Elder-Friendly Approaches to the Surgical Environment
Feb. 4, 2015
By Connie Bryson and AIHS staff
As our population ages, there is a larger number of elderly people who get sick and require surgery. Seniors experience twice as many damaging health problems as younger patients when admitted to hospital, including surgical complications.As Canada’s population ages and seniors live longer, it’s expected that one in four Canadians will be 65 or older by 2040. Alberta researchers have begun a three-year project called the Elder-Friendly Approaches to the Surgical Environment (EASE). The project aims to help the healthcare system adapt to our aging population, with the focus on surgery.
“It’s not the actual surgery that’s the issue—older people tend to be more complex patients because they’re frail or have other illnesses such as diabetes or cardiovascular disease. These factors can set them up for poor outcomes,” explains surgeon Dr. Rachel Khadaroo, surgeon, EASE project lead and assistant professor, Department of Surgery at the University of Alberta.
Alberta Innovates – Health Solutions’ (AIHS) Partnership for Research and Innovation in the Health System (PRIHS) program and Alberta Health Services have provided funding for the EASE study. Researchers working on this project are affiliated with the Seniors’ Health Strategic Clinical Network (SCN).
“We’re looking beyond the operating table for answers to better care. We’re testing new ways of doing pre-operative and post-operative care. We’re hoping to decrease the length of stay in hospital as well as complications such as falls and delirium, which are so detrimental to well-being.”
The EASE study is the first of its kind to transform a hospital unit into an elder-friendly environment.
Dr. Khadaroo has already collaborated with the Misericordia Hospital to help bring these elder friendly principles to their surgery ward. She and her team will be working with Edmonton’s University of Alberta Hospital and Calgary’s Foothills Hospital in 2015.
“Going forward, these approaches will be important for every hospital department, not just surgery. Our goal is that this unit will be modelled in other units in Alberta and across Canada.”
Hear from a patient
David Robertson admires the courage with which his father John Robertson took his diagnosis of colon cancer in January 2014. Ninety-one years old, John was living on his own in a seniors’ lodge in Edmonton. He was happy and seemingly healthy, a dedicated user of public transit to get himself around town. The diagnosis came as a shock but an even greater one was in store for the Robertson family—John was denied surgery. Eventually, abdominal bleeding lowered his hemoglobin perilously and he was taken to the University of Alberta Hospital. Emergency surgery was the only option. “John was on death’s door when I operated on him,” recalls surgeon Dr. Rachel Khadaroo. His recovery was slow but steady.
John is now living independently and running his own errands again. “We went from basically being told he’d die to him being back to his old self,” says David. “I still don’t know what to think about all this. The cardiologist said that although my dad was 91 he has the heart of a 60-year-old. But everyone before his emergency surgery seemed to focus on his age, not his potential for recovery.
- Care from an interdisciplinary team. A geriatrician, nursing and rehabilitation specialists, and a social worker will work with the surgical team, patient and family. “Our goal is patient- and family-centered care,” says Dr. Khadaroo. “We want everyone involved early in the decision making.
- Customized care. This involves a suite of evidence-based, best-care practices such as early mobilization and early feeding, and comfort rounds (where a healthcare worker assesses a patient every two hours; particularly helpful for older patients because they can help prevent delirium and decrease the likelihood of developing pressure ulcers). Dr. Khadaroo calls these practices “a low-tech approach to preventing huge problems.”
- Tailored transitions. Systems to help patients and their families plan—early on in their hospital stay—for a return home or move to alternate care. “We want everyone involved in the decision making early, not just when discharge is imminent,” says Dr. Khadaroo.
- Specialized rehabilitation. A physiotherapist collaborates with Khadaroo’s team to develop new patient-specific exercises that can be done in bed.
- Creation of an elder-friendly surgical unit. This long-term goal involves locating higher risk older patients on one unit.
The testing of these five approaches will take place in 2015 at Edmonton’s University of Alberta Hospital and at Calgary’s Foothills Hospital.
LEARN MORE: Muscle loss is key to loss of independence in elderly according to Dr. Khadaroo’s published research.