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Article ; Online: Trajectories of Postoperative Depressive Symptoms in Older Patients Undergoing Major Surgery.

Cenzer, Irena / Inouye, Sharon K / Raue, Patrick J / Keny, Christina / Cooper, Zara / Tang, Victoria L

JAMA network open

2024 Volume 7, Issue 1, Page(s) e2354154

MeSH term(s)	Aged ; Humans ; Depression/epidemiology ; Postoperative Period
Language	English
Publishing date	2024-01-02
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.54154
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Article ; Online: "There's So Much That They're Enduring": Experiences of Older Adults Undergoing Major Elective Surgery.

Kata, Anna / Dillon, Ellis C / Christina Keny, R N / Yank, Veronica / Covinsky, Kenneth E / Raue, Patrick J / Sandhu, Harleen K / Tang, Victoria L

Annals of surgery

2024

Abstract: Objective: This qualitative study aimed to explore the psychosocial experience of older adults undergoing major elective surgery from the perspective of both the patient and family caregiver.: Summary background data: Older adults face unique ... ...

Abstract	Objective: This qualitative study aimed to explore the psychosocial experience of older adults undergoing major elective surgery from the perspective of both the patient and family caregiver. Summary background data: Older adults face unique psychological and social vulnerabilities that can increase susceptibility to poor health outcomes. How these vulnerabilities influence surgical treatment and recovery is understudied in the geriatric surgical population. Methods: Adults aged 65 and older undergoing a high-risk major elective surgery at the University of California, San Francisco and their caregivers were recruited. Semi-structured interviews were conducted at three time points: 1-2 weeks before surgery, and at 1- and 3-months following surgery. An inductive qualitative approach was used to identify underlying themes. Results: Twenty-five older adult patients (age range 65-82 years, 60% male) and 11 caregivers (age range 53-78 years, 82% female) participated. Three themes were identified. First, older surgical patients experienced significant challenges to emotional well-being both before and after surgery, which had a negative impact on recovery. Second, older adults relied on a combination of personal and social resources to navigate these challenges. Lastly, both patients and caregivers desired more resources from the healthcare system to address "the emotional piece" of surgical treatment and recovery. Conclusions: Older adults and their caregivers described multiple overlapping challenges to emotional well-being that spanned the course of the perioperative period. Our findings highlight a critical component of perioperative care with significant implications for the recovery of older surgical patients.
Language	English
Publishing date	2024-04-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000006293
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Article ; Online: Social Strain is associated with Functional Decline in Older Adults after Surgery.

Tang, Victoria L / Cenzer, Irena / Keny, Christina / John Boscardin, W / Covinsky, Ken / Finlayson, Emily / Kotwal, Ashwin

Journal of general internal medicine

2023 Volume 39, Issue 2, Page(s) 351–353

MeSH term(s)	Humans ; Aged ; Activities of Daily Living ; Risk Factors ; Longitudinal Studies
Language	English
Publishing date	2023-11-09
Publishing country	United States
Document type	Letter
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-023-08484-x
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Article ; Online: Frailty and Surgical Decision Making.

Tang, Victoria L / Covinsky, Kenneth

Annals of internal medicine

2016 Volume 165, Issue 9, Page(s) 669–670

Language	English
Publishing date	2016-11-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/M16-1866
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Article ; Online: Advance Care Planning Prior to Death in Older Adults with Hip Fracture.

Kata, Anna / Cenzer, Irena / Sudore, Rebecca L / Covinsky, Kenneth E / Tang, Victoria L

Journal of general internal medicine

2020 Volume 35, Issue 7, Page(s) 1946–1953

Abstract: Background: Although hip fractures in older adults are associated with a high degree of mortality and disability, the use of advance care planning (ACP) in this population is unknown.: Objective: To determine the prevalence of ACP and need for ... ...

Abstract	Background: Although hip fractures in older adults are associated with a high degree of mortality and disability, the use of advance care planning (ACP) in this population is unknown. Objective: To determine the prevalence of ACP and need for surrogate decision-making prior to death in older adults with hip fracture and to identify factors associated with ACP. Design: Retrospective cohort study using Health and Retirement Study (HRS) interviews linked to Medicare fee-for-service claims data. Participants: Six hundred six decedent participants aged 65 or older who sustained a hip fracture during HRS enrollment and had a proxy participate in the exit HRS survey. Main measures: Survey responses by proxies were used to determine ACP, defined by either advance directive completion or surrogate designation, and to assess decision-making at the end of life. Multivariate logistic regression was used to analyze correlates of ACP. Key results: Prior to death, 54.9% of all participants had an advance directive and 68.9% had designated a surrogate decision-maker; however, 24.5% had no ACP. Of the total cohort, 32.5% required decisions to be made about treatment at the end of life and lacked capacity to make these decisions themselves. In this subset, 19.9% had no ACP. In all participants, ACP was less likely in non-white individuals (adjusted odds ratio (aOR) 0.14, 95% CI 0.06-0.31), those with less than a high school education (aOR 0.58, 95% CI 0.35-0.97), and those with a net worth below the median of the cohort (aOR 0.49, 95% CI 0.26-0.72). No clinical factors were found to be associated with ACP completion prior to death. Conclusions: A considerable number of older adults with hip fracture required surrogate decision-making at the end of life, of whom one fifth had no ACP prior to death. Clinicians providing care for these patients are uniquely poised to address ACP.
MeSH term(s)	Advance Care Planning ; Aged ; Hip Fractures/epidemiology ; Hip Fractures/therapy ; Humans ; Medicare ; Proxy ; Retrospective Studies ; Terminal Care ; United States/epidemiology
Language	English
Publishing date	2020-05-04
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-020-05644-1
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Article ; Online: Public Opinions About Surgery in Older Adults: A Thematic Analysis.

Dharmasukrit, Charlie / Ramaiyer, Malini / Dillon, Ellis C / Russell, Marcia M / Dutt, Meghan / Colley, Alexis / Tang, Victoria L

Annals of surgery

2021 Volume 277, Issue 3, Page(s) e513–e519

Abstract: Objective: To examine public opinions of surgery in older adults.: Background: Increasing numbers of older adults are undergoing surgery. National healthcare organizations recognize the increased risks of postoperative complications and mortality in ... ...

Abstract	Objective: To examine public opinions of surgery in older adults. Background: Increasing numbers of older adults are undergoing surgery. National healthcare organizations recognize the increased risks of postoperative complications and mortality in the older surgical population and have made efforts to improve the care of older adults undergoing surgery through hospital-level programs. However, limited research has explored the opinions and responses of the wider U.S. public regarding surgery in older adults. Methods: We performed a qualitative, thematic analysis of reader comments posted in response to online newspaper articles relating to surgery in older adults. Articles were published in 2019-2020 and targeted for a popular press audience. Results: Nine hundred eight reader comments posted in response to 6 articles relating to surgery in older adults were identified. Articles were published in online editions of print newspapers with a digital circulation between 1.3 and 5.7 million subscribers. Three themes were identified: (1) wariness/distrust towards healthcare: including general distrust of medicine and distrust of surgery, (2) problems experienced: ineffective communication and unrealistic expectations, and (3) recommended solutions: the need for multidisciplinary teams and patient-centered communication. Conclusions: Overall, the public viewed surgery in older adults with wariness/distrust due to ineffective communication and unrealistic expectations. Specialized surgical care tailored to the unique needs of older adults is needed. The public perspective suggests that U.S. health systems should strongly consider adopting programs that provide care to meet the unique needs of older adults undergoing surgery and ultimately improve both patient outcomes and their surgical experience.
MeSH term(s)	Humans ; Aged ; Public Opinion ; Communication ; Group Practice ; Medicine ; Postoperative Complications/epidemiology
Language	English
Publishing date	2021-11-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000005286
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Article ; Online: Psychosocial Stress Before Major Oncologic Operations: A Qualitative Content Analysis of Palliative Care Provider Documentation.

Shinall, Myrick C / Beskow, Laura M / Karlekar, Mohana / Martin, Sara F / Robbins, Samuel G / Tang, Victoria L

Annals of surgery

2021 Volume 274, Issue 6, Page(s) e649–e650

MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms/psychology ; Colorectal Neoplasms/surgery ; Documentation ; Female ; Humans ; Liver Neoplasms/psychology ; Liver Neoplasms/surgery ; Male ; Middle Aged ; Palliative Care ; Pancreatic Neoplasms/psychology ; Pancreatic Neoplasms/surgery ; Preoperative Period ; Qualitative Research ; Stress, Psychological/psychology
Language	English
Publishing date	2021-04-05
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000004897
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Article: Postoperative Functional Outcomes in Older Adults.

Brinson, Zabecca / Tang, Victoria L / Finlayson, Emily

Current surgery reports

2016 Volume 4, Issue 6

Abstract: As the world's aging population grows, the surgical population is increasingly made up of older adults. Due to changes in physiologic function and increasing comorbidity burden, older adults are at increased risk of morbidity, mortality, and functional ... ...

Abstract	As the world's aging population grows, the surgical population is increasingly made up of older adults. Due to changes in physiologic function and increasing comorbidity burden, older adults are at increased risk of morbidity, mortality, and functional decline after surgery. In addition, decision to undergo surgery for the older adult may be based on the postoperative functional outcome rather than survival. Although few studies have evaluated an older adult's function as a postoperative outcome, surgeons are becoming increasingly aware of the importance of maintaining or regaining function in an older patient. Interventions to improve postoperative functional outcomes are being developed and show promising results. This review discusses existing literature on postoperative functional outcomes in older adults and recently developed interventions.
Language	English
Publishing date	2016-05-04
Publishing country	United States
Document type	Journal Article
ISSN	2167-4817
ISSN	2167-4817
DOI	10.1007/s40137-016-0140-7
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Article ; Online: What Matters? The Valued Life Activities of Older Adults Undergoing Elective Surgery.

Kata, Anna / Dutt, Meghan / Sudore, Rebecca L / Finlayson, Emily / Broering, Jeanette M / Tang, Victoria L

Journal of the American Geriatrics Society

2019 Volume 67, Issue 11, Page(s) 2305–2310

Abstract: Objectives: Valued life activities are those activities an individual deems particularly important or meaningful. Surgery in older adults can affect their ability to perform valued activities, but data are lacking. We characterized these activities and ... ...

Abstract	Objectives: Valued life activities are those activities an individual deems particularly important or meaningful. Surgery in older adults can affect their ability to perform valued activities, but data are lacking. We characterized these activities and assessed performance of them following surgery. Design: Retrospective observational study. Setting: Preoperative program for older adults undergoing elective surgery at an academic hospital. Participants: Older adults (N = 194) in the program from February 2015 to February 2018. Measurements: A preoperative written questionnaire asked, "What are the activities that are most important to you to be able to do when you return home from surgery?" Participants could list up to three activities. Content analysis was used to develop domains of valued life activities and categorize responses. Postoperative questionnaires and medical records were used to determine ability to perform activities 6 months after surgery. Results: Of 194 participants (mean age = 74.9 ± 9.1 y), 57.7% were female; 33.5% had more than two comorbid conditions. We elicited 510 valued activities, with a mean of 2.6 (± .7) activities per participant. Content analysis revealed five categories: (1) recreational activities (28.9%); (2) mobility (24.9%); (3) activities of daily living (ADLs; 17.5%); (4) instrumental activities of daily living (IADLs; 16.9%); and (5) social activities (12.0%). Ultimately, 154 participants had surgery, of which 27.3% were unable to perform one of their valued activities at 6 months. Performance varied between activity categories; 91.9% of mobility activities, 90.8% of ADLs, 80.3% of IADLs, 77.3% of social activities, and 65.5% of recreational activities were able to be performed after surgery. Conclusion: Older adults expressed a wide range of valued life activities. More than one-quarter were unable to engage in at least one valued life activity after surgery, with recreation the most commonly affected. Assessment of valued life activities should be incorporated into the perioperative management of older adults. J Am Geriatr Soc 67:2305-2310, 2019.
MeSH term(s)	Activities of Daily Living ; Aged ; Elective Surgical Procedures ; Female ; Geriatric Assessment/methods ; Humans ; Male ; Preoperative Care/methods ; Retrospective Studies ; Surveys and Questionnaires
Language	English
Publishing date	2019-08-10
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, N.I.H., Extramural
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.16102
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Article ; Online: Multisite Implementation of an American College of Surgeons Geriatric Surgery Quality Improvement Initiative.

Ma, Meixi / Peters, Xane D / Zhang, Lindsey M / Hornor, Melissa / Christensen, Kataryna / Coleman, JoAnn / Finlayson, Emily / Flood, Kellie L / Katlic, Mark / Lagoo-Deenadayalan, Sandhya / Robinson, Thomas N / Rosenthal, Ronnie A / Tang, Victoria L / Ko, Clifford Y / Russell, Marcia M

Journal of the American College of Surgeons

2023 Volume 237, Issue 2, Page(s) 171–181

Abstract: Background: The American College of Surgeons (ACS) Coalition for Quality in Geriatric Surgery (CQGS) identified standards of surgical care for the growing, vulnerable population of aging adults in the US. The aims of this study were to determine ... ...

Abstract	Background: The American College of Surgeons (ACS) Coalition for Quality in Geriatric Surgery (CQGS) identified standards of surgical care for the growing, vulnerable population of aging adults in the US. The aims of this study were to determine implementation feasibility for 30 selected standards, identify barriers and best practices in their implementation, and further refine these geriatric standards and verification process. Study design: The CQGS requested participation from hospitals involved in the ACS NSQIP Geriatric Surgery Pilot Project, previous CQGS feasibility analyses, and hospitals affiliated with a core development team member. Thirty standards were selected for implementation. After implementation, site visits were conducted, and postvisit surveys were distributed. Results: Eight hospitals were chosen to participate. Program management (55%), immediate preoperative and intraoperative clinical care (62.5%), and postoperative clinical care (58%) had the highest mean percentage of "fully compliant" standards. Goals and decision-making (30%), preoperative optimization (28%), and transitions of care (12.5%) had the lowest mean percentage of fully compliant standards. Best practices and barriers to implementation were identified across 13 of the 30 standards. More than 80% of the institutions reported that participation changed the surgical care provided for older adults. Conclusions: This study represents the first national implementation assessment undertaken by the ACS for one of its quality programs. The CQGS pilot testing was able to demonstrate implementation feasibility for 30 standards, identify challenges and best practices, and further inform dissemination of the ACS Geriatric Surgery Verification Program.
MeSH term(s)	Humans ; United States ; Aged ; Quality Improvement ; Pilot Projects ; Hospitals ; Surgeons ; Postoperative Complications/epidemiology
Language	English
Publishing date	2023-04-26
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1181115-8
ISSN	1879-1190 ; 1072-7515
ISSN (online)	1879-1190
ISSN	1072-7515
DOI	10.1097/XCS.0000000000000723
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