{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:39:14Z","timestamp":1787009954379,"version":"build-2736575974"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T00:00:00Z","timestamp":1720051200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n BACKGROUND<\/jats:title>\n Maintaining functional status is an essential therapeutic goal in peri-operative care of older adults. Although several recommendations concerning peri-operative management are available, pragmatic approaches to their sustainable implementation are lacking.<\/jats:p>\n <\/jats:sec>\n \n OBJECTIVE<\/jats:title>\n Multiple evidence-based recommendations for peri-operative care of older adults were bundled into a multicomponent intervention and assessed for feasibility and effectiveness.<\/jats:p>\n <\/jats:sec>\n \n DESIGN<\/jats:title>\n A quality improvement study with before\u2013after comparison using a hybrid implementation-effectiveness approach.<\/jats:p>\n <\/jats:sec>\n \n SETTING<\/jats:title>\n University Medical Centre. The trial was conducted from 2017 to 2020, follow-up was 1 week, 1 month and 6 months after surgery.<\/jats:p>\n <\/jats:sec>\n \n PATIENTS<\/jats:title>\n Patients at least 65\u200ayears old were scheduled for surgery; excluded: intercranial, ophthalmological, and emergency surgery; planned postoperative stay in the intensive care unit. A total of 720 patients were eligible; 278 patients were recruited, 95 (34) of whom were female.<\/jats:p>\n <\/jats:sec>\n \n INTERVENTIONS<\/jats:title>\n The intervention consisted of a set of recommended measures for peri-operative management of older patients, including pre-operative assessment and measures to manage frailty, malnutrition, polypharmacy, cognitive impairment and delirium. Patients were sequentially assigned to three groups: control (no change from usual care), transition (to implementation of the intervention) and intervention (fully implemented).<\/jats:p>\n <\/jats:sec>\n \n MAIN OUTCOME MEASURES<\/jats:title>\n Feasibility was assessed by determining the level of implementation, and barriers were identified by conducting qualitative interviews with the medical staff. Intervention effectiveness was estimated by Instrumental Activities of Daily Living (IADL; Lawton and Brody, primary clinical outcome) 1 and six months postoperatively. The secondary outcomes included postoperative complications, cognitive performance, quality of life and length of hospital stay.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n The implementation rate was 77%. Pre-operative IADL was 9.9\/10 (range 8 to 10; SD 0.4) and 9.7\/10 (6 to 10, 0.8) for the control and intervention groups, respectively. There was no statistically significant difference between the groups in IADL (0.07, 95% CI \u22120.23 to 0.36,\n P<\/jats:italic>\n \u200a=\u200a0.66) and 6 months after surgery (0.01, 95% CI \u22120.29 to 0.31,\n P<\/jats:italic>\n \u200a=\u200a0.95).\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n The implementation of evidence-based interventions to improve peri-operative care of older patients showed good feasibility in clinical routine but did not improve patients\u2019 functional status, which was already at a high level pre-operatively.<\/jats:p>\n <\/jats:sec>\n \n TRIAL REGISTRATION<\/jats:title>\n ClinicalTrials.gov, Identifier: NCT03325413<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/ea9.0000000000000055","type":"journal-article","created":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T05:00:16Z","timestamp":1720414816000},"page":"e0055","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Feasibility and effectiveness of an evidence-based intervention bundle to improve peri-operative care of older adults"],"prefix":"10.1097","volume":"3","author":[{"given":"Cynthia","family":"Olotu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Lebherz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Mende","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cordelia","family":"Hempel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Philipp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Schroeter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Pl\u00fcmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgit","family":"Koch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"H\u00e4rter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Z\u00f6llner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Levente","family":"Kriston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Kiefmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,8]]},"reference":[{"key":"R1-20240826","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.1007\/s40520-020-01624-x","article-title":"Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus","volume":"32","author":"Aceto","year":"2020","journal-title":"Aging Clin Exp Res"},{"key":"R2-20240826","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1093\/ageing\/afy057","article-title":"Prognostic factors of functional outcome after hip fracture surgery: a systematic review","volume":"47","author":"Sheehan","year":"2018","journal-title":"Age Ageing"},{"key":"R3-20240826","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1097\/EJA.0000000000000817","article-title":"Preoperative evaluation of adults undergoing elective noncardiac surgery: updated guideline from the European Society of Anaesthesiology","volume":"35","author":"De Hert","year":"2018","journal-title":"Eur J Anaesthesiol"},{"key":"R4-20240826","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.bja.2020.10.037","article-title":"Improving perioperative brain health: an expert consensus review of key actions for the perioperative care team","volume":"126","author":"Peden","year":"2021","journal-title":"Br J Anaesth"},{"key":"R5-20240826","first-page":"81","article-title":"Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients","volume":"41","author":"Aldecoa","year":"2024","journal-title":"Eur J Anaesthesiol"},{"key":"R6-20240826","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1016\/j.jamcollsurg.2015.12.026","article-title":"Optimal perioperative management of the geriatric patient: a best practices guideline from the American College of Surgeons NSQIP and the American Geriatrics Society","volume":"222","author":"Mohanty","year":"2016","journal-title":"J Am Coll Surg"},{"key":"R7-20240826","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.clnu.2017.02.013","article-title":"ESPEN guideline: clinical nutrition in surgery","volume":"36","author":"Weimann","year":"2017","journal-title":"Clin Nutr"},{"key":"R8-20240826","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.1213\/ANE.0000000000004785","article-title":"Prehabilitation for the frailty syndrome: improving outcomes for our most vulnerable patients","volume":"130","author":"Norris","year":"2020","journal-title":"Anesth Analg"},{"key":"R9-20240826","doi-asserted-by":"crossref","first-page":"112513","DOI":"10.1016\/j.psychres.2019.112513","article-title":"An introduction to effectiveness-implementation hybrid designs","volume":"280","author":"Landes","year":"2019","journal-title":"Psychiatry Res"},{"key":"R10-20240826","doi-asserted-by":"crossref","first-page":"e031837","DOI":"10.1136\/bmjopen-2019-031837","article-title":"Improvement of perioperative care of the elderly patient (PeriAge): protocol of a controlled interventional feasibility study","volume":"9","author":"Olotu","year":"2019","journal-title":"BMJ OPEN"},{"key":"R11-20240826","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1093\/bja\/aes139","article-title":"Patient blood management in Europe","volume":"109","author":"Shander","year":"2012","journal-title":"Br J Anaesth"},{"key":"R12-20240826","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1111\/jgs.15767","article-title":"American Geriatrics Society 2019 Updated AGS Beers Criteria(R) for potentially inappropriate medication use in older adults","volume":"67","year":"2019","journal-title":"J Am Geriatr Soc"},{"key":"R13-20240826","first-page":"3","article-title":"Potentially inadequate medications in the elderly: PRISCUS 2.0\u2014first update of the PRISCUS List","volume":"120","author":"Mann","year":"2023","journal-title":"Dtsch Arztebl Int"},{"key":"R14-20240826","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1097\/MLR.0b013e3182408812","article-title":"Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact","volume":"50","author":"Curran","year":"2012","journal-title":"Med Care"},{"key":"R15-20240826","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1093\/geront\/9.3_Part_1.179","article-title":"Assessment of older people: self-maintaining and instrumental activities of daily living","volume":"9","author":"Lawton","year":"1969","journal-title":"Gerontologist"},{"key":"R16-20240826","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1097\/EJA.0000000000000118","article-title":"Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures","volume":"32","author":"Jammer","year":"2015","journal-title":"Eur J Anaesthesiol"},{"key":"R17-20240826","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1002\/gps.1042","article-title":"DemTect: a new, sensitive cognitive screening test to support the diagnosis of mild cognitive impairment and early dementia","volume":"19","author":"Kalbe","year":"2004","journal-title":"Int J Geriatr Psychiatry"},{"key":"R18-20240826","doi-asserted-by":"crossref","first-page":"271","DOI":"10.2466\/pms.1958.8.3.271","article-title":"Validity of the Trail Making Test as an Indicator of Organic Brain Damage","volume":"8","author":"Reitan","year":"1958","journal-title":"Perceptual and Motor Skills"},{"key":"R19-20240826","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.1097\/00003246-200107000-00012","article-title":"Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)","volume":"29","author":"Ely","year":"2001","journal-title":"Crit Care Med"},{"key":"R20-20240826","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1186\/1471-2318-14-141","article-title":"Long-term prediction of changes in health status, frailty, nursing care and mortality in community-dwelling senior citizens-results from the Longitudinal Urban Cohort Ageing Study (LUCAS)","volume":"14","author":"Dapp","year":"2014","journal-title":"BMC Geriatr"},{"key":"R21-20240826","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/00005650-199603000-00003","article-title":"A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity","volume":"34","author":"Ware","year":"1996","journal-title":"Med Care"},{"key":"R22-20240826","doi-asserted-by":"crossref","first-page":"163","DOI":"10.2466\/pms.1995.80.1.163","article-title":"Sit-to-stand test for measuring performance of lower extremity muscles","volume":"80","author":"Bohannon","year":"1995","journal-title":"Percept Mot Skills"},{"key":"R23-20240826","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1007\/s00038-013-0504-z","article-title":"Population-based reference values for the 1-min sit-to-stand test","volume":"58","author":"Strassmann","year":"2013","journal-title":"Int J Public Health"},{"key":"R24-20240826","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/j.1532-5415.1991.tb01616.x","article-title":"The timed \u201cUp & Go\u201d: a test of basic functional mobility for frail elderly persons","volume":"39","author":"Podsiadlo","year":"1991","journal-title":"J Am Geriatr Soc"},{"key":"R25-20240826","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1093\/ageing\/15.1.53","article-title":"Grip strength, mental performance and nutritional status as indicators of mortality risk among female geriatric patients","volume":"15","author":"Phillips","year":"1986","journal-title":"Age Ageing"},{"key":"R26-20240826","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/0022-3956(82)90033-4","article-title":"Development and validation of a geriatric depression screening scale: a preliminary report","volume":"17","author":"Yesavage","year":"1982","journal-title":"J Psychiatr Res"},{"key":"R27-20240826","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1016\/j.jclinepi.2015.04.014","article-title":"A simple formula for the calculation of sample size in pilot studies","volume":"68","author":"Viechtbauer","year":"2015","journal-title":"J Clin Epidemiol"},{"key":"R28-20240826","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1213\/ANE.0000000000005269","article-title":"Segmented regression in an interrupted time series study design","volume":"132","author":"Schober","year":"2021","journal-title":"Anesth Analg"},{"key":"R29-20240826","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1002\/sim.4067","article-title":"Multiple imputation using chained equations: issues and guidance for practice","volume":"30","author":"White","year":"2011","journal-title":"Stat Med"},{"key":"R30-20240826","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1136\/bmjqs-2015-004411","article-title":"SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process","volume":"25","author":"Ogrinc","year":"2016","journal-title":"BMJ Qual Saf"},{"key":"R31-20240826","first-page":"240","article-title":"Social aspects in diagnosis and therapy of very elderly patients. Initial experiences with a newly developed questionnaire within the scope of geriatric assessment","volume":"27","author":"Nikolaus","year":"1994","journal-title":"Zeitschrift fur Gerontologie"},{"key":"R32-20240826","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s12603-016-0797-8","article-title":"Minimal important change and minimal detectable change in activities of daily living in community-living older people","volume":"21","author":"Suijker","year":"2017","journal-title":"J Nutr Health Aging"},{"key":"R33-20240826","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1213\/ANE.0000000000005223","article-title":"An implementation-effectiveness study of a perioperative delirium prevention initiative for older adults","volume":"131","author":"Donovan","year":"2020","journal-title":"Anesth Analg"},{"key":"R34-20240826","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/1748-5908-2-40","article-title":"A conceptual framework for implementation fidelity","volume":"2","author":"Carroll","year":"2007","journal-title":"Implement Sci"},{"key":"R35-20240826","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1177\/0269215510380830","article-title":"The effects of preoperative exercise therapy on postoperative outcome: a systematic review","volume":"25","author":"Valkenet","year":"2011","journal-title":"Clin Rehabil"},{"key":"R36-20240826","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.1001\/jama.289.15.1969","article-title":"Disseminating innovations in healthcare","volume":"289","author":"Berwick","year":"2003","journal-title":"JAMA"},{"key":"R38-20240826","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1007\/s00391-020-01722-5","article-title":"Prevalence of cognitive disorders in acute care nursing","volume":"54","author":"Mai","year":"2021","journal-title":"Zeitschrift Gerontol Geriatrie"},{"key":"R39-20240826","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1097\/EJA.0000000000001639","article-title":"Peri-interventional outcome study in the elderly in Europe: a 30-day prospective cohort study","volume":"39","year":"2022","journal-title":"Eur J Anaesthesiol"},{"key":"R40-20240826","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1016\/j.jgo.2019.02.004","article-title":"Functional status in a geriatric oncology setting: a review","volume":"10","author":"Couderc","year":"2019","journal-title":"J Geriatr Oncol"},{"key":"R41-20240826","first-page":"6","article-title":"The functional independence measure: a new tool for rehabilitation","volume":"1","author":"Keith","year":"1987","journal-title":"Adv Clin Rehabil"},{"key":"R42-20240826","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1017\/S1041610219001091","article-title":"Assessing functional status using the IADL-extended scale: results from the HELIAD study","volume":"32","author":"Kalligerou","year":"2020","journal-title":"Int Psychogeriatr"},{"key":"R43-20240826","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/codi.13785","article-title":"Preoperative geriatric assessment and tailored interventions in frail older patients with colorectal cancer: a randomized controlled trial","volume":"20","author":"Ommundsen","year":"2018","journal-title":"Colorectal Dis"},{"key":"R44-20240826","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1111\/j.1532-5415.2011.03488.x","article-title":"Effect of an inpatient geriatric consultation team on functional outcome, mortality, institutionalization, and readmission rate in older adults with hip fracture: a controlled trial","volume":"59","author":"Deschodt","year":"2011","journal-title":"J Am Geriatr Soc"},{"key":"R45-20240826","doi-asserted-by":"crossref","first-page":"1970","DOI":"10.1111\/jgs.16022","article-title":"Investigating and remediating selection bias in geriatrics research: the selection bias toolkit","volume":"67","author":"Banack","year":"2019","journal-title":"J Am Geriatr Soc"}],"container-title":["European Journal of Anaesthesiology Intensive Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/EA9.0000000000000055","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T00:02:37Z","timestamp":1724630557000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/EA9.0000000000000055"}},"subtitle":["A quality improvement study"],"short-title":[],"issued":{"date-parts":[[2024,7,4]]},"references-count":44,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.1097\/ea9.0000000000000055","relation":{},"ISSN":["2767-7206"],"issn-type":[{"value":"2767-7206","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,4]]}}}