EP119: Ten Things Older Adults Need to Know Before Elective Surgery This Is Getting Old Podcast with Melissa B PhD

Over the past five years, more than 20 million Americans aged 65 and over had elective surgery. This number is expected to grow to more than 27 million by 2030.
While elective surgery can be life-changing and even life-saving, it’s not without its risks. There are many things to consider before elective surgery – from the cost of the procedure to who will provide caregiving afterwards during recovery.
In addition to the normal conversations, exams, and tests that will be run to clear an older adult for surgery, there are ten additional things older adults and their families should know before heading into the Operating Room.
Most surgical offices will require thorough lab work, along with heart, lung, and kidney function tests; but if you are over 65 years old or the loved one of someone who’s going to have the elective surgery, be sure you—and those the surgical team — know the following because many of these have been linked to a higher risk of death or complications after an older adult has surgery. These recommendations are based on the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society Developed Best Practice Guidelines recommend the following:
Key points covered in this episode: 
✔️ #1: Know The Person’s Pre-Surgery Cognitive Ability Though you may be an older adult, have been feeling great recently, and even played golf the day before surgery, things can take a turn for the worse post-operation. You can end up looking pretty sick to providers who don’t know you—and due to pervasive ageism, health care professionals can unfortunately make an assumption that you have a cognitive impairment (when you don’t!)
You want to be sure that your surgical team knows what the person's cognitive ability was before the surgery ~ because you should return to baseline with your thinking. 
✔️ #2: Depressed Or Not? Depression has been associated with a higher likelihood of dying after surgery and more days in the hospital after surgery. It is essential that the surgical team understands what the person’s emotional state was before surgery.
Older adults may not want to talk about it, but if a loved one is going in for surgery, please ask: “Have you been feeling down or depressed lately?”
✔️ #3: Any Alcohol Or Substance Abuse/ Dependence Issues? While a glass of wine with dinner or a beer while watching the game may be part of your routine, there may also be some signs that alcohol use is more along the lines of alcohol dependency or abuse. 
There are four questions that are asked, and we call it the CAGE questionnaire:
C: Have you ever felt the need to Cut down on your drinking?
A: Have you ever felt Annoyed by people criticizing your drinking?
G: Have you ever felt Guilty about your drinking?
E: Have you ever had an Eye-opener (a drink first thing in the morning) to steady your nerves or get rid of a hangover?
Substance abuse isn’t only about alcohol. It can includes taking other drugs. In either case, alcohol and substance misuse also puts the person at a higher risk for complications after surgery
✔️ #4: Know Your Risk Of Post-Surgery Delirium And How To Recognize It In A Loved One Delirium is a change in mental status, and people can fluctuate in and out of it. They may be confused at times and then clearheaded at other times in the same day.
Being 70 or older and taking multiple medications increase a person’s risk for delirium.  Before elective surgery, it is essential to let your loved one’s surgical team know about any medications they are taking and if they have had issues with delirium in the past.
The bottom line after surgery: If you have any feeling that your loved one “just isn’t right”, mention it to their medical team because it needs to be investigated.
✔️ #5: Know Functional Status And History/ Risk Of Falls Can the person get dressed? Take a bath? Get out of a chair or the bed by