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Strength Before Surgery Frailty Screening and Prehabilitation for Rural Older Adults in Middlebury, Vermont
Briche, Martin
Briche, Martin
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Abstract
Frailty is a state of decreased physiological reserve that increases vulnerability to physiological stressors and is associated with higher rates of postoperative complications, prolonged hospitalization, readmission, institutionalization, and mortality among older adults. Rural populations may face additional risk due to social isolation, transportation barriers, and limited access to post-acute care. Despite these challenges, structured frailty screening is not routinely incorporated into primary care or preoperative evaluation. This project evaluated the need for structured frailty screening among rural older adults and developed a feasible preoperative screening and intervention framework for implementation in Middlebury, Vermont. A review of the literature and community stakeholder interviews were conducted to identify locally relevant drivers of postoperative vulnerability. Interviews with a home health physical therapist and an adult day program nurse highlighted functional and social determinants of frailty often underrepresented in traditional screening tools, including mobility limitations, nutrition, medication complexity, and home environment barriers. These insights informed the development of a proposed screening pathway using the validated FRAIL scale for adults aged 65 years and older during preoperative visits. Patients would be stratified by risk and referred to appropriate services, including physical therapy, nutrition counseling, and case management, with the addition of a patient-centered prehabilitation education handout. Integrating structured frailty screening into rural preoperative care may improve identification of vulnerable patients and support targeted interventions to enhance surgical readiness and reduce preventable postoperative decline.
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2026-03-12
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Middlebury Family Health