The proposed research will use major elective abdominal surgery as a model for catastrophic health events to study the natural history of postoperative long-term functional recovery in a cohort of Mexican American elders. Several factors make major elective abdominal surgery a particularly rich model for catastrophic health events: it is frequently performed; it provides controlled access to what is usually an acute, unpredictable event; there is usually little related presurgical symptomatic chronic illness (eg, elective repair of abdominal aortic aneurysm); and it invokes multidimensional disruption of functional independence. Previous studies do not answer questions regarding determinants of functional recovery in the elderly after major abdominal surgery for two primary reasons: (1) they examine only coronary artery bypass operations or lower risk operations done for specific physical impairment (eg, hip fracture repair, hip replacement, cataract surgery) and (2) do not approach the issue with an integrated biomedical psychosocial model of independence.
Specific aims are to (1) describe the impact of major abdominal surgery on functional independence in a cohort of Mexican American elders, (2) map the natural history of functional recovery, and (3) identify important modifiable determinants for long-term postoperative functional outcome. Long-term objectives are development of interventions to enhance functional recovery, prevent disability, and prolong independence in Mexican American elders. The primary hypothesis is that poorer preoperative functional status for five primary modifiable determinants of independence (physical, cognitive, social, affective and medical comorbid status) is associated with worse functional recovery. Subjects who are greater and or equal to 65, scheduled for major elective abdominal operations, and without major debilitating illness likely to drive functional recovery will be recruited from both academic and community sites. Subjects will undergo an extensive battery of instruments to assess functional independence for the five primary modifiable determinants of functional independence preoperatively and postoperatively at five days, one, three, and six months. Multivariable analysis will be used to evaluate the relationship between preoperative status for five primary modifiable determinants and postoperative functional independence, defined by Activities of Daily Living and Instrumental Activities of Daily Living. Results will substantially expand knowledge about predictors of functional recovery after major abdominal surgery in the elderly, will have unique significance for Mexican American elders, and should provide insights for other types of surgery and catastrophic health events. Additionally, the results will help target potential interventions to prevent disability and enhance functional recovery.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Exploratory Grants (P20)
Project #
3P20AG012044-03S1
Application #
6098558
Study Section
Project Start
1996-09-19
Project End
1998-08-31
Budget Start
Budget End
Support Year
3
Fiscal Year
1996
Total Cost
Indirect Cost
Name
University of Texas Health Science Center San Antonio
Department
Type
DUNS #
800772162
City
San Antonio
State
TX
Country
United States
Zip Code
78229
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