关键词: 智随访；老年人；衰弱；居家管理；德尔菲法

Abstract: Objective: To explore the application effect of home frailty management program based on the intelligent follow-up platform in elderly patients after surgery. Methods: The home frailty management program based on the intelligent follow-up platform in elderly patients after surgery was constructed by literature research and Delphi method. A total of 82 postoperative patients admitted to a tertiary grade A hospital in Tianjin from February to April 2022 were included by convenience sampling method, and 41 patients admitted from February 1 to March 15, 2022 were in the control group, 41 patients admitted from March 16 to April 30, 2022 were in the intervention group. Those in the control group adopted the conventional frailty management scheme, and those in the intervention group adopted the home frailty management program based on the intelligent follow-up platform, and the intervention period was 6 months. The differences in health behavior ability, frailty, hand grip strength, gait speed, physical function and quality of life were compared between the two groups. Results: The frailty score of the intervention group was lower than that of the control group (P<0.05). The health behavior ability score, grip strength, gait speed, physical function and quality of life of the intervention group were higher than those of the control group (P<0.05). Conclusion: The home frailty management program based on the intelligent follow-up platform has positive effects on improving health behavior ability, frailty, and quality of life of elderly patients after operation with great clinical application value.

Key words: intelligent follow-up; aged; frail; home management; Delphi method