Affiliation:
1. Center for Surgery and Public Health Brigham and Woman's Hospital Boston Massachusetts USA
2. Department of Surgery Brigham and Woman's Hospital Boston Massachusetts USA
3. Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai New York New York USA
4. Department of Psychosocial Oncology and Palliative Care Dana Farber Cancer Institute Boston Massachusetts USA
5. Department of Medicine Brigham and Woman's Hospital Boston Massachusetts USA
6. Department of Medicine Beth Israel Deaconess Medical Center Boston Massachusetts USA
7. Division of Palliative Care and Geriatric Medicine, Department of Medicine Massachusetts General Hospital Boston Massachusetts USA
Abstract
AbstractIntroductionSerious illness is a life‐limiting condition negatively impacting daily function, quality of life, or excessively straining caregivers. Over 1 million older seriously ill adults undergo major surgery annually, and national guidelines recommend that palliative care be available to all seriously ill patients. However, the palliative care needs of elective surgical patients are incompletely described. Understanding baseline caregiving needs and symptom burden among seriously ill older surgical patients could inform interventions to improve outcomes.MethodsUsing Health and Retirement Study data (2008–2018) linked to Medicare claims, we identified patients ≥66 years who met an established serious illness definition from administrative data and underwent major elective surgery using Agency for Healthcare Research and Quality (AHRQ) criteria. Descriptive analyses were performed for preoperative patient characteristics, including: unpaid caregiving (no or yes); pain (none/mild or moderate/severe); and depression (no, CES‐D < 3, or yes, CES‐D ≥ 3). Multivariable regression was performed to examine the association between unpaid caregiving, pain, depression, and in‐hospital outcomes, including hospital days (days admitted between discharge date and one‐year post‐discharge), in‐hospital complications (no or yes), and discharge destination (home or non‐home).ResultsOf the 1343 patients, 55.0% were female and 81.6% were non‐Hispanic White. Mean age was 78.0 (SD 6.8); 86.9% had ≥2 comorbidities. Before admission, 27.3% of patients received unpaid caregiving. Pre‐admission pain and depression were 42.6% and 32.8%, respectively. Baseline depression was significantly associated with non‐home discharge (OR 1.6, 95% CI 1.2–2.1, p = 0.003), while baseline pain and unpaid caregiving needs were not associated with in‐hospital or post‐acute outcomes in multivariable analysis.ConclusionsPrior to elective surgery, older adults with serious illnesses have high unpaid caregiving needs and a prevalence of pain and depression. Baseline depression alone was associated with discharge destinations. These findings highlight opportunities for targeted palliative care interventions throughout the surgical encounter.
Funder
National Institutes of Health
Subject
Geriatrics and Gerontology