Seniors Take Steps Toward Better Surgical Outcomes

Older patients preparing for surgery are getting pedometers and encouragement to exercise as part of an effort by Duke geriatricians and aging researchers to improve surgical outcomes for seniors.

The prehabilitation program is part of the Perioperative Optimization of Senior Health (POSH) program, a Duke initiative launched in 2011. The presurgical exercise project, known as POSH-fit, focuses on patients older than age 65 who are scheduled for surgery but not currently exercising. The participants are considered to have an increased risk of slower postsurgical recovery because of their age, health status, medications, and physical function.

Participants are limited to those scheduled for general surgical procedures and spine surgery. Patients undergoing cardiac surgery are not included.

Patients who receive pedometers are encouraged to increase their step counts and overall physical activity in the weeks preceding their surgery.

The trackers provide hard metrics on step counts, offering clinicians an opportunity to observe daily progress, says Miriam C. Morey, PhD, a professor of medicine in the Division of Geriatrics and co-director of Duke’s Claude D. Pepper Older Americans Independence Center. Morey is also a senior fellow at the Center for the Study of Aging and Human Development. “We believe we are empowering patients to take positive ‘steps’ toward improving their chances of a positive recovery from surgery,” she adds.

When researchers compare different approaches, they have found that simply giving patients the pedometers and offering one-time encouragement bundled with other strategies to improve surgical preparation may not be as effective as offering counseling and encouragement throughout the surgical experience.

“The data are beginning to come together to allow us to correlate step counts with hospital lengths-of-stay and points of discharge, whether in a rehabilitation center or at home,” Morey says. “We are interested in learning whether low baseline step count is a predictor of poor outcomes and whether change in step counts before surgery might be an indicator of recovery potential. In terms of the data, we will learn much more as the program grows.”

This initiative syncs with a goal established by the Duke Center for Geriatric Surgery and the Duke Center for the Study of Aging and Human Development to improve resilience among seniors.

“We define resilience as the ability to recover from a stressor event,” says Morey. “We use the surgery as the stressor in POSH-fit and then look at step counts before, during, and after the surgical procedure to make the assessment.”