Key Takeaways
- Similar to how pediatric patients are given specialized medical care, older patients need to be treated differently compared to regular adults.
- The Geriatric Surgery Verification program makes sure providers account for physical, psychosocial, environmental, and nutritional factors in a patient’s pre-operative, surgical, and post-operative recovery processes.
- This care model helps older patients have shorter hospital stays, quicker recoveries, lower rates of re-admission, and fewer complications.
When healthcare providers treat young children, they don’t use the same techniques and treatments they would use for adults. They customize everything about how they diagnose and treat children – the diagnostic process, the type and amount of medication they prescribe, the length of stay, the type of psychosocial support they receive, the unique discharge needs, and other important factors.
Similarly, the Geriatric Surgery Verification (GSV) Program acknowledges the unique needs of the elderly population and creates a care model to address them.
“Over the years, we have learned that the geriatric population really needs to be treated differently than the ordinary population,” said M. Gordon Whitbeck, Jr. MD, FAAOS, Executive Medical Director of RRH Orthopedic & Sports Medicine, and Chair of the Department of Orthopedic Surgery at Rochester General Hospital.
Dr. Whitbeck explains how the GSV program works at Rochester Regional Health hospitals in the Greater Rochester and Finger Lakes regions, and how patients are receiving better care and experiencing strong recoveries as a result.
Why older adults need different surgery protocols
The GSV program is designed to optimize care given to geriatric patients before, during, and after they undergo surgery.
Older patients have several factors that can make their surgery and recovery more challenging, including:
- Limited mobility
- Limited social support network
- More fragile bones
- Impaired cognitive function
- Increased fall risk
- Multiple medical problems
- Multiple medications
- Reduced organ function
- Reduced metabolic function
Starting certain medications or having medication interactions can complicate the pre-operative and post-operative surgery process for elderly patients, as well.
“In elderly patients, there are some medications to which they're particularly susceptible, especially when it comes to developing delirium,” Dr. Whitbeck said.
Increased delirium in older patients can lead to:
- Longer hospital stays
- Longer recovery times
- More falls
- Higher mortality rate
“Geriatric patients are not just regular human beings who simply have a higher age attached to their name,” Dr. Whitbeck said. “We need to account for all of these factors when preparing them for surgery and post-operative recovery.”
How the GSV program supports older patients
When an elderly patient meets with their surgical team, the GSV program ensures the patient is assessed not only for their physical health, but also their social and home environments to determine the best ways to meet all of their needs.
As part of their pre-operative evaluation, patients are asked about medical conditions, medications they are taking, but also where they live, their nutrition, caregivers or family members who are able to support them, and other relevant factors that affect their daily life.
“When consulting providers see patients as part of pre-operative evaluations, they look at all of these factors and make recommendations for all of these issues to be addressed by both their orthopedic surgery team and a medical hospitalist team as needed,” Dr. Whitbeck said.
Once all the information about the patient is gathered, providers are able to implement informed guidelines for patient care from the days leading up to surgery all the way through post-operative recovery. Patients don’t need to opt into this program; their providers integrate these recommendations into their care from beginning to end.
As a result of the GSV program, hospitals across the country who have this program in place are seeing
- diminished lengths of hospital stays
- fewer post-operative medical complications
- reduced severity of post-operative medical complications
- reduced re-admissions
- decreased infection rates
- decreased mortality
- improved speed of recovery
By putting a firm organizing structure around the many resources that are needed when caring for elderly patients, the streamlined care, evaluation, and treatment of each patient is set to a higher standard.
“Variation is the enemy of quality and an ally of poor outcomes,” Dr. Whitbeck said. “The value of a program like this is that it brings a consistent process that integrates all of the aspects of care throughout the continuum to enhance outcomes in this challenging geriatric population.”
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