General surgery

The researches find that the doctors recommended two high-risk surgeries to restore blood flow. Without the procedures, McHenry, 82, would die. The surgeon at a Boston teaching hospital ticked off the possible complications. Karen McHenry, the patient’s daughter; remembers feeling there was no choice but to say “go ahead.” It’s a scene she’s replayed in her mind hundreds of times since; with regret. On the operating table, Bob McHenry had a stroke. For several days, he was comatose. When he awoke, he couldn’t swallow or speak and had significant cognitive impairment.

High-risk surgeries

Vascular dementia and further physical decline followed until the elderly man’s death five years later. Before her father’s October 2012 surgery; “there was not any broad discussion of what his life might look like if things didn’t go well;” said Karen McHenry, 49, who writes a blog about caring for older parents. “They couldn’t even imagine what ended up happening.” It’s a common complaint: Surgeons don’t help older adults and their families understand the impact of surgery in terms people can understand; even though older patients face a higher risk of complications after surgeries.

Nor do they routinely engage in “shared decision-making;” which involves finding out what’s most important to patients and discussing surgery’s potential effect on their lives before setting a course for treatment. Older patients, it turns out; often have different priorities than younger ones. More than longevity, in many cases, they value their ability to live independently and spend quality time with loved ones; according to Dr. Clifford Ko, professor of surgery at UCLA’s David Geffen School of Medicine.

Caring for older parents

Now new standards meant to improve surgical care for older adults have endorse by the American College of Surgeons. All older patients should have the opportunity to discuss their health goals and goals for the procedure, as well as their expectations for their recovery and their quality of life after surgery, according to the standards. Surgeries should review their advance directives  instructions for the care they want in the event of a life-threatening medical crisis or offer patients without these documents the chance to complete them.

Surrogate decision-makers authorized to act on a patient’s behalf should be named in the medical record. If a stay in intensive care is expected after surgery, that should be made clear, along with the patient’s instructions on interventions such as feeding tubes, dialysis, blood transfusions, cardiopulmonary resuscitation and mechanical ventilation. This is far cry from how “informed consent” usually works. Generally, surgeons explain to an older patient the physical problem, how surgery is meant to correct it and what complications are possible, backed by references to scientific studies.