Recent data from the University of Michigan’s National Poll on Healthy Aging highlights the concerns many older adults feel about elective surgery. However, the survey responses also show that two-thirds of those who went ahead with surgery were very satisfied with the outcome despite their worry. And that worry is natural—while you may derive benefits such as pain relief and improved mobility, surgery comes with a potentially uncomfortable recovery period, increased caregiving needs, and financial costs.
Making the Decision to Have Elective Surgery
Elective surgery is surgery scheduled in advance to address health issues that are not immediately life threatening. Examples include joint replacement, gallbladder removal, cataract surgery, and hernia repair (see our July issue for more on the latter). A range of factors may influence a person’s thinking when it comes to proceeding with elective surgery. “Even if a procedure may seem like the obvious solution to a health problem, your decision about whether to go ahead with an operation really depends on what is important to you,” says Mount Sinai geriatrician Patricia Bloom, MD. “For example, if you have hip arthritis and are considering joint replacement, you might focus on getting fully mobile again so you can return to activities you enjoyed. But another person might focus more on how a long recovery period might affect their ability to care for a loved one who is in poor health. The decision to have hip replacement surgery may be very different for these two people. The benefit of the surgery, in terms of achieving the individual patient’s goal, may or may not outweigh the inconvenience of the surgery.”
In August 2021, the National Poll on Healthy Aging asked 2,110 people, ages 50 to 80, about their decision-making in regard to elective surgery. In all, 30 percent of the respondents said they had considered having or had elective surgery in the past five years. Among this group, nearly two-thirds reported having had concerns about potential pain or discomfort afterward, and 57 percent worried about how difficult their recovery might be. The potential out-of-pocket costs associated with the surgery loomed large for 46 percent of the respondents, while 34 percent were concerned about having someone to take care of them after their operation, and 17 percent said they worried about not being able to fulfill caregiving responsibilities for other people if they had surgery.
COVID-19 Concerns
Elective surgery has been in the spotlight during the COVID-19 pandemic because it often has been cancelled to free up hospital beds for people with serious COVID-19 symptoms. Among poll respondents who had considered having elective surgery during the past year, 46 percent were concerned about potential exposure to COVID-19 in the hospital. But those who were vaccinated against the virus were less likely to say they were very concerned than those who were unvaccinated. “The Centers for Disease Control and Prevention recommend that adults ages 50 and older get a second booster shot to better maintain their COVID-19 immunity,” Dr. Bloom notes. “While the vaccine is not a guarantee you will avoid COVID-19, there is strong evidence it can significantly decrease the risk of serious illness from the virus.”
Getting Informed
In the poll, most of the people who had considered elective surgery in the last five years had discussed the procedure with a surgeon or with their primary-care provider. “One of the benefits of elective surgery is that you have time to find out what the surgery entails and discuss any concerns you have with your health-care provider,” Dr. Bloom says. “It is important to get informed about the benefits, risks, and post-surgery considerations.” She adds that it also is vital to choose the right surgeon. “Older people contemplating surgery, especially the frail elderly or those with multiple underlying co-morbidities, would do well to have a surgeon who has performed the procedure on a lot of older patients, and/or have a geriatrician or internist who is attuned to the care of older adults involved in their post-operative care,” she says. “There are so many issues that might need to be addressed, like identifying and treating post-op delirium and cognitive changes as a result of anesthesia, post-op infections, the need for rapid mobilization and acute rehabilitation, and the possible adjustment of medication dosages, among other issues.” See What You Can Do for questions to ask your surgeon.
Be Cautious About Other Information Sources
About 33 percent of poll respondents said that family members and/or friends were sources of information, and 28 percent used the internet. Dr. Bloom says that talking to family and friends who may have had the same surgical procedure can be helpful. “They can give you a general idea of what to expect and recommend strategies to help you manage postsurgical pain and any temporary functional limitations that may interfere with your ability to carry out activities of daily living,” she says. “But keep in mind that not everybody experiences surgery in the same way. If a family member or friend doesn’t have positive memories of their procedure or recovery, try not to let it put you off surgery that might make a big difference to your life.” Likewise, be wary when it comes to seeking information online— stick to reputable sources, such as websites linked to large teaching institutions like Mount Sinai.
“Prehabilitation” Can Help
Some surgical departments and groups have “prehabilitation” clinics to help people prepare for elective surgery by addressing nutrition, exercise, tobacco use, and other factors that can affect recovery. Ask your surgeon if this service is available to you. And as well as preparing for your surgery, think about what you can do to make your recovery easier—see this month’s From the Editor for helpful tips.
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