Frailty Matters / Living with Frailty / Navigating the System

Navigating the System

Navigating the healthcare system can be tricky, even for people who are experienced with it. CFN recognizes this and has created this page to help guide your interactions with the system.

Navigating the System Page Graphic

Preparing for Doctors Appointments

Preparing for appointments will allow you to make the best use of your time with your healthcare professional, especially when living with frailty.

 

Tips

  • Take a friend with you to appointments
    • They can be a second advocate for you
    • They can take notes and help track questions asked/answered
    • They can provide emotional support
  • Before the appointment, make a list of information you want to share with the healthcare professional
  • Write down questions you want to ask
    • See “Questions to Ask” below
  • Create a detailed health history that you can share repeatedly with various members of your care team. You can:
    • Write it down
      OR
    • Use a medical app to store it (see a list of apps in our “Resources” section)
  • Prepare a list of all medications you’re taking, including prescription, over-the-counter, and supplements
  • Bring any medical or assistive equipment to the appointment—especially if it’s an appointment specifically for this purpose, such as for vision or hearing care
  • For in-office appointments, be sure to arrive early and leave time for traffic and parking
  • For at-home appointments, find a space that is private and without distractions
  • Take notes during the appointment—have a dedicated notebook for appointments
  • Remember, you are an expert in your own life—don’t be afraid to speak up

Questions to Ask

  • If you believe you might be living with frailty, but have not yet been diagnosed, ask your healthcare professional to carry out a Comprehensive Geriatric Assessment
    • Doing so will allow for better, more suited care
  • Ask about developing a care plan
    • Discuss life priorities, consider various options, and agree on goals together with your doctor
    • Ask if you should be referred to a geriatric specialist
    • Make goals actionable items, not vague statements (e.g., falls prevention training vs. build up muscle strength to assist with balance)
    • Ensure it is an ongoing conversation, not a one-time event
    • Ensure the plan is shared with all healthcare providers
  • Initiate a conversation about advance care planning
    • This should be part of the care plan
    • Discuss values and goals about treatment options
    • Discuss quality of life outcomes regarding certain treatment options
    • Identify a substitute decision maker, should you be too ill to make decisions about your own care
  • Ask for a medication review
    • What are their aims, benefits, side effects, possible interactions?
    • Does the dosage need to be adjusted?
    • Is the medication proving beneficial and does it align with your goals? For example, is it doing what it’s supposed to do? Can you administer it correctly (e.g., inhalers, eye drops, swallowing pills)? Do you remember to take your pills?
  • What can you do, or can your caregiver do, to support your care plan, apart from regular healthcare visits?
    • What type of diet and exercise could benefit from?
    • What actions can you take to make improvements in your frailty status? (Frailty is dynamic and it can be lessened with certain actions)
  • If you’re experiencing functional decline, ask about free falls prevention training resources in your area
  • When looking for a doctor who will make a house call, check with these sources:
    • Does your primary care provider offer this service or can they recommend someone who does?
    • Does your local hospital offer a house call service?
  • Don’t be afraid to ask for clarification and simplification of any medical terms you do not understand

Citations

Abdul-Razzak, A., You, J., Sherifali, D., Simon, J., & Brazil, K. (2014). ‘Conditional candour’ and ‘knowing me’: An interpretive study on patient preferences for physician behaviours during end-of-life communication. BMJ Open 2014; 4:e005653. doi: 10.1136/bmjopen-2014-005653

Duggleby, W. (January 2014). Which way from here? Navigation competencies for the care of older rural adults at the end of life. [Final Report to CIHR]. Retrieved from https://www.cfn-nce.ca/wp-content/uploads/2018/09/Which-Way-from-Here-Final-report-7-January-2014.pdf

Freedman, A., & McDougall, L. (2019). Frailty 5 checklist: Teaching primary care of frail older adults. Canadian Family Physician, 65(1), 74-76. Retrieved from https://www.cfp.ca/content/65/1/74

Giguere, A.M.C., Farmanova, E., Holroyd-Leduc, J., Straus, S.E., Urquhart, R., Carnovale, V., Breton, E., Guo, S., Maharaj, N., Durand, P.J., Légaré, F., Turgeon, A.F., & Aubin, M. (2018). Key stakeholders’ views on the quality of care and services available to frail seniors in Canada. BMC Geriatrics, 18:290. https://doi.org/10.1186/s12877-018-0969-y

Holroyd-Leduc, J., Resin, J., Ashley, L., Barwich, D., Elliott, J., Huras, P., Légaré, F., Mahoney, M., Maybee, A., McNeil, H., Pullman, D., Sawatzky, R., Stolee, P., & Muscedere, J. (2016). Giving voice to older adults living with frailty and their family caregivers: Engagement of older adults living with frailty in research, health care decision making, and in health policy. Research Involvement and Engagement, 2(23). doi: 10.1186/s40900-016-0038-7

McMaster Health Forum. (13 August 2016). Strengthening care for frail older adults in Canada. [Citizen Brief] Retrieved from https://www.mcmasterforum.org/docs/default-source/product-documents/citizen-briefs/strengthening-care-frail-older-adults-cb.pdf?sfvrsn=2

Pesut, B., & Duggleby, W. (August 2016). NCARE: Volunteer/healthcare provider navigation: Supporting older adults living with advancing chronic illness, summary report August, 2016. Retrieved from http://pesut-lab.sites.olt.ubc.ca/files/2014/05/NCARE-Study-Results-_-Brief-Sept-15-2016.pdf

Preparing for Surgery – Get Strong!

You can prepare for surgery just as you can prepare for a medical appointment—even if the preparation looks slightly different. Here are some tips on how to prepare for an upcoming surgery.

 

Tips

  • Ask important health-related questions before agreeing to the surgery and take notes
    • See our “Questions to Ask” section
  • Write down the location, date, and time of the surgery
  • Plan to arrive ahead of time, leaving time for traffic, weather, and parking
  • Note any eating and drinking restrictions and follow them in the lead up to the surgery
  • Living with frailty can affect your surgery outcomes and recovery—ask your doctor how this will affect you
    • If you haven’t been diagnosed with frailty, ask your doctor if this is a risk factor for you
  • Prior to surgery, make arrangements to have friends, family, and professional healthcare workers support you after your surgery during the recovery period
  • Prior to surgery, prepare your living space for your return post-surgery
  • Try to lead your healthiest lifestyle in the lead up to surgery
    • Quit or reduce smoking
    • Exercise
    • Eat a nutritious diet
  • One of the most important pre-surgery tips is to “get strong!”—did you know exercising in the weeks leading up to a surgery may help ease recovery? See our “Get Strong!” section

Questions to Ask

  • Should I have surgery?
    • What are my options?
    • What is likely to happen if I do have surgery? If I don’t?
  • What should I expect if everything goes well?
    • What will my daily life look like after surgery? (Right after, three months later, one year later?)
  • In your opinion, how will this surgery affect my other health problems (such as diabetes or high blood pressure)?
    • I am living with frailty. How will this affect my surgery outcomes?
  • After I leave the hospital, what type of care do you think I will need?
  • If I’m too sick to speak for myself, how can I make sure you know my wishes?
  • If I decide to appoint someone to make medical decisions for me, what do I need to do to make those arrangements official?

Adapted from: https://www.star2.com/health/fitness/2018/02/04/importance-preparing-older-adults-surgery/

Get Strong!

Get Strong!

Initial findings from CFN-funded work suggest that pre-op exercise can lead to better outcomes after major surgeries in older adults living with frailty, by helping people become more resilient. Including prehabilitation in your surgery plan is better than rehabilitation alone as a post-operative activity.

“Surgery is a bit like running a half-marathon,” says Dr. McIsaac. “It places a big demand on the body. You want to train for that, so you can recover quickly and well. For older patients with frailty, it’s about getting stronger to avoid disability and reduce the chances of post-operative complications like blood clots, pneumonia, heart attacks and infections, so they can return to their lives in a better state of health than before the surgery.”

Here’s what you can do to prepare for your surgery:

  • In the weeks leading up to your surgery, complete an at-home pre-op exercise program—or “prehab”
  • In general, physical activity (this could be work, chores, leisure activities, etc.) at all times is a good practice. The World Health Organization recommends:
    • At least 150 minutes (2.5hr) of moderate-intensity aerobic physical activity or at least 75 (1hr 15 minutes) minutes of vigorous-intensity aerobic physical activity throughout the week
    • Aerobic activity should be performed in bouts that are at least 10 minutes long
    • If you have limited mobility or functional decline, aim for activity that enhances balance and prevents falls at least three days per week
    • Do muscle-strengthening activities at least 2 days per week
    • Activities could include: walking, dancing, gardening, swimming, household chores, games, sports
  • Ask someone to check in on you, with a call or visit each week, to maintain exercise motivation
  • Check with your healthcare provider to make sure you’re doing the right physical activity for your situation
  • Combine exercise with a balanced diet
    • See our “AVOID” pages for more information on “Activity” and “Diet and Nutrition”

Citations

Arora, R. C., Brown, C. H., Sanjanwala, R. M., McKelvie, R. (2018). “NEW” prehabilitation: A 3-way approach to improve postoperative survival and health-related quality of life in cardiac surgery patients. Canadian Journal of Cardiology, 34, 839-849. doi: https://doi.org/10.1016/j.cjca.2018.03.020

Brown, N. A., and Zenilman, M. E. (2010). The impact of frailty in the elderly on the outcome of surgery in the aged. Advances in Surgery, 44, 229-249. doi: 10.1016/j.yasu.2010.05.014

European Food Information Council. (23 July 2015). Physical activity and health. [Website]. Retrieved from https://www.eufic.org/en/healthy-living/article/physical-activity-and-health

Hoogeboom, T. J., Dronkers, J. J., Hulzebos, E. H. J., and van Meeteren, N. L. U. (2014). Merits of exercise therapy before and after major surgery. Curr Opin Anesthesiol, 27(2), 161-166. doi: 10.1097/ACO.0000000000000062

Hulzebos, E. J. H., and van Meeteren, N. L. U. (2016). Making the elderly fit for surgery. BJS Open, 103, e-12-e15. doi: 10.1002/bjs.10033

McIsaac, D. I., Jen, T., Mookerji, N., Patel, A., Lalu, M. M. (2017). Interventions to improve the outcomes of frail people having surgery: A systematic review. PLoSONE, 12(12). doi: https://doi.org/10.1371/journal.pone.0190071

McIsaac, D. I., Saunders, C., Hladkowicz, E., Byrson, G. L., Forster, A. J., Gagne, S., Huang, A., Lalu, M., Lavallée, L. T., Moloo, H., Nantel, J., Power, B., Scheede-Bergdahl, C., Taljaard, M., van Walraven, C., and McCartney, C. J. L. (2018). PREHAB study: a protocol for prospective randomised clinical trial of exercise therapy for people living with frailty having cancer surgery. BMJ Open, 8. doi: 10.1136/bmjopen-2018-022057

McIsaac, D. I., Talljaard, M., Bryson, G. L., Beaule, P. E., Gagne, S., Hamilton, G., Hladkowicz, E., Huang, A., Joanisse, J., Lavallée, L.T., Moloo, H., Thavorn, K., van Walraven, C., Yang, H., Forster, A. J. (2016). Comparative assessment of two frailty instruments for risk-stratification in elderly surgical patients: Study protocol for a prospective cohort study. BMC Anesthesiology, 16:111. doi: 10.1186/s12871-016-0276-0

Public Health Agency of Canada, Division of Aging and Seniors. (2002) Healthy aging: Physical activity and older adults. Retrieved from http://publications.gc.ca/Collection/H39-612-2002-4E.pdf

Rothenberg, K. A., Stern, J. R., George, E. L., Trickey, A. W., Morris, A. M., Hall, D. E., Johanning, J. M., Hawn, M. T., Arya, S. (2019). Association of frailty and postoperative complications with unplanned readmissions after elective outpatient surgery. JAMA Network Open, 2(5). doi: 10.1001/jamanetworkopen.2019.4330

World Health Organization. (2010). Global recommendations on physical activity for health. [Website]. Retrieved from https://www.who.int/dietphysicalactivity/publications/9789241599979/en/

World Health Organization. (2019). Physical activity and older adults: Recommended levels of physical activity for adults aged 65 and above. [Website]. Retrieved from https://www.who.int/dietphysicalactivity/factsheet_olderadults/en/

Recovering from Surgery

Recovering from surgery is a lot easier when you’ve planned for the procedure, asked the important questions (see our “Preparing for Surgery” section), and prepared for your recovery prior to having the surgery. After surgery, the focus is on regaining your health and getting back to pre-surgery levels of function.

 

Tips

  • Just as prehabilitation is important in preparing for surgery, rehabilitation and exercise are important to recovering from surgery
  • Try to maintain your mobility as much as possible as soon as possible
    • Walking helps open your lungs and reduces the risk of blood clots and pneumonia
  • Become active—to the extent possible—as soon as you can
    • Turn and shift position in bed, so you’re not remaining in one spot
    • Do “bicycling” in bed
    • Always check with your physician before engaging in exercise
  • Getting proper nutrition is key to a smooth recovery
    • Food is medicine—it’s just as important as prescription medications in the healing process
    • Ask for assistance when eating your hospital meals, if required
    • Make sure you take time to eat hospital meals, and speak up if something is preventing you from doing so
    • Once you leave the hospital, ensure you continue to eat food high in vitamins, protein, and other nutrients
  • Deep coughing and deep breathing is important to help prevent pneumonia and other breathing difficulties
  • Manage your pain and take prescribed pain medication
  • Return to wearing your glasses and/or hearing aids as soon as possible to avoid becoming disoriented
  • Take steps to avoid delirium
    • Avoid risky medications
    • Stimulate your mind by socializing, reading, listening to music, and playing brain games
    • Take steps to get a good night’s sleep
    • Try relaxation techniques to calm and relax your mood
    • Stay hydrated
    • Ensure you’re eating nutritious meals
  • Follow care instructions as outlined by your healthcare team
  • Attend all follow-up appointments
  • Ensure you have a network of support, so you’re not recovering alone

Questions to Ask

  • What should I expect if everything goes well with my recovery?
    • What will my daily life look like after surgery? (Right after, three months later, one year later?)
  • I am living with frailty. How will this affect my recovery?
    • Is there anything I can do to address this risk?
  • After I leave the hospital, what type of care do you think I will need?
    • How can I set up this care?
    • Are there any special instructions I will need to follow? What are they?
    • When are my next follow-up appointments?
  • I want maintain my mobility and get active as soon as possible. How soon can I do this?
    • What type of activity would you recommend?
    • What should I avoid?
  • If something happens and I’m too sick to speak for myself, how can I make sure you know my wishes?
  • If I decide to appoint someone to make medical decisions for me, what do I need to do to make those arrangements official?

Citations

Brown, N. A., and Zenilman, M. E. (2010). The impact of frailty in the elderly on the outcome of surgery in the aged. Advances in Surgery, 44, 229-249. doi: 10.1016/j.yasu.2010.05.014

Hoogeboom, T. J., Dronkers, J. J., Hulzebos, E. H. J., and van Meeteren, N. L. U. (2014). Merits of exercise therapy before and after major surgery. Curr Opin Anesthesiol, 27(2), 161-166. doi: 10.1097/ACO.0000000000000062

Hulzebos, E. J. H., and van Meeteren, N. L. U. (2016). Making the elderly fit for surgery. BJS Open, 103, e-12-e15. doi: 10.1002/bjs.10033

International Federation of Delirium Societies. (2019). iDelirium: A unified voice for advancing delirium science. [Website]. Retrieved from http://idelirium.org/

McComb, A., Warkentin, L. M., McNeely, M. L., and Khadaroo, R. G. (2018). Development of a reconditioning program for elderly abdominal surgery patients: The Elder-friendly Approaches to the Surgical Environment-Bedside reconditioning for Functional ImprovemenTs (EASE-BE FIT) pilot study. World Journal of Emergency Surgery, 13:12. doi: https://doi.org/10.1186/s13017-018-0180-7

Stanford Health Care. (2019). General surgery – recovering. [Website]. Retrieved from https://stanfordhealthcare.org/medical-treatments/g/general-surgery/procedures/recovering.html

University of Utah Health. (2019). Getting life back to normal after surgery. [Website]. Retrieved from https://healthcare.utah.edu/the-scope/shows.php?shows=0_jcd5tg17