WASHINGTON >> The 92-year-old had a painful tumor on his tongue, and major surgery was his best chance. Doctors called a timeout when he said he lived alone, in a rural farmhouse, and wanted to keep doing so.
“It was ultimately not clear we could get him back there” after such a big operation, said Dr. Tom Robinson, chief of surgery at the VA Eastern Colorado Health Care System.
The Denver hospital is trying something new: When its oldest patients need a major operation, what to do isn’t decided just with the surgeon but with a team of other specialists, to make sure seniors fully understand their options — and how those choices could affect the remainder of their lives.
It’s part of a move to improve surgical care for older Americans, who increasingly are undergoing complex operations despite facing higher risks than younger patients.
The American College of Surgeons launched a program Friday to encourage hospitals around the country to adopt 30 new standards to optimize surgery on patients who are 75 and older — information seniors and their families eventually will be able to use in choosing where to get care.
Seniors account for more than 40% of surgeries, which is expected to grow as the population ages.
Certainly there are plenty of robust elders who can withstand major operations.
But as people get older, they don’t bounce back like they did even in middle age. Seniors rapidly lose muscle with even a short period in bed. They tend to have multiple illnesses that complicate recovery. And 15% of older adults who live at home — and a third of 80-somethings — face particular risks because they’re frail, meaning they’re weak, move slowly and get little physical activity.
The new standards stress team-based care and better communication about surgical risks and quality of life, to help patients choose their treatment. They must be evaluated for vulnerabilities such as frailty, being prone to falls or having dementia, and the hospital must have plans to handle them. After surgery, standards run the gamut from geriatric-friendly hospital rooms to preventing post-surgery complications like delirium, a frightening state of confusion that can impair recovery and cause long-term memory and thinking problems.
The surgeons’ group, with funding from the John A. Hartford Foundation, created a geriatric surgery “verification program,” similar to programs credited with spurring trauma and pediatric surgery improvements. Hospital participation is voluntary, but those that join will be inspected and have to document how patients fare.
Consider that 92-year-old with a tumor on his tongue. After consultations with speech and swallowing experts, and an evaluation of his house, Robinson said the man ultimately chose a smaller operation rather than trying for a cure.
“These are difficult conversations,” Robinson said. But choosing to spend, say, their last year at home rather than two in a nursing home, “those are trade-offs people are making.”