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February 19, 2019

Surgical Decision Making for Older Adults

Author Affiliations
  • 1Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
  • 2VA Greater Los Angeles Healthcare, Los Angeles, California
JAMA. 2019;321(7):716. doi:10.1001/jama.2019.0283

Surgery in older patients involves an increased risk of complications and subsequent changes to quality of life.

Considering Health Goals

Before deciding to undergo an operation, patients should establish their health care–related priorities, such as the importance of prolonging life, preserving independence, or maintaining quality of life. Once these are determined, patients should discuss with their surgeon how the proposed operation will influence those priorities. For example, a patient considering hip replacement surgery whose goal is to improve pain and function may decide to proceed with the operation in order to meet that goal. In another example, patients who have rectal cancer needing surgical resection must consider the risks of postoperative complications and not being able to care of themselves at home for a very long time. If your personal priority is maintaining a certain quality of life and being independent (for example, living at home) rather than living longer but depending on others, you may decide not to proceed with surgery.

What Will the Recovery From Surgery Be Like?

Older patients take more time to recover and need more support compared with younger patients. Some patients go directly home after surgery and are able to recover without assistance or with minimal help from a friend or family member. More commonly, some sort of assistance is needed to help recover, such as home visits from nurses or physical therapists. Some patients are transferred to a skilled nursing facility from the hospital after surgery to receive full-time care. It is important to ask what will likely happen in your case when you leave the hospital. While a surgeon may not be able to provide a definite answer, he or she will consider your preoperative physical status and the type of operation needed to assess what your recovery process might be like.

After Recovery, What Will Daily Life Be Like?

After the recovery process is complete, a patient’s return to his or her previous state of health depends on many factors such as physical strength and how major the operation was. New mobility aids or treatments such as a walker, supplemental oxygen, or medications may be necessary. Even if you are able to return to your baseline function after surgery, certain aspects of daily life may be different. It is important to ask the surgeon about these things before an operation to accurately balance the risks and benefits of surgery and to determine the effect of surgery on daily life. Every patient is different, and the surgeon will use his or her best judgment to advise you about what your life after surgery might be like.

Final Decision Making

The decision whether to have surgery is personal. You should gather as much information as possible about the proposed surgery and how it will affect you. Ask your doctors about every aspect of care that you have concerns about. You should also talk to family members and loved ones to help make your decision. There is no right or wrong answer, only what is best for each patient personally.

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For More Information

To find this and other JAMA Patient Pages, go to the For Patients collection at jamanetworkpatientpages.com. A JAMA Patient Page on what to ask your surgeon before an operation was published in the February 3, 2015, issue of JAMA.

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
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Article Information

Conflict of Interest Disclosures: Dr Russell reported receipt of consultant fees from the American College of Surgeons and Healthgrades. No other disclosures were reported.

Source: Oresanya LB, Lyons WL, Finlayson E. Preoperative assessment of the older patient: a narrative review. JAMA. 2014;311(20):2110-2120. doi:10.1001/jama.2014.4573