Miriam C Morey1,2,3, Kenneth M Manning1, Ying Guo3,4, Shelley R McDonald1,2,3, Mitchell T Heflin1,2,3, Kathryn N Porter Starr1,2,3, Richard Sloane1,3, Nancy L Loyack5, Sandhya Lagoo-Deenadayalan3,6,5. 1. Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, North Carolina. 2. Department of Medicine, Duke University Medical Center, Durham, North Carolina. 3. Duke Center for the Study of Aging and Human Development/OAIC, Duke University Medical Center, Durham, North Carolina. 4. Duke- National University of Singapore Medical School, Singapore. 5. Surgery, Durham VA Healthcare System, Durham, North Carolina. 6. Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Abstract
OBJECTIVES: Impending surgery presents a high risk for older adults given their vulnerability to adverse outcomes. New approaches to peri-operative care bring together surgeons, geriatricians, and other Multidisciplinary specialties to co-manage the geriatric surgical patient. However, few have incorporated interventions to promote physical activity (PA) throughout this period. We describe findings from two quality improvement (QI) initiatives that adopted the use of PA trackers to monitor and promote PA during the peri-operative period. METHODS: QI project within Perioperative Optimization of Senior Health (POSH) clinic at two medical centers (Duke and Durham Veterans Healthcare System (VA)) in Durham, North Carolina. Participants included 38 adults, ages 65+. Participants from POSH-at-Duke received PA trackers with one-time bundled advice from the provider team on nutrition, activity, pain management, medications and other relevant education prior to surgery. Participants from POSH-at-VA received the same one time bundled advice in addition to a visit with an exercise health coach who provided PA guidance followed by weekly PA telephone counseling throughout entire peri-operative period to 4-weeks post-surgery. Primary outcome was daily step counts. RESULTS: Ninety three percent of participants approached agreed to use PA trackers. POSH-at-Duke had mean daily step counts of 3,951 at baseline, 4,437 two days prior to surgery, and 1,838 at 4-week post-operative visit as opposed to POSH-at-VA with 2,063 steps at baseline, 5,452 two days prior to surgery, and 4,236 at 4-week post-operative visit, p=0.049 for trajectory differences. CONCLUSION: PA trackers coupled with appropriate continuous PA counseling has a potential utility in promoting resilience in the geriatric surgical candidate.
OBJECTIVES: Impending surgery presents a high risk for older adults given their vulnerability to adverse outcomes. New approaches to peri-operative care bring together surgeons, geriatricians, and other Multidisciplinary specialties to co-manage the geriatric surgical patient. However, few have incorporated interventions to promote physical activity (PA) throughout this period. We describe findings from two quality improvement (QI) initiatives that adopted the use of PA trackers to monitor and promote PA during the peri-operative period. METHODS: QI project within Perioperative Optimization of Senior Health (POSH) clinic at two medical centers (Duke and Durham Veterans Healthcare System (VA)) in Durham, North Carolina. Participants included 38 adults, ages 65+. Participants from POSH-at-Duke received PA trackers with one-time bundled advice from the provider team on nutrition, activity, pain management, medications and other relevant education prior to surgery. Participants from POSH-at-VA received the same one time bundled advice in addition to a visit with an exercise health coach who provided PA guidance followed by weekly PA telephone counseling throughout entire peri-operative period to 4-weeks post-surgery. Primary outcome was daily step counts. RESULTS: Ninety three percent of participants approached agreed to use PA trackers. POSH-at-Duke had mean daily step counts of 3,951 at baseline, 4,437 two days prior to surgery, and 1,838 at 4-week post-operative visit as opposed to POSH-at-VA with 2,063 steps at baseline, 5,452 two days prior to surgery, and 4,236 at 4-week post-operative visit, p=0.049 for trajectory differences. CONCLUSION: PA trackers coupled with appropriate continuous PA counseling has a potential utility in promoting resilience in the geriatric surgical candidate.
Authors: Roberto Benzo; Dennis Wigle; Paul Novotny; Marnie Wetzstein; Francis Nichols; Robert K Shen; Steve Cassivi; Claude Deschamps Journal: Lung Cancer Date: 2011-06-12 Impact factor: 5.705
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