Up next in 10
The American College of Colorectal Surgeons has issued a Best Practice guideline for how to operate on older adults with colorectal cancer safely.
https://journals.lww.com/dcrjournal/fulltext/2022/04000/The_American_Society_of_Colon_and_Rectal_Surgeons.8.aspx
This podcast reviews that guideline. This comprehensive guideline recommends that, instead of the age of an older patient, the patient's fitness or frailty should be taken into consideration. It also talks about interventions such as rehabilitation or enhanced recovery after surgery programs. The manuscript (linked above) and this companion podcast provide a comprehensive 40,000-foot view on how cancer centers should embark on a multidisciplinary care approach to optimize the care process and outcomes of older adults with colorectal cancer.
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0:05
welcome to the deep dive Let's jump
0:06
right in We're living longer which is uh
0:10
generally great news right Absolutely
0:13
But it does mean that well more of us as
0:16
we age are likely going to need surgery
0:19
at some point That's the reality And
0:21
surgery can be crucial I mean
0:23
life-saving definitely life improving
0:24
sometimes for sure But you know it's not
0:27
without risks And those risks they could
0:29
definitely be higher for older folks
0:32
They can And the thing is it's often
0:34
overlooked that older adults coming in
0:36
for surgery um they usually have more
0:39
going on than just the one issue needing
0:41
the operation right A complex picture
0:44
Exactly Their overall health profile is
0:46
often well complicated And while we
0:48
might instinctively think okay age
0:50
that's the main risk factor Yeah it
0:52
seems obvious What the research keeps
0:53
showing us pretty consistently is that
0:55
something else is often uh well a much
0:58
stronger predictor of how they'll
0:59
actually recover Okay let's get into
1:00
that You're talking about frailty
1:02
Precisely frailty And this deep dive
1:05
today it's based specifically on some uh
1:08
really important new clinical practice
1:10
guidelines These come from the American
1:12
Society of Colon and Rectal Surgeons
1:14
ASCRS a major group Yeah And they
1:17
basically synthesized a huge amount of
1:19
research on this very topic How to
1:22
evaluate and manage frailty in older
1:25
adults having colarctal surgery That's
1:27
right These guidelines pull together the
1:29
latest evidence So our mission here
1:31
really is to unpack them for you distill
1:33
the key takeaways Exactly We want you to
1:35
understand what frailty really means in
1:38
this surgical context why it's just so
1:40
critical for outcomes and importantly
1:42
what the recommended approaches are Now
1:44
the goal being the goal being to give
1:46
older patients especially those
1:48
identified as frail the absolute best
1:50
shot at a good outcome And you know
1:52
that's not just about surviving the
1:54
operation right It's about quality of
1:55
life afterwards It's about truly living
1:58
well afterward That's the focus Okay So
2:01
let's dive into the core problem
2:02
highlighted in these guidelines because
2:04
the central finding it's uh it's pretty
2:07
striking It is treatment recommendations
2:09
They argue should really prioritize a
2:11
patients degree of frailty like their
2:13
physiological age their resilience
2:16
rather than just their chronological age
2:19
It's a big shift in thinking because for
2:21
years you know studies used age often
2:24
with these well somewhat arbitrary cut
2:26
off 65 70 75 standard practice almost
2:29
kind of but the evidence is getting
2:31
clearer and clearer the link between
2:34
just your age and years and how you do
2:36
after surgery It's inconsistent It
2:39
really doesn't paint the whole picture
2:40
right Because frailty isn't just a
2:42
number It's more about um having less
2:45
reserve Like your body's backup systems
2:47
are low That's a great way to put it
2:48
Reduced reserve capacity across multiple
2:51
body systems So when a major stressor
2:53
hits and surgery is a major stressor if
2:56
that reserve isn't there you're just
2:57
much more vulnerable Vulnerable to
2:59
complications tougher recovery Exactly
3:01
And the guidelines often refer back to
3:03
Freed's phenotypic definition It's quite
3:05
specific Okay What does that involve It
3:07
defines frailty based on having three or
3:09
more of five specific things Slow
3:12
walking speed weak grip strength low
3:14
self-reported physical activity
3:16
unintentional weight loss or just
3:18
feeling exhausted much of the time And
3:20
the data linking this frailty state to
3:22
outcomes is strong Very strong Frailty
3:25
consistently predicts those adverse
3:27
outcomes we worry about getting
3:29
readmitted to the hospital longer stays
3:32
needing to go to a nursing facility
3:33
instead of home Serious complications
3:35
too Yes serious complications And
3:37
unfortunately mortality as well Studies
3:39
using big databases like ACS NSQIP or
3:43
those involving comprehensive geriatric
3:45
assessments they show frailty predicts
3:47
these issues more reliably than just age
3:49
or even common scores like the ASA
3:52
physical status So it's a more accurate
3:53
red flag It seems to be There's specific
3:56
evidence for instance in older patients
3:59
having cancer surgery where frailty was
4:01
linked to higher six-month mortality but
4:03
their age or their ASA score actually
4:05
wasn't Wow Okay So if frailty is this
4:08
key vulnerability identifying it early
4:10
seems absolutely paramount The
4:13
guidelines really push for screening for
4:16
frailty in the clinic for surgery Is
4:18
that I mean is that practical Clinics
4:20
are busy places It is and the guidelines
4:22
emphasize that it is feasible Now the
4:24
gold standard is the comprehensive
4:25
geriatric assessment the CGA That sounds
4:28
comprehensive It is It's a deep dive
4:30
physical mental psychosocial functional
4:32
health But it does take time The good
4:35
news though is that there are shorter
4:37
quicker screening tools Ah okay Tools
4:40
that work in a regular clinic visit
4:42
Exactly Tools that can flag those
4:44
potentially vulnerable older adults
4:47
effectively without taking up you know
4:48
an hour That makes sense Can you give
4:51
some examples What are these quicker
4:52
tests Sure A really good one is the
4:54
timed up and go test the tei Super
4:57
simple You just time how long it takes
4:59
someone to stand up from a chair walk 3
5:02
m turn around walk back and sit down
5:04
again And that simple timing tells you
5:06
something significant It can taking 20
5:09
seconds or more on the 2D that's been
5:11
shown to predict major complications a
5:13
longer hospital stay and needing more
5:15
specialist input during the hospital
5:16
stay Interesting What else Gate speed
5:20
Just how fast someone walks Slower than
5:22
about 08 to 1 meter pers can predict
5:25
poor outcomes Even just asking about
5:27
recent falls Really Just asking Yeah
5:30
More than one fall in the last 6 months
5:32
that's been linked to higher posttop
5:34
complications and needing institutional
5:36
care Simple but powerful indicators They
5:38
can be And then there are calculated
5:40
frailty indices like the MFI or the RAI
5:44
These pull together data from different
5:46
patient characteristics like a combined
5:47
score sort of Yeah And they can predict
5:50
things like length of stay ICU needs
5:52
where the patient goes after discharge
5:54
even mortality both short-term and
5:56
longer term And I noticed they also
5:58
mentioned assessing sarcopenia That's
6:00
muscle loss right Exactly Loss of muscle
6:03
mass and strength with age You can
6:05
actually quantify it sometimes using CT
6:07
scans They might already be getting
6:08
measuring muscle size Right And finding
6:10
copenia that correlates with worse
6:12
outcomes too Mortality complications
6:15
it's another piece of the puzzle And for
6:17
emergencies quick assessments Yeah they
6:20
touched on tools like the FTRST It's
6:22
designed for rapid risk estimation in
6:24
emergency settings Looks quickly at
6:26
cognition living situation mobility
6:29
recent hospital stays how many meds
6:31
they're on Polyfarm pharmacy right To
6:34
help gauge risk fast and inform those
6:36
crucial decisions for the patient and
6:38
family Okay So beyond the physical
6:40
aspect strength
6:42
movement the guidelines really zero in
6:45
on cognitive function Assessing that
6:47
before surgery this is hugely important
6:49
and often missed Why is that Well mild
6:52
cognitive impairment MCI and even
6:54
outright dementia are surprisingly
6:56
common in older adults even those living
6:58
independently seeming fine Really how
7:00
common Depending the age group dementia
7:02
can affect you know up to 40% of older
7:04
individuals And MCI could be present in
7:06
up to half of those over 65 Wow that's
7:08
that's much higher than I would have
7:09
guessed And why is screening for that
7:11
vulnerability so critical before an
7:13
operation Because pre-operative
7:15
cognitive impairment is one of the
7:16
absolute strongest predictors of
7:18
developing post-operative delirium Ah
7:20
delirium We hear a lot about that risk
7:22
and screening for cognitive issues
7:24
beforehand is strongly recommended
7:26
because it lets the team anticipate that
7:28
high risk They can put preventative
7:30
strategies in place right from the start
7:33
Proactive prevention What tools do they
7:36
use for cognitive screening Some common
7:38
ones are pretty quick The mini cog for
7:39
instance Mini cog Yeah It involves
7:41
recalling three words and drawing a
7:43
clock face Takes just a few minutes A
7:45
low score like two or less is linked to
7:48
a significantly higher risk of posttop
7:50
delirium Simple again but informative
7:53
Definitely Another one is the SAGE The
7:56
self-administered neurocognitive
7:58
examination It can pick up MCI and early
8:01
dementia Self-administered Yeah Patients
8:03
can do it themselves maybe in the
8:04
waiting room or even at home before
8:06
their appointment There's even a digital
8:07
version which is great for tracking
8:09
changes over time And spotting cognitive
8:11
impairment before surgery It's not just
8:14
about predicting delirium is it It has
8:16
other implications Absolutely It signals
8:19
first off that you might need to involve
8:21
family members or designated surrogates
8:24
more closely in the decision-m Making
8:26
sure everyone understands the goals the
8:28
risks Exactly Ensuring informed consent
8:32
is truly informed It also flags the need
8:35
for potentially more support and closer
8:37
monitoring after discharge especially if
8:39
there are memory issues Might need extra
8:41
help at home right And getting a
8:43
geriatrician or maybe a neurosychologist
8:45
involved early on can be really
8:47
beneficial in these cases Okay So
8:50
screening tools help identify the risks
8:52
physical frailty cognitive issues what's
8:55
next The guidelines really emphasize
8:58
optimizing these patients a proactive
9:01
team approach Yeah And a key strategy
9:03
here is something called prehabilitation
9:05
Prehab I've heard that term more lately
9:08
What is it exactly It's basically a
9:10
structured program to boost the patients
9:12
health and resilience before the surgery
9:14
happens Getting them in the best
9:16
possible shape to handle the stress
9:17
preparing them for the hit Essentially
9:19
what does that typically involve The
9:21
core is usually exercise training but
9:23
it's often multimodal meaning it
9:25
includes other things too Nutritional
9:27
therapy is key Strategies to reduce
9:29
anxiety making sure other existing
9:31
medical conditions are as stable as
9:33
possible Maybe smoking the station or
9:36
cutting back on alcohol a whole package
9:39
And is there solid proof this prehab
9:41
actually works Does it make a difference
9:43
Yes the evidence is building Meta
9:46
analyses which pulled data from multiple
9:48
studies have shown prehabilitation can
9:51
significantly lower overall complication
9:53
rates Lower complications like what kind
9:55
Particularly pulmonary lung
9:56
complications and cardiac issues after
9:59
major abdominal surgery How long does
10:00
prehab usually take It varies in the
10:02
studies but often programs lasting
10:04
around 4 to 6 weeks show clear benefits
10:07
Gives the body some time to adapt and
10:09
build strength Makes sense You mentioned
10:11
exercise training I saw a really
10:13
interesting point in the sources about
10:14
wearable tech tracking steps before
10:17
surgery Oh yeah that study was
10:18
fascinating They used wearable activity
10:20
trackers like Fitbit basically Yeah And
10:23
they found that patients who are more
10:25
active and they define that as taking
10:27
over 5,000 steps a day in the weeks
10:30
leading up to colctal surgery Okay They
10:33
had significantly fewer complications
10:35
overall and fewer serious complications
10:37
compared to the less active patients So
10:39
just being more active beforehand seems
10:41
protective It strongly suggests that yes
10:45
higher pre-operative activity seems
10:47
linked to a lower risk of post-operative
10:49
problems Now you could argue maybe
10:51
people who are already more active are
10:53
just inherently less frail There's that
10:55
possibility But it definitely highlights
10:57
that connection between fitness before
10:59
surgery and how well you recover after
11:02
Nutrition seems like another critical
11:04
piece you mentioned Absolutely vital We
11:06
know weight loss and poor nutritional
11:08
status are big risk factors for worse
11:10
outcomes in older surgical patients So
11:12
boosting nutrition is key crucial often
11:15
involves working with a dietitian And
11:16
there's even some interesting research
11:18
suggesting nutritional supplements might
11:20
work together with exercise
11:21
synergistically to improve energy and
11:24
performance during prehab And the mental
11:26
side anxiety depression also critical
11:29
and maybe sometimes overlooked
11:31
Depression is more common as people age
11:33
and it is associated with worse surgical
11:35
outcomes higher rates of delirium too So
11:38
managing that helps The guidelines site
11:40
studies showing that addressing anxiety
11:42
and depression pre-operatively maybe
11:44
through relaxation techniques or other
11:47
support for cancer patients for example
11:49
can improve their quality of life and
11:51
reduce symptoms during that really
11:53
stressful period Okay so prehab gets
11:56
patients optimized but the guidelines
11:59
also stress this team approach bringing
12:02
in expertise beyond the surgeon It's
12:04
fundamental This is where specialists
12:06
like geriatricians really shine
12:08
Geriatricians doctors specializing in
12:10
older adults right They have specific
12:12
training in managing what we call
12:14
geriatric syndromes Things like delirium
12:16
preventing falls handling complex
12:19
medication lists you know polyfarm
12:20
pharmacy things that are common in older
12:22
patients Exactly And while they may be
12:24
still underutilized in surgical settings
12:27
the studies show a massive impact when
12:29
they are involved How so Well there was
12:31
one really compelling study It found
12:33
that having geriatric co-management was
12:35
associated with less than half the
12:38
90-day death rate after cancer surgery
12:41
compared to just the standard surgical
12:43
care Wait say that again Less than half
12:44
the death rate Yes less than half It's a
12:47
genuinely striking statistic That's huge
12:49
What makes their input so valuable
12:51
They're just incredibly skilled at
12:53
spotting and managing those specific
12:55
vulnerabilities the subtle cognitive
12:58
issues the signs of
13:00
frailty optimizing complex medical
13:02
problems things a busy surgeon might not
13:05
catch or have the time to delve into
13:07
They bring that specific lens precisely
13:09
Another study looked specifically at
13:11
older colarctal surgery patients It
13:13
found that a multid-disciplinary team
13:15
approach guided by a CGA led to
13:17
significantly fewer geriatric specific
13:19
complications delirium other syndromes
13:22
even though the patients in that group
13:23
were actually sicker to start with So
13:25
better outcomes even in higher risk
13:27
patients and pulled data from lots of
13:29
studies confirms it When geriatricians
13:31
are involved in the hospital care you
13:33
tend to see shorter hospital stays lower
13:36
mortality fewer readmissions It's why
13:39
initiatives like the ACS geriatric
13:41
surgery verification program are
13:42
emerging They underscore just how vital
13:45
this team approaches And I saw a mention
13:47
of assessing social vulnerabilities too
13:49
Social frailty What's that about Yeah
13:52
that's an emerging concept Social
13:53
frailty It basically means being at risk
13:55
of losing the social connections and
13:57
resources you need to meet basic social
13:59
needs like isolation lack of support
14:02
kind of Yeah Risk factors include older
14:04
age lower education levels And how does
14:07
that connect to recovering from surgery
14:09
Because recovery from major surgery is
14:10
tough right Especially for older adults
14:12
they often rely heavily on their social
14:14
network family friends community support
14:16
for practical help rides meals
14:19
medication reminders Exactly Practical
14:22
help emotional support just having
14:24
someone check in Studies show that
14:26
having stronger social integration and
14:28
support is linked to better functional
14:30
outcomes after surgery better health
14:32
rellated quality of life Practical
14:35
social support can even make a real
14:36
difference in helping frail older adults
14:39
actually stick with positive health
14:41
changes like exercise or diet once
14:43
they're back home Makes total sense Okay
14:46
so we've assessed optimized with the
14:48
team prehab considered social factors
14:51
What about the actual surgery and
14:53
immediate posttop period How is that
14:55
tailored Well the guidelines talk quite
14:57
a bit about enhanced recovery protocols
14:59
or ERPs ERPs those standardized pathways
15:02
right They aim to optimize recovery
15:04
through things like patient education
15:05
upfront specific ways of managing fluids
15:07
and feeding using multiple types of pain
15:10
relief to cut down on opioids and
15:11
getting patients moving early early
15:13
mobilization Yeah ERPs are pretty common
15:16
now but the guidelines say they need
15:17
tweaking for older frail patients
15:19
Critically important point Yes The core
15:22
principles get moving get eating are
15:24
good for everyone including older adults
15:27
But the specifics often need adaptation
15:29
based on their individual health issues
15:31
Like what Like fluid management It needs
15:34
really careful handling if someone is
15:36
heart failure or kidney problems or when
15:38
to take out a urinary catheter might
15:40
differ if there are prostate issues And
15:43
crucially medication management Being
15:45
careful with drugs absolutely essential
15:48
avoiding or minimizing drugs known to
15:50
cause problems in older adults Resources
15:53
like the AGS beers criteria list
15:55
medications to be cautious with Studies
15:57
show older adults do benefit from ERPs
16:00
but they need that careful
16:01
individualized tailoring Got it What
16:03
about the surgical technique Minimally
16:06
invasive versus open The guidelines
16:08
strongly lean towards considering
16:10
minimally invasive approaches
16:11
laparoscopic or robotic surgery for
16:13
frail older adults having colarctal
16:15
surgery whenever it's feasible and
16:17
appropriate and the thinking there is
16:18
because the evidence shows these
16:20
techniques are safe and beneficial for
16:21
older patients even the very elderly you
16:24
know over 85 what kind of benefit pulled
16:26
analyses consistently show advantages
16:28
over traditional open surgery shorter
16:30
hospital stays faster return of bowel
16:33
function lower rates of common
16:35
complications like pneumonia wound wound
16:37
infections and alas that sluggish bowel
16:40
problem and that shorter hospital stay
16:42
that seems especially important for
16:43
older people It really is Getting out of
16:46
the hospital sooner means they can get
16:48
back to their own environment which
16:49
helps maintain mobility preserve their
16:51
functional status These are huge goals
16:54
for older adults Less time being
16:56
inactive in a hospital bed Exactly Now
16:59
we always have to acknowledge potential
17:01
selection bias in retrospective studies
17:03
Maybe surgeons chose less frail patients
17:06
for minimally invasive techniques
17:08
sometimes Sure But overall the weight of
17:10
the evidence strongly points to benefits
17:12
when it's the right choice for the
17:13
patient Okay let's spend a moment on a
17:15
really major posttop risk you mentioned
17:17
earlier Delirium The guidelines give
17:20
this specific attention They do because
17:23
it's such a significant issue
17:24
Postoperative delirium is incredibly
17:26
common It can affect up to half of older
17:28
adults after surgery 50% That's
17:30
staggering It is And what's worse it's
17:33
often missed by the healthare team So
17:35
what exactly is delirium What should
17:38
people look for It's an acute sudden
17:40
change in mental status The absolute
17:42
hallmarks are fluctuating in attention
17:45
Their ability to focus just comes and
17:47
goes along with changes in their level
17:49
of awareness or disorganized thinking
17:51
and the consequences They can be severe
17:53
and long-asting Delirium can lead to
17:55
permanent functional decline cognitive
17:57
decline higher rates of other
17:59
complications higher mortality a greater
18:01
chance of needing nursing home placement
18:03
and it drives up healthcare costs Plus
18:06
sometimes delirium is the first sign
18:08
that another complication like an
18:09
infection is brewing So it's a serious
18:12
warning signal How do clinicians screen
18:14
for it Standardized tools are used like
18:17
the confusion assessment method or CAM
18:19
It looks for those key features the
18:21
acute onset the inattention disorganized
18:24
thinking or an altered level of
18:26
consciousness And here's a critical
18:28
question Can it be prevented
18:29
Encouragingly yes A significant portion
18:31
of delirium cases studies suggest up to
18:33
50% are potentially preventable Half How
18:37
What are the key prevention strategies
18:39
It's usually a bundle of non-drug
18:41
interventions Multimodal
18:43
non-farmacologic strategies are key Like
18:46
what kind of things Things like keeping
18:47
the patient oriented clocks calendars
18:50
reminding them where they are who people
18:52
are promoting good sleep minimizing
18:55
noise and light at night getting them
18:57
mobilized out of bed walking as early
19:00
and safely as possible making sure their
19:02
glasses and hearing aids are actually
19:04
being used and working properly Simple
19:07
things but maybe easily overlooked They
19:09
can be And then again medication review
19:11
is absolutely vital Avoiding or
19:14
minimizing those high-risisk drugs the
19:15
ones that can trigger delirium Exactly
19:17
Again referring to things like the beers
19:19
criteria helps identify culprits Certain
19:22
painkillers like opioids sedatives like
19:24
bzzoazipines and drugs with
19:26
anticolinergic side effects need very
19:28
careful use or avoidance if possible And
19:31
who is most at risk Does it tie back to
19:33
the vulnerabilities we discussed It
19:35
absolutely does The strongest known
19:38
predictors for developing delirium are a
19:40
personal history of having had delirium
19:42
before underlying frailty and that
19:44
preoperative cognitive impairment we
19:46
talked about screening for Knowing those
19:48
risk factors helps target the prevention
19:50
efforts where they're needed most Okay
19:52
All this focus on assessment
19:54
optimization careful management It feels
19:58
like it leads to the most fundamental
19:59
point the most patient centered one Yeah
20:02
How do we actually define success for
20:03
these patients This is so critical The
20:05
guidelines really push for this Moving
20:07
beyond just clinical metrics Yes For
20:10
frail older adults facing major surgery
20:13
having explicit early conversations
20:15
about their goals of care is absolutely
20:18
essential Goals of care conversations
20:20
These need to happen early Involve the
20:22
patient their family or caregivers if
20:23
appropriate and the whole
20:25
multiddisciplinary team And they cover
20:27
Well yes anticipated longevity might be
20:29
part of it but maybe even more
20:30
importantly what's their desired
20:32
functional status How important is
20:35
independence to them What about comfort
20:37
So it's shifting the focus Not just can
20:40
we cure the disease but how will this
20:42
treatment impact the life you want to
20:44
live Precisely Numerous studies and
20:47
surveys show that for many frail older
20:49
adults maintaining their ability to
20:51
function to live independently is valued
20:54
just as highly sometimes more highly
20:56
than simply living longer or getting rid
20:58
of the disease at any cost That's a
21:00
profound perspective It is and treatment
21:03
decisions need to reflect that We need
21:05
to present a realistic picture of
21:06
potential outcomes for each option
21:09
including the risks to their function
21:10
and cognition These are tough
21:12
conversations no doubt especially in
21:14
emergencies which is why having them
21:16
early is better Exactly When there's
21:18
time to think to discuss before things
21:20
become urgent and if those are the goals
21:22
you're saying our measures of success
21:24
need to evolve too that maybe length of
21:26
stay or time to first bowel movement
21:29
while clinically relevant aren't the
21:31
whole story for these patients They
21:32
probably aren't the whole story No they
21:34
don't fully capture what matters most to
21:35
an older frail individual The guidelines
21:38
really advocate for incorporating
21:40
patient- centered outcomes like what
21:42
functional recovery metrics become
21:44
really important Can the patient regain
21:46
independence in their activities of
21:47
daily living bathing dressing eating Can
21:52
they walk safely again Using tools like
21:54
the ADL scale maybe redoing a mini COG
21:57
assessment or repeating the TU test or a
22:00
six-minute walk test can track this
22:02
Measuring function directly Yes there
22:05
was one study highlighted showing that
22:06
functional decline defined as needing
22:08
more help with daily activities after
22:10
surgery was a significant negative
22:12
outcome in itself Even if the patient
22:14
didn't have any traditional surgical
22:16
complications like infection just losing
22:18
function was a bad outcome a very
22:20
meaningful one for the patient And then
22:22
there are patient reported outcomes Pro
22:26
getting the patient's own perspective
22:27
Exactly How do they feel about their
22:29
quality of life their symptoms pain
22:31
fatigue even things like loneliness
22:34
capturing their subjective experience
22:35
often using validated questionnaires And
22:38
this is where the sources had that
22:39
really surprising finding Yes it was
22:41
quite striking A randomized control
22:44
trial looking at cancer patients median
22:46
age was 61 So not exclusively older but
22:49
relevant found something remarkable What
22:52
was it Simply monitoring their patient
22:54
reported outcomes weekly via electronic
22:56
surveys and alerting the clinical team
22:59
when symptoms reached a certain
23:01
threshold Just doing that actually
23:03
improved their overall survival Wait
23:06
improved survival just by tracking and
23:08
responding to how patients said they
23:10
felt Correct Compared to the group
23:12
getting standard care without that
23:14
regular pro monitoring it strongly
23:17
suggests that actively listening to and
23:19
then acting on patient reported issues
23:21
isn't just about symptom management or
23:23
feeling better It can actually extend
23:24
life The evidence from that trial points
23:26
that way It really underscores that the
23:28
patients voice their reported experience
23:30
is far more than just a nice to have It
23:32
can have profound impacts on outcomes we
23:34
used to think were purely driven by
23:36
clinical interventions Wow That is yeah
23:39
that's a powerful thought to process It
23:41
really shifts the perspective on what
23:43
constitutes effective care doesn't it It
23:45
absolutely does So if we try to pull all
23:46
these threads together caring for older
23:49
adults who need major surgery like
23:52
colctal procedures it really demands
23:55
looking far beyond just their birth date
23:57
miles beyond It means zeroing in on
23:59
their actual physiological resilience
24:02
their frailty using broader assessment
24:05
tools that capture function cognition
24:08
social factors bringing in that
24:09
multid-disciplinary team especially
24:11
geriatric expertise implementing
24:13
proactive strategies like
24:15
prehabilitation getting them ready
24:16
tailoring the surgical approach adapting
24:18
posttop care like ERPs being incredibly
24:21
vigilant about preventing and managing
24:23
risks like delirium Vigilance is key and
24:26
maybe most fundamentally aligning the
24:28
entire treatment plan with what the
24:30
patient values most their independence
24:32
their function their quality of life and
24:34
then measuring our success based on
24:36
those outcomes It's really a move away
24:38
from any kind of one-sizefits-all
24:40
medicine towards deeply personalized
24:41
care Recognizing the unique package of
24:44
needs strengths vulnerabilities and
24:46
priorities that each individual older
24:48
patient brings Which leaves us and you
24:50
listening with a final thought to really
24:52
mle over Building on that incredible pro
24:55
study finding if truly prioritizing and
24:58
actively responding to what patients
24:59
tell us matters most things like
25:02
maintaining independence or managing
25:03
symptoms can not only enhance their
25:05
quality of life but potentially even
25:07
extend their survival Well what would a
25:09
health care system that was genuinely
25:10
built around patient reported values
25:12
actually look like And maybe more
25:14
importantly how far are we really from
25:16
creating it
#Aging & Geriatrics
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