Surgeons are now preparing seniors for surgery by first putting them a diet and exercise regimen for several weeks prior to surgery.
Surgeons: Preparing Seniors For Surgery
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.
Innovative hospitals such as Duke University Medical Center, the University of California-San Francisco Medical Center and Michigan Medicine are working to change that. 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.
Research suggests these interventions can enhance seniors’ readiness for surgery and potentially lead to improved outcomes. “Changing how we approach older patients is really an imperative,” said Dr. Emily Finlayson, director of the Center for Surgery in Older Adults at UCSF.
The American College of Surgeons (ACS) plans to launch a national effort to improve surgical care for seniors, after defining a broad array of standards that hospitals should meet. The goal is to promote centers of excellence in geriatric surgery.
Surgeons: Preparing Seniors For Surgery Works
New evidence from Duke’s POSH (Perioperative Optimization of Senior Health) program demonstrates the value of prepping at-risk seniors for surgery.
In January, researchers reported that older adults who went through the POSH program before major abdominal operations spent less time in the hospital (four days versus six days for a control group), were less likely to return to the hospital in the next 30 days (7.8 percent vs. 18.3 percent), and were more likely to return home without the need for home health care (62.3 percent vs. 51.1 percent). They also had slightly fewer complications.
POSH is an interdisciplinary model of care, bringing together surgeons, geriatricians, anesthesiologists and social workers. They engage older patients and their families. Seniors referred by surgeons attend one- to two-hour appointments at Duke’s Geriatric Evaluation and Treatment Clinic, where they receive a comprehensive geriatric assessment focused on their functioning. Surgeons assess what they can do, with what degree of difficulty.
They are tested for mobility, cognition,and existing medical conditions. Support from family or other caregivers, is important.
Surgeons: The POSH Surgery Plan For Seniors
The plan is tailored to each patient. Recommendations are:
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 and benzodiazepines.
Eat 30 grams of protein three times a day; drink lots of fluids starting three days before surgery (your urine should be light yellow to clear); and make sure you have someone to sit with you in the hospital and be with you when you return home.
Empowering older patients to take action before surgery instead of sitting around and worrying is POSH program’s “magic sauce.”
Maximizing longevity and decreasing complications is the goal.