Context

Elderly patients, defined as adults aged 65 years and above, represent a growing segment of the surgical population.1 Despite numerous advances in surgical techniques and postoperative care, elderly patients face unique physical and psychological challenges that can exacerbate their risk of poor clinical outcomes.2 The recent study by Kata et al explores the psychosocial experiences of elderly patients undergoing major elective surgery,3 a topic with a limited previous literature despite its critical implications for the surgical patient experience and quality of life.

Findings

The study identified three main themes: (1) patients encountered significant challenges to psychosocial well-being that negatively affected recovery and outcomes; (2) personal and social support helped patients to navigate these challenges; and (3) patients and their caregivers described a need for additional resources from health systems to address the psychosocial aspects of surgical treatment. Specifically, participants reported distress during the preoperative period over the anticipation of surgery, physical limitations experienced postoperatively and uncertainty with the long-term prognosis. Of note, both patients and caregivers indicated an absence of structured support from health systems to address these issues.

Commentary

The findings of this study underscore the urgent need for integrating mental health and social support services into the perioperative care of elderly patients. This necessity is not only significant but also can have consequences of surgical outcomes. Left unaddressed, preoperative anxiety and depression among elderly surgical patients have been linked to higher rates of postoperative morbidity, mortality and greater length of hospitalisation.4

In this setting, a multipronged approach may be used to improve on the alarming patient experiences identified by this study. Surgical care teams can be educated on the necessity of addressing emotional well-being as part of standard patient care. Moreover, as the study highlights the important role of caregivers in providing personal and social support, surgical care teams can further involve family members and caregivers in the perioperative care process, ensuring that the patient’s own desires and goals are integrated into surgical work-up, shared decision-making and throughout treatment and recovery. However, the burden on caregivers themselves has also been well described.5 Although social support from family members and caregivers is crucial, the study also highlights that it may often be insufficient to meet all the complex needs of elderly surgical patients. This may be mitigated by health systems through the consideration of preoperative and postoperative counselling and mental health services that extend beyond the hospital setting.

These potential approaches to improving the psychosocial aspects of the surgical patient experience may represent promising areas of focus for future quality improvement initiatives.6 By doing so, surgeons, care teams and health systems together can improve both surgical outcomes and the overall quality of life for this vulnerable population.