When any patient undergoes surgery, everyone involved hopes for a successful outcome. But senior patients face special risks if things go wrong on the operating table – risks that all too often are never thoroughly discussed with the patient and family ahead of time. In the event of complications, patients and loved ones are caught completely unprepared. However, according to this important article just published by Kaiser Health News, a new day may finally be dawning in the world of geriatric surgery.
Geriatric Surgery Standards Help Patients, Families Ask the Right Questions
The Kaiser article was written by Judith Graham. “It’s a common complaint,” she writes: “Surgeons don’t help older adults and their families understand the impact of surgery in terms people can understand, even though older patients face a higher risk of complications after surgery. Nor do they routinely engage in ‘shared decision-making,’ which involves finding out what’s most important to patients and discussing surgery’s potential effect on their lives before setting a course for treatment.” As most seniors know but many surgeons overlook, the health care priorities of elderly patients are often quite different from those of their younger counterparts. Seniors tend to value their ability to keep living independently more highly than they prize mere longevity, according to geriatric experts. But if doctors fail to understand this, a whole host of unintended outcomes can follow even fairly simple surgery when things fail to go as planned.
Graham cites the case of an 82-year-old heart patient facing risky but – in the surgeon’s view – necessary surgery to restore blood flow. “The surgeon at a Boston teaching hospital ticked off the possible complications,” Graham writes. “The patient’s daughter remembers feeling there was no choice but to say ‘go ahead.’ It’s a scene she’s replayed in her mind hundreds of times since, with regret.” Tragically the man suffered a stroke on the operating table. After waking from a coma, he could neither swallow nor speak, and he displayed significant confusion. Soon he developed vascular dementia and, after steady physical decline, he passed away five years later. The biggest problem, said the man’s 49-year-old daughter, is that there had been no real discussion before the surgery of what her father’s life might look like if things didn’t go well. The daughter told Kaiser Health News, “We couldn’t even imagine what ended up happening.”
Geriatric Surgery Standards: With GSV, Real Change May Finally be On Its Way
Finally, according to Kaiser, real change seems to be coming. “Now, new standards meant to improve surgical care for older adults have been endorsed by the American College of Surgeons. All older patients should have the opportunity to discuss their health goals and goals for the procedure, as well as their expectations for their recovery and their quality of life after surgery, according to the standards.” The comprehensive set of standards is called the Geriatric Surgery Verification Program, or GSV for short, and in order for hospitals and surgery centers to be GSV certified, they have to adhere to a long list of requirements. “Americans aged 65 years and older are the fastest-growing segment of our population,” says the American College of Surgeons. But most hospitals are ill-prepared to serve an aging population with unique clinical needs. “This surge in the number of older, uniquely vulnerable adults is poised to create one of the greatest health care challenges of our time.” The GSV Program is one answer.
We downloaded the entire Geriatric Surgery Verification Program manual here on the website of the American College of Surgeons. This comprehensive manual – all 102 pages of it – details all the practices and standards a facility must follow to maintain its own fully-operational, fully-certified GSV program. The guidelines require hospitals to have a physician (preferably a surgeon) on the medical staff who serves as a Geriatric Surgery Director, providing leadership and oversight. Patient rooms are required to be “geriatric-friendly,” designed to accommodate the needs of older adults and their visiting family. There’s even a requirement for a Geriatric Surgery Nurse Champion on each surgical floor to make sure the program is implemented at all levels among the front-line staff. The certification requirements are truly comprehensive.
Geriatric Surgery Standards Go Beyond the Clinical to Reveal Goals and Values
Some doctors are finally realizing that their “just the facts” approach is a bad fit for senior patients. “Surgical discussions often focus on surgical disease as an isolated problem to be fixed (the so-called ‘fix it’ model),” the GSV manual says. But instead, “Older adults should have the opportunity to identify an overall health goal that is personal and specific, such as ‘I want to be able to walk at my grandson’s wedding this summer.’ The overall health goal should be expressed in the patient’s own words.” The manual suggests asking open-ended questions as a way of gauging patient goals and values – questions like, “What does living well mean to you?” “What brings you strength?” “What should I know about you to take the best care of you?”
There’s much more to this story that we can’t cover here. If you or a senior loved one are facing the prospect of surgery, we recommend reading the Kaiser article by Judith Graham, because it will open your eyes to the kind of conversations you should be having with your medical team. At the same time, we strongly suggest that the quarterback of that medical team should be a board-certified geriatrician, someone well-versed in the unique healthcare needs of seniors. We’ll gladly refer you to a geriatric physician near you if you’ll contact us during the week.
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(originally reported at www.khn.org)