How Seniors Can Prepare for Surgery and Heal Faster
Planning for an operation is daunting. That’s even more true for many older adults, who may have health problems that could impact their recovery. “Every patient is unique, and that’s especially true for older adult patients,” says Hiroko Kunitake, MD, MPH, a Mass General Brigham colorectal surgeon. Dr. Kunitake is the surgical director of the Perioperative Optimization of Senior Health (POSH) Program at Massachusetts General Hospital.
There are steps you can take before surgery to optimize your health and boost the odds of a positive outcome. “By collaborating with your medical team and planning ahead, you can maximize the chances of a successful surgery and ensure a smooth recovery,” says Masaya Higuchi, MD, MPH, a Mass General Brigham geriatric medicine physician and medical director of the POSH Program.
Drs. Higuchi and Kunitake share strategies to help reduce the risks for older adults before, during, and after surgery.
Most common surgeries for elderly patients
Many medical conditions can be treated surgically, and the population of older adults undergoing surgery is increasing rapidly. As technology has advanced, surgical procedures can safely be offered to patients who may have been considered too high risk in the past. In addition, many more surgeries are now done using minimally invasive techniques. These approaches can reduce the amount of pain after an operation and decrease the length of recovery time.
Among patients over age 70, the most common surgeries include:
- Cancer surgery, including surgery for colorectal cancer
- Gallbladder removal (cholecystectomy)
- Lens and cataract (eye) surgeries
Questions to ask before surgery
If you’re considering surgery or caring for a loved one who needs an operation, you probably have a lot of questions. This checklist can help you prepare for your doctor visit.
Make a list.
“Before your appointment, write down the things you want to ask, and the things you’d like your doctor to understand about your health goals,” Dr. Higuchi suggests. “It can be easy to forget things you wanted to talk about at the time of your appointment, especially when you’re overwhelmed with medical information.”
Bring support.
Talking about medical conditions and treatment options can be overwhelming. There’s a lot of information to process, and a lot of questions to ask. “It always helps to have a friend or family member with you to help ask questions and take notes,” Dr. Kunitake says.
Talk about timelines.
Some medical conditions should be treated as soon as possible. But many others aren’t urgent. Talk to your doctor about whether it’s reasonable to schedule surgery a few months down the road. “When you can plan ahead, you have more time to optimize your health before the procedure,” Dr. Higuchi says.
Discuss what to expect.
It’s important to ask what the recovery process looks like. That includes details like how long you will spend in the hospital and what type of care or services you’ll need as you recover.
“It’s also important to get a sense of how surgery might impact you functionally, like walking and eating, in the months to come,” Dr. Kunitake says. “Ask about whether to expect needing to go to for rehabilitation or physical therapy, and whether you can expect to live independently after you recover.”
Ask about programs or services that can help optimize recovery.
Programs like those offered by the POSH Clinic work with older patients and their care teams to develop personalized plans to improve surgical outcomes, Dr. Kunitake adds. And some medical specialties offer their own resources to help you prepare for surgery.
For instance, many joint replacement programs offer “prehabilitation” (also called prehab) to help people maximize their physical function prior to surgery. Prehab can help strengthen muscles and improve flexibility before a knee replacement or other joint surgery. Ask your doctor if such programs are available where you’re receiving care.
How to prepare weeks before surgery
Whether you’re having surgery in a few months or a few weeks, there are things you can do to prepare your body and brain. Those actions are built around the “5Ms,” Dr. Higuchi explains:
1. Mind
One common complication of surgery in older adults is a condition known as postoperative delirium. This sudden change in mental function can cause people to become confused and disoriented. It can develop as a reaction to anesthesia, medications, or sometimes in response to the surgery itself. Older adults can also develop cognitive problems after surgery that affect skills such as memory, attention, and decision-making.
You can reduce the risk of delirium and cognitive impairment by tending to your psychological well-being and cognitive function in the weeks and months before surgery:
- Optimize sensory input, such as updating eyeglass prescriptions and hearing aids
- Treat mental health problems, such as depression and anxiety, with medication or therapy
2. Mobility
Improving strength, balance, and mobility before surgery can do a lot to streamline your recovery. “I can’t overstress the importance of physical fitness and strength,” says Dr. Higuchi.
He suggests walking, balance exercises, and gentle resistance exercises (such as lifting light weights or using resistance bands) in the weeks and months before a scheduled surgery. “Every bit of exercise you can do before surgery will be helpful to your recovery after,” he adds.
3. Medications
Some medications can interact with anesthesia or increase the risk of complications such as cognitive problems or bleeding after surgery. “It’s important to speak to your primary care doctor ahead of surgery to make sure you aren’t taking any high-risk medications,” Dr. Higuchi says.
Be sure to mention over-the-counter medications and supplements you take, too. “Have this conversation as soon as possible,” he adds. “If you do need to make changes, it’s ideal to do that well ahead of surgery.”
4. Multicomplexity
It’s a big word for a simple concept: Older adults often juggle multiple medical conditions. And they may have other factors that influence their health and health care, such as their psychological conditions, social situations, and more.
Patients, caregivers, and doctors should work together to consider how those conditions might affect their recovery. They should also think about the factors that will affect their well-being as they prepare for surgery. Those factors include:
- Getting good nutrition
- Where you’ll stay as you recover
- The safety of your environment (for instance, arranging to sleep on the first floor if you can’t climb stairs after surgery)
- What kind of assistance you might need, and who will provide it
- The resources available to you, such as physical therapy or rehabilitation
5. What matters most
Not everyone has the same goals for surgery. One person might want to treat their medical condition in the most aggressive manner possible, even if it means a prolonged recovery. For another person, being in a rehabilitation center for weeks or months might be unacceptable.
When it comes to your health, your goals and values are what counts. Have a conversation with your doctors and caregivers well ahead of surgery to clarify your goals.
“Sometimes, considering what is important to them can lead patients to decide that surgery isn’t actually the best option,” says Dr. Kunitake. “What’s important is that you work with your medical team to find other ways to manage your symptoms that align with what matters most to you.”
As you think about your goals, it’s a good time to update your healthcare proxy — a document that names people who can make healthcare decisions for you if you’re unable to do so. Make sure you also take time to talk to loved ones about your preferences for medical care and what matters most to you, Dr. Higuchi adds.
Surgery does come with risks. But when you’re prepared, you can minimize those risks as you work to achieve better health. “It’s always important to hope for the best outcome,” Dr. Higuchi says. “And it’s valuable to plan ahead so that you have strategies in place to address any complications or challenges that might arise.”
With plans in place, patients should be optimistic about their outcomes from surgery, he adds. “You are the captain of your ship. By working together with your health care providers, you can maximize your chance of overcoming your illness, achieving your goals of care, and recovering from surgery as well and as fast as possible.”