Perioperative medicine for older people: Learning across continents

Partridge, Judith; Aitken, Rachel M; Dhesi, Jugdeep

doi:10.1111/ajag.12723

Cited by 5 publications

(8 citation statements)

References 15 publications

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“…While our study was undertaken across two countries, our findings may not be generalisable to other countries. However, given the development of perioperative medicine is a global movement [6], the findings are likely to resonate with geriatricians in several countries. Like other qualitative studies, the findings may not be representative of the whole geriatrician population, and this study predominantly included heads of geriatric medicine department, although we actively sought a wide range of perspectives.…”

Section: Discussionmentioning

confidence: 99%

“…Momentum for integrated proactive perioperative services for older patients is growing across several countries [6]. A recent survey showed that geriatricians perceive a need to provide greater input into the care of older surgical patients [15].…”

Section: Discussionmentioning

confidence: 99%

“…5 Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, and Prince of Wales Clinical School, University of New South Wales, Sydney, Australia. 6 Kolling Institute of Medical Research, Sydney Medical School, University of Sydney and Royal North Shore Hospital, Sydney, Australia.…”

Section: Acknowledgementsmentioning

confidence: 99%

“…Therefore surgeons are looking after older and more complex patients who have multimorbidity, polypharmacy, frailty and other geriatric syndromes which increase their risk of perioperative morbidity and mortality [3][4][5]. This has seen the emergence of perioperative medicine for older patients [6], where a multidisciplinary surgical team assesses, manages and optimises the patient throughout the continuum of care from the decision to operate to long-term recovery. While traditional perioperative management has involved optimisation of single-organ systems or specific diseases (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Geriatrician perspectives on perioperative care: a qualitative study

Thillainadesan

Jansen

et al. 2021

BMC Geriatr

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Background Perioperative medicine services for older surgical patients are being developed across several countries. This qualitative study aims to explore geriatricians’ perspectives on challenges and opportunities for developing and delivering integrated geriatrics perioperative medicine services. Methods A qualitative phenomenological semi-structured interview design. All geriatric medicine departments in acute public hospitals across Australia and New Zealand (n = 81) were approached. Interviews were conducted with 38 geriatricians. Data were analysed thematically using a framework approach. Results Geriatricians identified several system level barriers to developing geriatrics perioperative medicine services. These included lack of funding for staffing, encroaching on existing consultative services, and competing clinical priorities. The key barrier at the healthcare professional level was the current lack of clarity of roles within the perioperative care team. Key facilitators were perceived unmet patient needs, existing support for geriatrician involvement from surgical and anaesthetic colleagues, and the unique skills geriatricians can bring to perioperative care. Despite reporting barriers, geriatricians are contemplating and implementing integrated proactive perioperative medicine services. Geriatricians identified a need to support other specialties gain clinical experience in geriatric medicine and called for pragmatic research to inform service development. Conclusions Geriatricians perceive several challenges at the system and healthcare professional levels that are impacting current development of geriatrics perioperative medicine services. Yet their strong belief that patient needs can be met with their specialty skills and their high regard for team-based care, has created opportunities to implement innovative multidisciplinary models of care for older surgical patients. The barriers and evidence gaps highlighted in this study may be addressed by qualitative and implementation science research. Future work in this area may include application of patient-reported measures and qualitative research with patients to inform patient-centred perioperative care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Acknowledgementsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Geriatrician perspectives on perioperative care: a qualitative study

Thillainadesan

Jansen

et al. 2021

BMC Geriatr

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“…1 There is increasing evidence that such presurgical assessments are beneficial for risk stratification, particularly in older adults, a highly heterogeneous group that is often characterised by a reduced homeostatic capacity. 2,3 For example, the preoperative identification of frailty, a process that requires adequate staff resources and time given the multidimensional nature of the assessment, has been shown to predict postsurgery delirium, falls, infections, prolonged hospitalization, and mortality. 4,5 However, critical issues arising from these observations are (a) whether anything else can be done in the frail older patient awaiting surgery, apart from selecting the most appropriate anaesthetic protocol, surgical procedure, and rehabilitation plan and (b) whether the presence and the severity of frailty can be identified using alternative, more straightforward, tools.…”

mentioning

confidence: 99%

Preoperative polypharmacy assessment for risk stratification and management

Mangoni

Russell

Jarmuzewska

2022

Brit J Clinical Pharma

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Geriatric care for surgical patients: results and reflections from a cross-sectional survey in acute Belgian hospitals

et al. 2023

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Purpose To explore geriatric care for surgical patients in Belgian hospitals and geriatricians’ reflections on current practice. Methods A web-based survey was developed based on literature review and local expertise, and was pretested with 4 participants. In June 2021, the 27-question survey was sent to 91 heads of geriatrics departments. Descriptive statistics and thematic analysis were performed. Results Fifty-four surveys were completed, corresponding to a response rate of 59%. Preoperative geriatric risk screening is performed in 25 hospitals and systematically followed by geriatric assessment in 17 hospitals. During the perioperative hospitalisation, 91% of geriatric teams provide non-medical and 82% provide medical advice. To a lesser extent, they provide geriatric protocols, geriatric education and training, and attend multidisciplinary team meetings. Overall, time allocation of geriatric teams goes mainly to postoperative evaluations and interventions, rather than to preoperative assessment and care planning. Most surgical patients are hospitalised on surgical wards, with reactive (73%) or proactive (46%) geriatric consultation. In 36 hospitals, surgical patients are also admitted on geriatric wards, predominantly orthopaedic/trauma, abdominal and vascular surgery. Ninety-eight per cent of geriatricians feel that more geriatric input for surgical patients is needed. The most common reported barriers to further implement geriatric-surgical services are shortage of geriatricians and geriatric nurses, and unadjusted legislation and financing. Conclusion Geriatric care for surgical patients in Belgian hospitals is mainly reactive, although geriatricians favour more proactive services. The main opportunities and challenges for improvement are to resolve staff shortages in the geriatric work field and to update legislation and financing.

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Perioperative medicine for older people: Learning across continents

Cited by 5 publications

References 15 publications

Geriatrician perspectives on perioperative care: a qualitative study

Geriatrician perspectives on perioperative care: a qualitative study

Preoperative polypharmacy assessment for risk stratification and management

Geriatric care for surgical patients: results and reflections from a cross-sectional survey in acute Belgian hospitals

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