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Table 1 Complete overview of the study period

From: A multicomponent prehabilitation pathway to reduce the incidence of delirium in elderly patients in need of major abdominal surgery: study protocol for a before-and-after study

Time point

Study period

Eligibility assessment

Trial enrollment

70PLUS outpatient clinic

Admission

Discharge

Discharge + 2 weeks

6-months follow-up

12-months follow-up

Pathology result/ CTA

Multidisciplinary meeting

T0 – Informed consent obtained

T1

T2

T3

T3.5

T4

T5

Assessments

 Laboratory testing

 

X

X

X

   

 Nurse practitioner or investigator

  Baseline patient characteristics

 

X

     

  Factors of frailty

X

     

  MMSE

X

 

X

 

X

X

  CCI and ASA

X

     

  P-POSSUM

X

     

  ISAR-HP

X

   

X

X

  PARKER

X

   

X

X

  SNAQ

X

     

  KATZ-ADL

X

   

X

X

  Caregiver burden

X

  

X

X

X

  CESD-16

X

  

X

X

X

  WHOQOL-BREF

X

  

X

X

X

 Physiotherapist

  10MWT

 

X

     

  TCST

X

     

  TUG

X

   

X

X

  MIP

X

     

  Handforce

X

     

 Dietician

  MNA-SF

Indications for referral to dietician: Unintentional weight loss Loss of appetite BMI < 22 Undernourishment

X

     

  BMI

X

   

X

X

  SNAQ

X

     

 Geriatrician

  Comprehensive geriatric assessment

Indications for referral to geriatrician: Delirium in history MMSE ≤24 TUG ≥12.6 s Polypharmacy

X

     

Interventions

 Laboratory testing / Intravenous iron suppletion

  All patients

Single dose of 1000 mg Ferric carboxymaltose (Ferinject®) at day care when indicated: Hb level males < 8,1 mmol/L Hb level females < 7,4 mmol/L

X

     

 Physiotherapist

  All patients

30 min of daily walking or cycling 5 exercises to improve leg muscle strength 2 × 15 minutes respiratory muscle exercise Transfer training when indicated (getting out of bed)

X

     

 Dietician

  Malnourished patients / MNA-SF < 12

Dietary advice on required protein and calorie intake. Proteins: 1.2 g/kg bodyweight (BMI < 30)

Calories: WHO formula for basal need + 30%. Supplements are provided when required protein and calorie intake is not met after dietary advice.

X

     

 Geriatrician

  Frail patients

Non-pharmacological interventions to reduce risk of delirium. Pharmacological interventions (prophylaxis).

X

     

Time from pathology result to multidisciplinary meeting: < 1 week. Time from multidisciplinary meeting to T0: < 1 week. Time from T0 to T1: < 1 week. Time from T1 to admission: 10 days to 5 weeks

  1. MMSE Mini-Mental State Examination, CCI Charlson Comorbidity Index, ASA American Society of Anaesthesiology, P-POSSUM Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity, ISAR-HP Identification of Seniors At Risk – Hospitalized Patients, CES-D16 Centre for Epidemiological Studies – Depression 16 questions, WHOQOL-BREF World Health Organisation Quality of Life – BREF, 10MWT 10-m Walk Test, TCST Timed Chair Stand Test, TUG Timed-up and Go Test, MIP Maximum Inspiratory Pressure, MNA-SF Mini Nutritional Assessment – Short Form, BMI Body Mass Index, SNAQ Short Nutritional Assessment Questionnaire
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BMC Geriatrics

ISSN: 1471-2318

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