Elderly Friendly Approaches to the Surgical Environment

Funding: Alberta Innovates Health Solutions Partnerships for Research and Innovation in the Health System Grant (2014-2018)

Background: Seniors (age ≥ 65 years old) are anticipated to account for a quarter of the Canadian population by 2040 and the rapid growth of the elderly population is expected to last for decades. Population aging is projected to markedly increase healthcare demand and currently seniors account for 63% of acute inpatient days and 43% of provincial health expenditures.

Specific to surgery, it is estimated that more than half of all operations are performed on patients older than 65 years of age and approximately one third of these patients are discharged to an institutional care facility after major scheduled surgery. Because older patients are presenting for surgical evaluation of acute illness in increasing numbers, demand for surgical resources is increasing. Unfortunately, surgical models rarely take into account the special needs of this population; hospitals continue to be geared to provide care for those with single, acute illnesses rather than those with multiple acute and chronic conditions. Hospitalized seniors have higher rates of adverse events, surgical complications, and nosocomial infections than younger patients, along with an increased requirement for care, and reduced quality of life.

For the reasons outlined above, studies assessing innovative ways to optimize care delivery in elders undergoing acute care surgery are urgently needed.

Study Aim: To examine the impact of specialized, interdisciplinary, Elder-friendly Approaches to the Surgical Environment (EASE) on in-hospital morbidity and mortality in elders undergoing acute surgical care.

Study Design: A prospective before-after study design that will include a concurrent control group. Specific EASE interventions include:

• Capacity re-alignment to locate all elderly surgical patients on one nursing unit
• Interdisciplinary team-based care for the elderly surgical patient including a geriatrician
• Elder-friendly evidence-informed practices including comfort rounds with early mobilization, delirium prevention/management, optimal nutrition and prevention of post-operative complications
• Early discharge planning which include family, social worker, care coordinator and surgical team

Importance: This approach has never been implemented in a general surgical setting. This proposed unit is relevant to the sustainability of the health care system and to improving outcomes in older surgical patients, helping them to maintain their functional autonomy and quality of life.

Locations: University of Alberta Hospital, Edmonton, Alberta. Foothills Medical Center, Calgary, Alberta. Misericordia Community Hospital, Edmonton, Alberta.

For more information: http://clinicaltrials.gov/show/NCT02233153

Ongoing EASE Studies