It’s a problem that the medical community has known about for years – and it seems they’re finally doing something about it. Next year the American College of Surgeons (ACS) is planning to launch a new, nationwide program designed to help senior patients be better prepared for surgery. The goal is a faster recovery and better surgical outcomes for older patients who often suffer avoidable side-effects from the operations their physicians recommend.
This article on the Kaiser Health News website, written by Judith Graham, describes the problem and the proposed solution. The article is called “A Push to Get Older Adults in Better Shape for Surgery,” and the reason for this new “push” is simple: seniors heading into surgery physically and emotionally unprepared often pay a high medical cost. As Graham writes, “Surgery can be hard on older adults, resulting in serious complications and death far more often than in younger patients. But many seniors aren’t adequately prepared for the risks they might face.” For that reason, innovative medical facilities including nationally-recognized hospitals in North Carolina, California, Michigan and elsewhere are working to challenge the status quo and help seniors improve their health prior to being hospitalized. “In the weeks leading up to surgery, they prescribe exercise to seniors, make sure they’re eating healthy foods and try to minimize anxiety and stress, among other initiatives,” says Graham.
“Changing how we approach older patients is really an imperative,” said Dr. Emily Finlayson, director of the Center for Surgery in Older Adults at UC San Francisco. One excellent example, according to the Kaiser article, is a program at Duke University nicknamed POSH – “Perioperative Optimization of Senior Health.” The article describes POSH as an interdisciplinary model of care that brings surgeons, geriatricians, anesthesiologists and social workers together with older patients and their families. Seniors referred by surgeons to the POSH program receive a comprehensive geriatric assessment that measures everything from mobility to cognition. Program directors evaluate the level of home support and look into a patient’s medication requirements and nutritional regimen, among other factors.
So what has been the outcome? So far results just reported from the POSH program have been extremely encouraging. In one evaluation of a group of senior patients who had undergone major abdominal surgery, the POSH patients spent four recovery days in the hospital compared with six days for a control group. The POSH-prepared patients were half as likely as the less-prepared patients to return to the hospital in the ensuing 30 days, and were more likely to return home without the need for home health care.
In order to prepare seniors for surgery, Duke’s POSH program requires much more than a counseling session or two. “When patients leave our clinic, they have a very detailed to-do list,” said Dr. Shelley McDonald, an assistant professor of geriatrics who helps run POSH. Plans are highly individualized, but they often include instructions like these:
- Start walking 20 minutes a day, five days a week
- Do core-strengthening exercises three times a week
- Practice deep breathing three to four times a day
- Stop taking medications that can interact poorly with anesthesia, such as antihistamines
- Eat 30 grams of protein three times a day
- Drink lots of fluids starting three days before surgery
POSH counselors also make sure patients have someone to sit with them in the hospital and to stay with them when they return home.
Doctors at the University of Michigan offer a program similar to but simpler than Duke’s POSH. “The program focuses on four objectives before surgery,” says the Kaiser article: “walking more, getting lungs ready through breathing exercises, eating well and relaxing [by] spending time with friends and family, getting enough sleep, minimizing stress.” This helps older patients feel empowered by taking action prior to surgery rather than merely waiting in a state of stress and anxiety.
At AgingOptions we applaud this overdue approach to helping seniors not only survive but thrive after surgery. We’ve written before on the AgingOptions blog about the problem of frail seniors being misdiagnosed (including this article from April 2017) – now it seems that physicians are finally realizing that older patients require extra preparation before undergoing surgery. This is one more reason why we strongly recommend that our clients utilize the services of a geriatrician. These trained and certified medical specialists understand the unique medical needs of their senior patients and will take the time to make sure they get the care they need. If you would like a referral to a geriatrician in your area, please contact us and let us assist you.
Planning for your medical needs in retirement is extremely important – but it’s even more important to spend some time doing retirement planning that is truly comprehensive. That type of plan includes medical needs, housing choices, legal protection, financial preparation, even communication with your family. At AgingOptions we refer to that type of comprehensive, multi-faceted plan as a LifePlan, and in our experience there’s no other retirement blueprint quite like it.
Why not find out for yourself? Spend a few hours with Rajiv Nagaich at an upcoming AgingOptions LifePlanning Seminar – without cost or obligation. For a list of presently scheduled seminars, click here for our Upcoming Events page where you can register online (or, if you prefer, contact us by phone).
Some of the programs described in this article can prepare you for surgery, but what can truly prepare you for retirement? There’s nothing more effective than a LifePlan from AgingOptions. Age on!
(originally reported at www.khn.org)