One of the most pressing topics facing US healthcare is a rapidly aging population, with more than 61 million people in the country aged 65 or older. Because older adults are high consumers of medical care, all physicians should be prepared to address the needs of this population—and surgeons need to understand the importance of tailored approaches to emergency care.
Today’s Panel Session, “Urgency and Age: Navigating Emergency Surgery in Older Adults,” will explore some of the core topics that surgeons providing geriatric and emergency surgery need to keep in mind as they approach treating this demographic. The session takes place 8:00–9:30 am in Room W-187ab.
“Older adults generally have worse outcomes after surgery than younger patients, and this is more pronounced in emergency surgery, which is why looking at this vulnerable population is so important,” said session moderator Marcia M. Russell, MD, FACS, associate professor of surgery and vice chair for quality and safety at the David Geffen School of Medicine at the University of California, Los Angeles.
An expert panel comprising both surgeons and emergency medicine physicians will discuss some of the core elements that need to be considered when addressing urgent surgery in the emergency department (ED), the first of which will be the need for a prompt, accurate diagnosis.
“There can be challenges in making diagnoses in elderly patients as they can present differently in the ED,” said Dr. Russell, who also is the Chair of the ACS Committee on Geriatric Surgery Verification. “An older adult with perforated appendicitis could have a normal white blood cell count and minimal pain, for example, which can delay time-critical interventions.”
Another core element of operating on an elderly patient, particularly in an urgent setting, is screening for geriatric vulnerability, such as cognitive impairment, malnutrition, impaired mobility, and impaired function.
The panel will explore effective screening protocols tailored to the unique needs of older adults in the ED, which help to guide care decisions and should be done concurrently to the diagnostic workup, Dr. Russell said.
She notes that the information obtained from the diagnostic workup and screening for geriatric vulnerabilities helps to inform goals of care discussions, which is another area of focus for the session. This subject also ties into the multidisciplinary nature of urgent geriatric surgery and the ongoing need for communication between the care team and the patient, and within the care team itself.
“Older adults who undergo a high-risk surgery may need multiple medical specialties—medicine and geriatrics, pharmacy, nutrition, physician and occupational therapists—to get them through the perioperative course,” she said. “The patient's goals of care should be at the center of the discussion so that providers will better understand how to move forward.”
