Towards resilience: Prehabilitation for the elderly with colorectal cancer

On average, frail patients have a fourfold higher risk of adverse outcomes such as postoperative complications and delayed recovery compared to their non-frail counterparts. Frailty can present itself in a wide array of phenotypes in which it can manifest itself ( e.g. ADL-dependent, depression, malnutrition, social isolation, etc.). The aim of this thesis is bifold. First, to define what frailty means in a surgical context. Second, to shift the idea of frailty towards an opportunity to revert this condition or at least make older patients more resilient to withstand a stressor such as a surgical intervention.
Prehabilitation, defined as a multimodal approach to enhance a patient's condition prior to surgery has been gaining interest over the past years. The intervention is so intuitive that a layman might wonder why prehabiliation programs are only scarcely present in daily practice. An answer can lie in the fact that there is a lack of evidence for such behavioral interventions that require various disciplines (dietary specialists, physiotherapists, surgeons, geriatricians) to collaborate. As only 7% of all randomized controlled trials worldwide specifically focus on the elderly, the evidence is in this specific group is even more limited. The aim of this thesis is to assess the feasibility of prehabilitation in frail elderly patients, to focus on those who have the most to gain.