Prehabilitation of Elderly Patients With Frailty Syndrome Before Elective Surgery (PRAEP-GO)

Assessment results in a degree of care dependency from personal help according to the German dependency assessment (= "Neues Begutachtungs-Assessment" (NBA)) (Wingenfeld et al., 2008). The results of the assessments ranges between 0 and 100 points, which are transformed into a 0-5 ordinal scale. Higher points in the assessments indicate higher demand of care dependency. Accordingly, higher numbers on the ordinal scale indicate a higher level of care dependency as defined in the German statutory care insurance program.

Level of care dependency after surgery reported as Barthel Index

Assessment results according to the German dependency assessment (= "Neues Begutachtungs-Assessment" (NBA)) (Wingenfeld et al., 2008) using the results of the assessments on the scale from 0 to 100 points

Change in individual domains of the German dependency assessment (= "Neues Begutachtungs-Assessment" (NBA)).

Frequency of neurocognitive vulnerability at 3 or 12 months as surrogate for NCD is measured as composite score:

• Frequency of cognitive impairment/vulnerability is calculated from a change in composite of MiniCog, ANT, TMT-B and MOCA
• subjective concern (MMQ) and
• IADL/ADL

Cognitive vulnerability is suspected by limited MiniCog-test result. The MiniCog consists of two items, the word recall test and the clock-drawing test. Performance in these test is rated on a scale ranging from 0 - 5, with <3 points indicating a cognitive vulnerability.

Dementia risk is assessed by Montreal Cognitive Assessment (MOCA-30) deterioration (change) and its absolute value if < 26.

Delirium as perioperative complication assessed until hospital discharge using billing data.

Frailty is operationalized using modified Fried frailty criteria. Frailty scores from 0 to 5 (i.e., 1 point for each component; 0 = best to 5 = worst) represent robust (0), pre-frail (1-2), and frail (3-5) health status.

Perioperative complications assessed using Clavien Dindo till hospital discharge

Level of everyday mobility using Life-Space Assessment (LSA)

Extent of patients' autonomy preference concerning medical decisions; Autonomy-Preference-Index, modified German version (API-Dm). The scale consists of a 11-item questionnaire with 4 questions on preferred autonomy in health-related decisions and 7 items on information preference. The total results of the API and both subscales are transformed into a 0 - 100 scale with higher values indicating higher levels on autonomy and information preference, respectively.

Extent of patients, relatives and health professionals' involvement in shared decision-making process; 9-Item Shared Decision Making Questionnaire (SDM-Q-9/SDM-Q-Doc)

Arm circumference is measured in a standardized position and documented in centimeter.

Calf circumference is measured in a standardized position and documented in centimeter.

Changes of nutritional status after elective surgery.

Changes in body weight measured in kg.

Instrumental Activities of daily living (IADL) using the questionnaire by Lawton and Brody.

Functional endurance is measured using the 2-Minute-Step-Test (2-MST). The patient steps in place, raising each leg to a marker. The markers height is derived from biometrical measures of the patient. The assessor counts each step of the right leg in which the knee of the patient passes the marker. Higher counts of steps indicates better functional endurance.

The function of the respiratory system is assessed by expiratory peak flow measurement as surrogate parameter.

Depression is measured by frequency of depressive symptoms; Patient Health Questionnaire-8 (PHQ-8)]

Anxiety is measured frequency of anxiety symptoms; Generalized Anxiety Disorder Scale-7 (GAD-7)

Health related quality of life is measured with EQ-5D-5L questionnaire.

Patient- or proxy-reported functioning and disability is measured by the WHO Disability Assessment Schedule (WHODAS 2.0, 12-item version.

Incidence of falls

Activities-Specific Balance Confidence (ABC)-6-Scale. The scale consists of 6 questions who are rated on a 0-100 NRS-scale. The total result of the ABC-6-scale comprises of the average of all 6 items.

The satisfaction of the patient is measured with the questionnaire on patient satisfaction (ZUF-8). The ZUF-8 is a questionnaire on patient satisfaction after treatment. It consists of 8 questions which results in a score between 0 and 24 points, with higher values.indicating higher levels of satisfaction.

Data from patient records and residents' registration

Muscle strength measured by handgrip strength

Functional mobility is measured with gait speed over 15ft

Stair climbing speed test

Timed Up & Go Test (TUG) to test mobility and body balance

Postoperative complication of mobilization speed measured with CHARMI

Intensive care unit length of stay describes every day spent in an ICU bed.

Admission rate (planned / unplanned) on ICU

Time in hospital

Adverse discharge disposition other than to home and planned rehabilitation facility.

Assessment if a follow-up treatment or rehabilitation is necessary after the hospital stay.

New medical diagnoses at hospital discharge compared to baseline are assessed.

New medication at hospital discharge compared to baseline is assessed.

Patient record data, discharge letter

ScreeningThe health economic benefit of the intervention (prehabilitation) will be compared to standard of care in the German health care system using a health cost analysis framework.

Assessment of the appropriateness of the quantity and quality of the exercise interventions compared to exercise prescription guidelines.

Patient support by need/prescription of assistive devices ("Hilfsmittel") and therapeutic treatment ("Heilmittel").

Measured by number of drug agents

Measured by Alcohol Use Disorders Identification Test (AUDIT-C)

Measured by Fagerstrom (Fagerstrom & Schneider, 1989)

Sarcopenia is evaluated as a composite measure by three criteria that are assessed: 1) low muscle strength (hand grip strength), 2) low muscle quantity (calf circumference) and 3) low physical performance (gait speed or TUG).

The social situation 1 of the patient is measured by a Questionnaire for Social Situation (SOS, Subscales 1 and 2).

The social situation 2 of the patient is measured by BSSS, 8-items

Pain is measured with a pain score Numeric rating scale (0-10), a higher score indicates more pain.

Frequency of sensations of loneliness; 3-item UCLA Loneliness Scale