A Qualitative Study of Perioperative Depression and Anxiety in Older Adults

Abraham, Joanna; Meng, Alicia; Siraco, Susan; Kannampallil, Thomas; Politi, Mary C.; Baumann, Ana A.; Lenze, Eric J.; Avidan, Michael S.

doi:10.1016/j.jagp.2020.02.010

Cited by 22 publications

(21 citation statements)

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“…Even so, with a lengthy waitlist despite resuming elective surgeries, patients continue to experience clinical depression that could lead to disruption of their daily activities (The Lancet R, 2021 ). Moreover, anxiety and depression peri-operatively are psychological factors associated with surgical recovery, length of hospitalization, readmission rates and mortality of the older patient (Abraham et al, 2020 ; Ghoneim & O'Hara, 2016 ; Singleton & Poutawera, 2017 ). Even though it is important to be cognizant of peri-operative psychological distress, this study however, did not demonstrate the impact of postponement on HADS scores in a statistically significant manner.…”

Section: Discussionmentioning

confidence: 99%

Psychological distress among elderly surgical patients who had their surgery postponed during the COVID-19 pandemic

et al. 2022

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Background Many institutions withheld elective lists and triaged surgeries during the peak of coronavirus disease 2019 (COVID-19) pandemic. As a result, older surgical patients have had to wait for rescheduled dates in a long waitlist. This study aimed to identify the psychological impact in these patients when they returned for surgery. Methods This was a cross-sectional study which included 153 patients aged ≥ 65 years undergoing elective surgery. Trained interviewers recruited and assessed psychological status pre-operatively with two validated questionnaires - Hospital Anxiety and Depression Scale (HADS) and 36-item Short Form Health Survey (SF-36). Specific questions were asked about their postponed surgeries, appetite and fear. Results A total of 36 out of 153 (23.5%) patients had their procedures deferred during the first wave of COVID-19 pandemic. Postponed cases were significantly based on the nature of surgery (p = 0.002), cancer diagnosis (p = 0.006) and surgical specialty (p = 0.023). Median HADS scores were higher for patients who were postponed (2.00 versus 4.00 for anxiety, p = 0.180 and 0.00 versus 1.00 for depression, p = 0.424) although no statistical significance was shown. In the whole study population, anxiety was a significant predictor for depression and vice versa (p < 0.001) with other predictive risk factors for anxiety that were age ≥ 85 years old (odds ratio [OR] 6.14, p = 0.018), female (OR 2.41, p = 0.024), cancer (OR 2.19, p = 0.039) and major surgery (OR 2.39, p = 0.023). Similarly, older patients ≥ 85 years old (OR 10.44, p = 0.003) and female (OR 6.07, p = 0.006) had higher risk for depression. Both anxiety and depression were significant risks for loss of appetite (p = 0.005 and 0.001). Lastly, the fear of disease progression due to rescheduling was more frequent in cancer patients (p = 0.035). Conclusion The mental health and disease burden of older surgical patients should be taken into careful consideration when cases need to be postponed in our healthcare system.

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Section: Discussionmentioning

confidence: 99%

Psychological distress among elderly surgical patients who had their surgery postponed during the COVID-19 pandemic

et al. 2022

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“…Many interventions can be used to educate and prepare patients for surgery, from breathing and muscle exercises, incentive to stop smoking, dietary counselling, and appropriate counselling or psychological intervention for patients at risk of distress (McCann et al., 2019). In older adults, the perioperative factors identified that fear of surgery should be accessed, as knowledge about the surgery and its recovery, pain, neurocognitive disorders and medication management (Abraham et al., 2020).…”

Section: Discussionmentioning

confidence: 99%

Needs of older persons undergoing cardiac surgery: Exploring the perceptions of nurses, patients waiting for and patients having had surgery

Rodrigues

Henriques

2022

Nursing Open

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Technological and medical advances are increasing which means a growing number of adults are having surgical performances, usually older, higher risk, disabled and debilitated (Abreu, 2018;McCann et al., 2019). Open-heart surgery emerges when conservative ways of treatment are no longer a viable resource, it leads to acute stress, and it is associated with morbidity and mortality related to the underlying disease, surgical technical procedures and other factors (Abreu, 2018;McCann et al., 2019). Relying on evidence found through the years, we should not discuss whether implementing a pre-operative intervention in patients waiting for open-heart surgery is necessary, but rather how to implement it, making it more accessible to all (Ettema et al., 2014;McCann et al., 2019).Open-heart surgery patients are getting older; therefore, caring is increasingly more complex due to comorbid disease, frailty and psychosocial concerns (Abreu, 2018;McCann et al., 2019). It is estimated that in the next few years, the ageing of population will affect the perioperative patient care, and the number of surgical procedures will rise and consequently surgery waiting times (Abreu, 2018).

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“…In our prior needs assessment interview study with older surgical adults diagnosed with anxiety and depression and their treating clinicians, 18 we found that older surgical patients had varying care experiences, depending on their symptoms in the perioperative setting. Fear and uncertainty leading into the surgery and poor management of their depression and anxiety medications postoperatively were of key concern.…”

Section: Introductionmentioning

confidence: 91%

“…In other words, we lack effective interventions tailored for older surgical patients, in spite of the high prevalence of depression and anxiety in this population, 17 frequent co-occurring cognitive impairment and detrimental impact on surgical recovery. 18 …”

Section: Introductionmentioning

confidence: 99%

Perioperative mental health intervention bundle for older surgical patients: protocol for an intervention development and feasibility study

et al. 2022

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IntroductionThe perioperative period is high risk for older adults. Depression and anxiety are common perioperative problems, frequently coexisting with cognitive impairment. Older patients with these conditions are more likely than younger patients to experience postoperative delirium, long hospital stays, poor quality of life and rehospitalisation. These experiences can, in turn, exacerbate anxiety and depressive symptoms. Despite these risks, little is known about how to treat perioperative anxiety and depression among older adults.Methods and analysisWe designed a feasibility study of a perioperative mental health intervention bundle to improve perioperative mental health, specifically depression and anxiety. The overarching goals of this study are twofold: first, to adapt and refine an intervention bundle comprised of behavioural activation and medication optimisation to meet the needs of older adults within three surgical patient populations (ie, orthopaedic, oncological and cardiac); and second, to test the feasibility of study procedures and intervention bundle implementation. Quantitative data on clinical outcomes such as depression, anxiety, quality of life, delirium, falls, length of stay, hospitalisation and pain will be collected and tabulated for descriptive purposes. A hybrid inductive–deductive thematic approach will be employed to analyse qualitative feedback from key stakeholders.Ethics and disseminationThe study received approval from the Washington University Institutional Review Board. Results of this study will be presented in peer-reviewed journals, at professional conferences, and to our perioperative mental health advisory board.Trial registration numberNCT05110690.

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A Qualitative Study of Perioperative Depression and Anxiety in Older Adults

Cited by 22 publications

References 58 publications

Psychological distress among elderly surgical patients who had their surgery postponed during the COVID-19 pandemic

Psychological distress among elderly surgical patients who had their surgery postponed during the COVID-19 pandemic

Needs of older persons undergoing cardiac surgery: Exploring the perceptions of nurses, patients waiting for and patients having had surgery

Perioperative mental health intervention bundle for older surgical patients: protocol for an intervention development and feasibility study

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