Connection is Key to Recovery

Anesthesiologists promote holistic care during Older Adults Month

By Dr. Odmara Barreto Chang

An old adage commonly used among caretaking is “it takes a village.” Generally, this saying is used in the raising of a child but is applicable throughout the course of our lives. Community is vital to the health and wellbeing of all people, regardless of age, and rings especially true as we consider an approach to healthcare for older adults.

Every May, the Administration for Community Living leads the nation’s observance of Older Americans Month. The 2024 theme is “Powered by Connection,” which recognizes the profound impact that meaningful connections have on our health. Leading professional anesthesiologists from the California Society of Anesthesiologists, advocate for a multidisciplinary approach to anesthesia care that promotes diligent screening and creating lasting connections with patients and their greater care team to ensure the best patient care.

Last year, Harvard Medical School published research that suggests that postoperative delirium, one of the most common surgery complications in older adults, is associated with a 40% faster rate of cognitive decline than those who did not experience postoperative delirium. The researchers noted that further studies are needed, but that the study raises the possibility that delirium may predispose older patients to permanent cognitive decline that could even cause dementia. This study clearly shows the importance of delirium prevention which starts with careful screening of patients before they are administered anesthesia and staying in close contact with other members of the patient care team.

It is imperative that all members of the patient care team—from primary care doctors to anesthesiologists to surgeons—are actively sharing information about the patient’s health and screening diligently to best inform their care. In recent years, it has been noticed that not all primary care doctors are evaluating neurological conditions in their annual screenings and that as many as two-thirds of people with dementia may be misdiagnosed (PMID: 31783848). This small oversight reduces vital data that can be used to guide the perioperative care of older adults. Anesthesiologists also are trying to incorporate preoperative cognitive testing during preoperative evaluations but this is not always available. Patient care currently exists in specialized silos, but the best healthcare exists when every medical professional works in tandem to ensure the patient’s safety.

New approaches to screening to reduce the risk of postoperative delirium include participants using a computer tablet to complete the TabCAT Brain Health Assessment, a brief test developed at UCSF. This assessment measures spatial skills, the ability to generate words, and how well patients can match and recall objects. It is also crucial for patients to forgo certain medications prior to surgery that have been linked to an increased risk of delirium. There are simple recovery strategies to help reduce the risk of post-op delirium, such as giving patients’ prescription glasses back to them soon after surgery, and ensuring they have a loved one nearby when they wake up from anesthesia. Anesthesiologists across the state are already implementing these measures but more attention is needed on the importance of these extra steps and the difference they can make between a patient’s cognitive abilities declining after surgery or remaining intact.

It is important for medical professionals, no matter what sector they are in, to form a meaningful connection with their patients. Especially with older adults who may not have many loved ones to keep them company while going through surgery. Research shows that having a strong support system has a positive impact on our health. Medical professionals have a responsibility beyond the procedures and checkups. We are responsible for making sure the patient has support, especially after surgery, as it can lead to a swift recovery. Our ability to connect with patients is a crucial component to their lasting recovery.

Holistic health is not just a buzzword, but a necessary practice that all medical disciplines should enact to work together as a team for the best patient care possible. Diligence at every stage of the care process—from checking in on mental health to performing thorough screenings ahead of surgery—is vital to the overall health of our older patients this month, and every month. My colleagues at the California Society of Anesthesiologists are proud to pave the way to more holistic healthcare practices for our older adult patients to a healthier and happier future and encourage other disciplines in the medical field to follow suit. It takes a village, after all.

Odmara L. Barreto Chang, MD, PhD, is an anesthesiologist and neuroscientist in the Department of Anesthesia and Perioperative Care at the University of California San Francisco. Her research focuses on understanding the molecular and behavioral basis of cognitive impairment after surgery. She seeks to improve both the information patients receive during the perioperative evaluation in terms of their brain health assessment and develop potential neuroprotection approaches during the period of surgery and postoperative recovery.