Evaluating challenges care-partners and older adults confront after major elective surgery: A multimethods study.

Abstract

With the advent of enhanced recovery after surgery pathways, older adults who undergo major elective surgery return home early in the postoperative period and rely more on care-partner support. Little has been done to assess current challenges that older patient/care-partner dyads experience after major elective surgery and to identify intervention targets to improve transitions home after surgery. This multimethods study recruited 15 dyads of major elective surgery patients aged 65+ years from 3 surgical specialties and their care-partners (30 participants total). Demographic, quality of life, and caregiver burden surveys were completed. Each participant underwent a 1-on-1 interview exploring challenges, resources received, and communication experiences. Survey data were analyzed using descriptive statistics. Interview data were analyzed deductively, mapping themes onto the 5Ms of the Geriatrics framework. We enrolled 6 thoracic, 5 colorectal, and 4 orthopedic patients, along with their care-partners (n = 30). Most participants were female (67%) and educated (ie, college degree +, 57%). Zarit Burden Interview surveys suggested mild-moderate burden (9.3; standard deviation, 10.38) with thoracic care-partners reporting higher burden (14.33; standard deviation, 13.98). World Health Organization quality-of-life scores were also lower among thoracic surgery dyads. The range of when the interview occurred in relation to the surgery date was 1-5 months. Qualitative analysis revealed the need for emotional support, improved anticipatory guidance about expected recovery, and assistance with activities of daily living/independent activities of daily living and medication management. Older surgical patients and their care-partners identified specific targets to improve transitions out of the hospital during surgical recovery, including enhanced communication, education, and emotional/physical support. Surgical teams, researchers, and health care system leaders can use these findings to improve care quality and support care-partners assisting older adults.