At Michigan Medicine, an academic health center operated by the University of Michigan, a similarly intentioned but pared-down program focuses on four objectives before surgery: walking more, getting lungs ready through breathing exercises, eating well and relaxing (spending time with friends and family, getting enough sleep, minimizing stress). Participants get daily text reminders and can log their progress through a patient portal in the hospital's electronic health record.
Empowering older patients to take action before surgery instead of sitting around and worrying is the program's "magic sauce," said Dr. Michael Englesbe, a professor of surgery at Michigan Medicine who is involved with the program. Difficulties with billing Medicare for preoperative consultations and restructuring how physicians practice are the biggest challenges to implementing this kind of model widely. Still, "a lot of vendors are developing education and activity-tracking programs around surgery, and I expect these kinds of programs will become part of the standard of care in the not-too-distant future," Englesbe suggested.
At UCSF's Surgery Wellness program for older adults, patients are seen by a geriatrician, nutritionist, physical therapist, occupational therapist and a health coach. Consultations last about 90 minutes and result in concrete suggestions for seniors and their families as well as referrals, if needed, to specialists who can undertake more extensive evaluations.
Hoping to expand the reach of UCSF's approach, Finlayson and colleagues are developing a website and digital app, Prehab Pal, that will walk older adults and their caregivers through surgery prep. Created with input from seniors, it will have large-text fonts and easy-to-use design features. "We're putting the final touches on the first product and will pilot in March," Finlayson said.
For patients, knowing how to ask the right questions before surgery and appointing a surrogate to act on your behalf during and immediately after surgery is critically important, noted Rosenthal of ACS, who is also a professor of surgery and geriatrics at Yale University School of Medicine.
The Patient Preferences Project at University of Wisconsin School of Medicine and Public Health has developed and is testing a list of useful questions for older patients. Even if your local hospital doesn't have a program like those at Duke, Michigan Medicine or UCSF, you can ask your surgeon to address these questions:
Should I have surgery? What are my options? What is likely to happen if I do have surgery? If I don't have surgery? In your opinion, will surgery make me feel better? In your opinion, will surgery help me live longer? If so, how much longer? What should I expect if everything goes well? What will my daily life look like after surgery? (Right after, three months later, one year later?) Will I have any tubes or drains put in during or after surgery and will I need them at home? In your opinion, how will this surgery affect my other health problems (such as diabetes or high blood pressure)? After I leave the hospital, what type of care do you think I will need? What happens if things go wrong after surgery? Can you describe serious complications and explain what those might mean for me? If I'm too sick to speak for myself, how can I make sure you know my wishes? If I decide to appoint someone to make medical decisions for me, what do I need to do to make those arrangements official?
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
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