. Participants awaiting urgent or emergency cardiac interventions with estimated wait time of less than 2 weeks. Participants without medical clearance and or deemed not “fit” to exercise from the surgeons or cardiologist review.
Outcome results
None listed