Surgery in the older person: Training needs for the provision of multidisciplinary care

Abstract

INTRODUCTION Many older surgical patients are exposed to high risks of morbidity and mortality when undergoing both elective and emergency surgery. METHODS We provide an overview of perioperative care teams and the educational opportunities available to surgeons who undertake surgery in the older person. FINDINGS The number of older people undergoing surgery is increasing at a rate faster than the proportion of older people in the overall population. Management of the older surgical patient throughout the surgical pathway forms part of the Specialty Training Curriculum for Geriatric Medicine. While 'surgery in childhood' continues to form part of the general surgical higher training syllabus, surgery in the later years of life does not. There are limited postgraduate courses and training opportunities currently available to surgeons in this field. There is clear societal need to address perioperative care for older surgical patients, which has proved successful in some centers. Moreover, surgical trainees support the inclusion of geriatric medicine issues into their training. CONCLUSIONS The ageing population requires a multidisciplinary perioperative approach, with dedicated and appropriately trained clinicians and allied health care professionals to improve outcomes.

Working Collaboratively: Outcomes of Geriatrician Input in Older Patients Undergoing Emergency Laparotomy in a District General Hospital

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Aging, Informed Consent and Autonomy: Ethical Issues and Challenges Surrounding Research and Long-Term Care

“…(p. 57) The time has arrived where strong collective advocacy efforts need to be initiated to formally articulate specific human rights for older people such as autonomy, independence and ethics of care that in turn are used to define the duties and responsibilities of families, governments, researchers, and health professionals involved in the care and provision of medically related services for the aged. Pearce et al [113] highlight the shortfall in appropriately trained clinicians to deal with the increasing numbers of older people requiring surgical interventions later in life. This preceding challenge has obvious ethical and moral implications requiring attention and resolution by the medical profession and allied health care professionals.…”

A two-step surgery and a multidisciplinary approach in a centenarian patient with an acute presentation of right colon cancer

“…as older cancer patients are rarely enrolled in clinical trial, with scant evidence-based result for the oldest old, there is an urgent need to carry out high quality research into new models of care, pre-operative risk stratification and optimization [47,48]. Moreover, anesthesiologists, surgeons and geriatricians should receive specific training in the assessment and management of older surgical patients, as an key relevant step for the optimization of their care.…”