Improvement of Perioperative Care of Elderly Patients
- Conditions
- Perioperative Care
- Interventions
- Behavioral: Systematic inclusion of family membersBehavioral: Preoperative informationBehavioral: Physical and breathing exercisesDietary Supplement: Dietary supplementsOther: Evaluation of long-term medicationProcedure: Regional anesthesiaOther: Personal aidsDevice: Temperature managementDevice: NeurmonitoringProcedure: Pain catheter
- Registration Number
- NCT03325413
- Lead Sponsor
- Universitätsklinikum Hamburg-Eppendorf
- Brief Summary
The focus of this study is the development of a perioperative treatment concept for elderly patients, based on individual necessities and risk factors, aiming to improve patient outcome. The planned interventions include preoperative screening for malnutrition, frailty and uncalled-for long-term medication, if required followed by early prophylaxis and treatment of these risk factors, prior to or during surgery.
- Detailed Description
In Germany every second inpatient surgical intervention is performed on patients aged 60 years and above. These patients often offer an extensive set of risk factors such as frailty, malnutrition, poor physical fitness and multi-morbidity that may in turn lead to longer hospitalizations and decline of health and functional status after surgery. An age-related increase in postoperative complications, such as postoperative cognitive dysfunction (POCD) and delirium is associated with a higher rate of postoperative morbidity, mortality and longer hospitalization.
Early detection of risk factors and implementation of prophylactic measures is important to reduce postoperative complications and improve clinical outcomes in elderly patients. The aim of our study is to develop and verify a protocol - which allows for a systematic evaluation of risk factors and the implementation of prophylactic or therapeutic measures in order to optimize the postoperative outcome. The feasibility of our protocol will be verified in clinical practice by systematic process evaluations.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 310
- Age >64 years
- Written informed patients consent
- forthcoming elective surgery
- Time interval from inclusion to appointed surgery at least 5 days
- Refusal of consent
- Illiteracy
- Poor knowledge ofGerman language
- Mental disability
- Vision handicap (not corrected)
- Hearing handicap (not corrected)
- Benzodiazepine abuse
- Drug/ substance abuse
- Psychosis
- Parkinson disease
- Emergency surgery
- Planned postoperative ICU treatment
- Planned inpatient stay 1 night
- Cerebral surgery
- Ophthalmological surgery
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SEQUENTIAL
- Arm && Interventions
Group Intervention Description Full-scale intervention Neurmonitoring - Implementation Regional anesthesia Implementation of intervention measures Implementation Preoperative information Implementation of intervention measures Implementation Neurmonitoring Implementation of intervention measures Full-scale intervention Dietary supplements - Full-scale intervention Evaluation of long-term medication - Implementation Personal aids Implementation of intervention measures Full-scale intervention Physical and breathing exercises - Full-scale intervention Pain catheter - Implementation Systematic inclusion of family members Implementation of intervention measures Implementation Temperature management Implementation of intervention measures Implementation Physical and breathing exercises Implementation of intervention measures Implementation Dietary supplements Implementation of intervention measures Implementation Evaluation of long-term medication Implementation of intervention measures Full-scale intervention Systematic inclusion of family members - Full-scale intervention Preoperative information - Implementation Pain catheter Implementation of intervention measures Full-scale intervention Temperature management - Full-scale intervention Regional anesthesia - Full-scale intervention Personal aids -
- Primary Outcome Measures
Name Time Method Functional abilities Evaluation preoperatively, 1 month, 6 months after surgery Change in functional abilities from baseline, evaluated by Instrumental Activities of Daily Living (IADL) score
- Secondary Outcome Measures
Name Time Method Hospital length of stay 1 month Day of admission until day of discharge
Postoperative complications Evaluation evaluation of complications at 2-5 days, 1 month, 6 months after surgery Incidence of postoperative complications
Cognitive impairment Evaluation preoperatively, at 2-5 days, 1 month, 6 months after surgery DemTect: cognitive screening instrument, sensitive to the early symptoms of dementia
Attention and task switching Evaluation preoperatively, at 2-5 days, 1 month, 6 months after surgery The Trail Making Test A\&B (TMT A\&B): a neuropsychological test of visual attention and task alternation
Health related quality of life Evaluation preoperatively, 1 month, 6 months after surgery Measured by a 12-item short-form (SF-12) Health Survey
Attentional capabilities Evaluation preoperatively, at 2-5 days, 1 month, 6 months after surgery TAP Alertness: a computerized, standardized neuropsychological test for attentional performance.
Trial Locations
- Locations (1)
Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf (UKE)
🇩🇪Hamburg, Germany