Earlier Introductions to Palliative Care in Older Adults Undergoing High-Risk Surgery

a MiCDA Research Project Description

Investigators: Pasithorn Amy Suwanabol, Yun Li, Maria J. Silveira, Lona Mody, Daniel B. Hinshaw, Justin B. Dimick, Kenneth M. Langa

Funding: American College of Surgeons, 2017-2018 (Award Letter)

With the aging population, an increasing number of older adults will undergo surgical procedures. Increasing age continues to be the most predictive factor for morbidity and mortality as older patients have decreased functional reserve and therefore decreased capacity to recover from postoperative complications. Although older adults represent 40% of all inpatient operations, they account for more than 60% of all postoperative deaths and a similarly disproportionate share of postoperative complications.
In addition to the considerable risk of perioperative morbidity and mortality in older adults, the risk of prolonged recovery and continued disability is high. More than 10% of older adults require discharge to skilled nursing facilities following surgery, and a larger proportion experience postoperative functional impairments that can persist for upwards of 6-12 months. As well, ongoing care designed to prolong life among patients has only short-term impact ? 40% of older adults admitted to medical or surgical intensive care units die within the year.

Prolonged recovery and continued disability following surgery in older adults are underappreciated, which may lead patients to consent to procedures with unrealistic expectations. As a result, patients who undergo surgery and suffer a postoperative complication frequently receive unwanted invasive procedures. These patients are subjected to further burdensome surgery, protracted recovery and disability, and poor quality of life or even a prolonged dying process. Such patients may benefit from incorporation of palliative care services where the ultimate goal is to provide seriously-ill patients relief from suffering and the best quality of life at all stages of diseases. However, there is no clear consensus about a clear target for palliative care services and surgical patients rarely receive palliative care consultations.
Previous research lacks an in-depth understanding of the longitudinal impact of high-risk surgery in older adult patients. Specifically, the epidemiology of decline in surgical patients is unknown leading to the challenge of knowing when exactly to engage palliative care services. As well, facilitators and barriers to palliative care in this particular subset of patients have yet to be fully defined. This proposal seeks to address these critical gaps in our knowledge of the long-term implications of surgery in older adults and how surgeons play a role in the provision of palliative care.

Research Signature Theme:

Health and well-being in later life