Perioperative Care of the Older Adult

Course Overview

In the United States, almost 40% of all inpatient procedures are performed on patients aged 65 and older. At Mass General Brigham trauma centers, over 50% of injured patients are older adults, the majority of whom are frail. To prepare our health care system to care for the growing number of older adults who have increasing medical and psychosocial complexity and improved standards for geriatric surgical care being set by national stakeholders including CMS and the American College of Surgeons, front line clinicians including Advanced Practice Providers (APPs), surgical trainees, nurses, and surgical attendings urgently need more training in geriatric syndromes and the 4 pillars of Age-Friendly Health Systems (Medication, Mobility, what Matters, and Mentation) as well as multi-complexity. 

This training will address the needs of geriatric patients and instruct on how to avoid hazards of hospitalization such as delirium, falls, infections, loss of function, and caregiver strain. These issues are particularly relevant in surgery and trauma where mortality, complications, and other adverse outcomes are consistently higher for older patients than their younger counterparts. Evidence suggests that geriatric-focused clinical pathways can reduce delirium, ICU stays, length of stay, and readmissions in older surgical patients. Clinicians will benefit from in-depth training in geriatric care to enable the implementation of structures and processes to improve outcomes.  

Who Should Attend

• Specialty Physicians
• Physician Assistants
• Nurses
• Nurse Practitioners
• Primary Care Physicians 

Learning Objectives

Upon completion of this activity, participants will be able to:

• Apply the 4 Ms (Medication, Mobility, what Matters, and Mentation) of the Age-Friendly Health Systems Initiative to older surgical patients. 
• Identify strategies to mitigate risks for delirium and falls among older surgical patients. 
• Describe the associations between geriatric syndromes such as frailty, dementia, and adverse postoperative outcomes. 
• List potentially inappropriate medications for older surgical patients and strategies to optimize medications. 
• Describe approaches for a safe and effective care transition for older patients, caregivers, and families. 
• Recognize the components of effective communication with older patients, asking what matters most, and incorporate these priorities into surgical planning.