1 in 3 Older Americans With Dementia Died a Year After Major Surgery

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  • Researchers found nearly 1 in 7 older Americans who were not living in a nursing home died within a year after major surgery.
  • Those who were frail or living with dementia and had surgery were at far higher risk.
  • Over 1 in 4 frail seniors and almost 1 in 3 of those with probable dementia died in the same period.

About 14 percent of community-living older adults in the U.S. died in the year after undergoing major surgery, with a significantly higher risk for those who were frail or living with dementia, according to new research from Yale University that was published October 19 in JAMA Surgery.

The findings were based on data from roughly 1,000 community-living Medicare beneficiaries aged 65 and older that had major surgery between 2011 and 2017.

Dr. Thomas M. Gill, the Humana Foundation Professor of Geriatric Medicine at Yale and lead author of the study told Healthline he conducted this study because nationally representative estimates for mortality in the year after major surgery, both elective and non-elective, still aren’t readily available for older persons.

Patients averaged 79 years old

Gill and team analyzed data from 1,193 major surgeries from 992 community-living older adults enrolled in the National Health and Aging Trends Study (NHATS).

All patients were Medicare beneficiaries, and major surgeries and mortality were identified by linking to Centers for Medicare & Medicaid Services data.

Patients were 79 years on average, and 56 percent were women. Over 75 percent were white and nearly 17 percent were Black.

Stark figures for seniors with dementia, frailty

While researchers found nearly 1 in 7 older Americans who were not living in a nursing home died within a year after major surgery, for those who were frail or living with dementia – the numbers were far starker.

Over 1 in 4 frail seniors and almost 1 in 3 of those with probable dementia died in the same period.

In comparison, the expected one-year mortality rate was less than five percent if they did not have major surgery.

“Although we expected that indicators of geriatric vulnerability, including frailty and dementia, would increase mortality in the year after major surgery,” said Gill. “The magnitude of these effects were much larger than we had anticipated.”

A break in the system

An editorial in the Journal of the American Medical Association (JAMA) regarding Gill’s study warns of a “break in the system,” where the goals of surgery are often not accomplished following surgery.

“These findings are likely to have an even more drastic effect on patients in the assisted-living setting, with clear unmet needs for those most vulnerable,” the authors wrote.

The editorial concludes that results like those presented by Gill and team “may help create a better understanding of trade-offs in the consideration of surgery.”

These patients require special attention

“Older persons who have major surgery should be assessed for indicators of geriatric vulnerability,” said Gill. “Those who are vulnerable because of frailty and/or dementia warrant special attention to improve their long-term outcomes.

Experts explained some reasons why seniors may experience increased mortality risk after major surgery for Healthline.

“Aging can cause unique health issues especially since older patients often face different risks after invasive procedures,” said Dr. Louis Morledge, an internist at Lenox Hill Hospital in New York.

He explained that some of the basic concerns for geriatric patients include healing issues (slow to heal or reinfection of wound sites), cardiac and pulmonary issues, blood clotting that could sometimes result in thromboembolic embolism (blood clots in veins), and increased confusion or possible memory loss.

Sometimes surgery risk outweighs benefits

Asked if there could ever be a situation where surgery is delayed or not recommended because of the patient’s advanced age, Morledge said “Absolutely.”

“There will always be procedures where the implications and risks of the procedure firmly outweigh its benefits – especially for a geriatric patient population,” he explained.

Morledge advises that patients discuss any health problems before surgery, all medications taken, including nutritional or herbal supplements, and any concerns or fears about their surgery.

“The patient or caregiver should describe any surgeries and any problems experienced with anesthesia in the past,” he added. “Also talk about any memory problems or thinking problems you may have experienced after having anesthesia.”

Betsy Mills, PhD, Assistant Director of Aging and Alzheimer’s Prevention at the Alzheimer’s Drug Discovery Foundation (ADDF) said that delirium is one of the major post-surgical complications in geriatric patients.

“Delirium refers to a state of confusion or lack of mental awareness,” explained Mills. “In many cases, postoperative delirium is temporary, and resolves over time, though the recovery can be prolonged.”

She added that a potentially greater concern is the risk for postoperative cognitive dysfunction (POCD), which can lead to long-term cognitive decline, “which is also elevated in geriatric patients undergoing major surgery with general anesthesia.”

According to Mills, advanced age and baseline cognitive impairment are currently the best predictors for which individuals are most likely to experience postoperative delirium or cognitive dysfunction.

Reducing the risk for older patients

Asked if there are ways to mitigate the stress of major surgery on older patients living with frailty or dementia, Tarayn Dhansew, DO, a geriatrician at Lenox Hill Hospital in New York replied, “Thankfully yes.”

She explained that healthcare providers can do so through proactive Comprehensive Geriatric Assessment and the 4Ms model, early risk detection, and “subsequent actions” can all help reduce the stress of major surgery.

“The 4Ms model,” said Dhansew. “Helps provide a framework for caring for older adults by emphasizing four main domains: Mobility, Mentation, Medication and What Matters Most.”

She emphasized that this model is widely embraced by the Geriatrics and Palliative Medicine Division at Northwell Health.

“The comprehensive geriatric assessment addresses the major chronic conditions and cognitive status,” Dhansew continued. “All within the context of a patient’s overall functional status and what matters most for their goals of care.”

The bottom line

A recently published study finds older people who are frail or living with dementia have a significantly increased risk of dying in the year after undergoing major surgery.

Experts say that older patients have unique health issues and face different risks after surgery.

They also say that there are ways to detect these risks so healthcare providers can do their best to reduce the stress of surgical procedures.

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