Project 457573

Older adults are predisposed to suffering life-altering complications after surgery and strategies to mitigate these risks have shown inconsistent results. Part of the problem lies in that surgeons lack accessible tools to identify which patients are at risk of a poor outcome. Recent evidence suggests that older patients who have reduced function and health - a state known as frailty - are particularly vulnerable to stressors such as surgery. However, there is considerable heterogeneity in the contributing factors that make someone frail, for example weight loss versus muscle loss could be the primary reasons. Understanding the mechanisms by which frailty leads to poor outcomes is critical to tailor therapy in this vulnerable population. For example, multidisciplinary interventions such as nutritional supplementation and exercise training can be prescribed to patients before surgery depending on the factors that contributed to their frailty. The three objectives of my project are to (1) find feasible tools that can be used to detect frailty in older patients before surgery, (2) understand the mechanisms by which frailty leads to worse outcomes after surgery, and (3) identify therapies that can be appropriately tailored to older patients with frailty around the time of surgery. For Objective 1, I will focus on two simple physical tests that require minimal resources: (1) hand grip strength, and (2) the time required to stand from sitting, walk three meters, and return to sitting. To accomplish my objectives, I will capitalize on data from an ongoing Canadian study of older patients having major surgery. The results of my study will inform how surgeons across the country can readily identify and prescribe therapies for older surgical patients who are most at risk of suffering devastating outcomes after surgery. This information will guide resource allocation on targeted therapies for those who are most likely to benefit around the time of surgery.