A recent study from the University of California, San Francisco found the poor physical function, dementia, and depression all raise older people’s risk of death after a major operation and should be considered in their pre-surgery assessments.
The study is published in JAMA Surgery. The lead author is Dr. Victoria Tang, an assistant professor of geriatrics and of hospital medicine.
The team analyzed data on more than 1,300 U.S. patients, aged 66 and older, who had one of three types of major surgery (abdominal aortic aneurysm repair, coronary artery bypass graft or colectomy) between 1992 and 2014.
Before surgery, at least 90% of the patients were independent or did not need help with activities of daily living.
In addition, 6% had dementia, 23% had thinking (“cognitive”) impairment without dementia, and 25% had depression.
Activities of daily living include bathing, dressing, eating, using the bathroom, getting in and out of bed, and walking across the room.
Instrumental activities of daily living include preparing meals, handling finances, using the phone, shopping, and taking medication.
The team found that overall, 17% of the patients died within a year after surgery.
Rates of death were 29% among those who needed support for at least two activities of daily living versus 13% among those who were independent.
The risk of death rose as the number of risk factors increased: 10% for no factors, 16% for one factor, and nearly 28% for two factors.
These findings show the need for research into how to incorporate these risk factors into pre-surgery assessments of seniors.
The team says improving the understanding of functional, cognitive, and psychological risk factors in this population, particularly in predicting risk beyond typical medical factors, is essential to providing patient-centered care.
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