Postoperative Transitions in Care for Older Adults With Frailty and Their Informal Caregivers

Abstract

Adults over the age of 65 are undergoing elective inpatient surgery more often than any other age group. Approximately 40% of older adults having surgery also live with frailty. Preoperative frailty is associated with many poor patient- and system-level outcomes after surgery. The postoperative transition in care is a vulnerable time for older adults with frailty and their informal caregivers. When patients transition out of hospital after surgery they can experience uncertainty around medications, lack of follow-up, ineffective communication between care providers and the patient, which can result in adverse health outcomes. Further, patients and their caregivers are often unprepared to navigate the postoperative transition in care which can lead to stress and poor experience. Hospital standards have been developed to improve the care of geriatric surgical patients, with specific goals for optimizing transitions in care to improve outcomes. However, many of these standards have not been systematically implemented and are not specific to older adults with frailty. While knowledge synthesis studies have identified transitional care interventions for older adults, there remains a gap in postoperative transitions in care for older adults with frailty. The overarching aim of this dissertation was to develop foundational, patient-centered knowledge on postoperative transitions in care for older adults with frailty and their informal caregivers. This work encompasses four separate but related studies. The first study is a scoping review where the objective was to synthesize what processes and outcomes are being used to evaluate postoperative transitions in care for older adults in the literature. The second and third studies are both qualitative studies in the interpretive description tradition where the objectives were to explore what is important during a postoperative transition in care from the perspectives of older adults with frailty and their informal caregivers. The fourth study is a secondary analysis of a multi-center cohort study where the objective was to evaluate the association of non-home discharge with decisional regret trajectories in the year after elective inpatient surgery among older adults. The results of these studies demonstrate that there is a need to develop and evaluate postoperative transitional care programs that prioritize the unique needs of older adults with frailty and their informal caregivers.