New horizons in the perioperative care of older adults

Abstract

Older adults undergoing surgery have high perioperative morbidity and mortality. Age-related physiological changes and prevalence of geriatric syndromes such as frailty increase the risk of adverse postoperative outcomes. Geriatricians utilise comprehensive geriatric assessment (CGA) and management to identify and manage geriatric syndromes, and deliver patient-centred perioperative care. Perioperative models of CGA are established for older patients undergoing hip fracture surgery. Recent trials support the benefits of perioperative models of CGA for non-orthopaedic surgery, and have influenced current care recommendations for older surgical patients. Areas for further action include addressing the implementation gap between recommended evidence-based perioperative care and routine perioperative care, evaluating the clinical and cost-effectiveness of perioperative models of CGA for patients living with frailty, and embedding routine use of patient-reported outcome measures to inform quality improvement.

Geriatric care for surgical patients: results and reflections from a cross-sectional survey in acute Belgian hospitals

“…In current literature, studies in the orthogeriatric population predominate, but there seems to be an evolution towards scientific research in other surgical specialties [ 15 ]. However, a recent review showed that only few studies have compared proactive geriatric care with usual care in surgical specialties other than orthopaedic/trauma surgery [ 28 ].…”

“…In current literature, studies in the orthogeriatric population predominate, but there seems to be an evolution towards scientific research in other surgical specialties [15]. However, a recent review showed that only few studies have compared proactive geriatric care with usual care in surgical specialties other than orthopaedic/trauma surgery [28]. Important to mention is that geriatric care is well implemented in Belgian hospitals due to a Royal Decree which states that hospitals must provide in acute geriatric hospital wards, an IGCT, a multidisciplinary geriatric day hospital, an outpatient clinic for geriatric patients and a partnership with primary care [10].…”

A national study of 23 major trauma centres to investigate the effect of a geriatrician assessment on clinical outcomes in older people admitted with serious injury in England (FiTR 2): a multicentre observational cohort study

“…Alternatively, the assessment might have been limited to a frailty score only, and indirectly reduced mortality by activating frailty-adapted pathways of care. 21,22 Despite implementation of geriatric medicine services in many surgical centres, work still needs to be done to…”

Vasculogeriatrics: embracing shared care with our colleagues in geriatric medicine should not be a threat

“…By sharing patient centred goals and the perspective of experts in care of the elderly, we can mitigate the perioperative risk and streamline patient flow without compromising our way of work, personal preferences, schedules or control. [18][19][20] Although clear to us that we and our patients only benefit by shared care with our geriatricians, patient reported outcomes will strengthen the case for a shared care model aside from costeffectiveness in a specialty where quality of life may have greater importance than quantity. The practical implementation of our model could provide a framework for other units who may wish to work together in this way.…”

“…As our population ages and co‐morbid conditions such as diabetes and obesity increase, procedural risk in our patient cohorts will only get higher. By sharing patient centred goals and the perspective of experts in care of the elderly, we can mitigate the perioperative risk and streamline patient flow without compromising our way of work, personal preferences, schedules or control 18–20 . Although clear to us that we and our patients only benefit by shared care with our geriatricians, patient reported outcomes will strengthen the case for a shared care model aside from cost‐effectiveness in a specialty where quality of life may have greater importance than quantity.…”