Understanding preoperative concerns and attitudes towards prehabilitation in older surgical populations: A survey study

STUDY OBJECTIVES: To identify common preoperative concerns in older surgical populations and explore their attitudes towards prehabilitation, functional, and cognitive assessments. DESIGN: Multicenter cross-sectional study. SETTING: Preoperative questionnaire examining preoperative concerns and attitudes towards prehabilitation, functional, and cognitive assessments. PATIENTS: 236 non-cardiac surgical patients ≥65 years old. MEASUREMENTS: Concerns across five domains-surgery, anesthesia, functional status, cognitive status, and financial burden-were measured on a five-point Likert scale, ranging from 'not concerned at all' to 'very concerned.' Attitudes towards prehabilitation and preoperative assessments were assessed on a five-point scale from 'strongly disagree' to 'strongly agree.' Exploratory factor analysis identified concerns, and confirmatory factor analysis validated them. Reliability was assessed with Cronbach's alpha, and model fit was evaluated using the root mean square error of approximation, comparative fit index, and related indices. RESULTS: Surgical concerns were highest (2.5 ± 1.2), particularly regarding postoperative pain, surgical failure, and complications. Concerns about anesthesia (2.0 ± 1.3) and functional status (1.9 ± 1.3) followed, with lower concerns about cognitive status (1.5 ± 1.1) and financial burden (1.4 ± 0.9). Attitudes towards prehabilitation were generally positive. Most participants were open to functional assessments and training programs, though only 37 % were willing to undergo memory assessment. Factor analysis revealed a five-factor structure of preoperative concerns: basic activities of daily living, instrumental activities of daily living, surgical/anesthesia concerns, cognitive/financial concerns, and discharge concerns. Confirmatory factor analysis supported this structure with adequate model fit. CONCLUSIONS: This study highlights common preoperative concerns among older adults, particularly regarding surgery, anesthesia, and functional status, with greater concern reported by those with functional dependence. While attitudes towards prehabilitation were generally positive, there was low willingness to undergo preoperative memory testing. Future research should refine prehabilitation programs to optimize effectiveness, accessibility, and adherence in older adults and further evaluate their impact on surgical outcomes.