Manage Surgery As an Elderly Patient

Surgery can be a stressful and scary procedure. As an elderly person, you want to ensure that your surgery goes as easily as it can. Before your surgery, you should make your preferences known and follow all preoperative directions. After the surgery, you should aim to reduce falls, avoid delirium, and keep yourself safe.

Steps

Managing Preoperative Concerns

1. Make your treatment preferences known to doctors and caregivers. Before you have surgery, you should discuss your treatment preferences with your health care team and caregivers. You should document what things you consent for the doctors to do and things you do not agree to. If you already have an advance directive, you should update it to reflect the risks of your surgery.
   • For example, you and your doctor and caregivers should discuss any advance directives, like your preferences on life support and resuscitation.
2. Determine your Appoint-a-Power-of-Attorney. Before your surgery, you should talk to a caregiver or trusted family member or friend about being your proxy. A proxy is someone who you trust with your wishes to make decisions for you when you are unable. Choose a person you trust and who you know will follow your orders.
   • You should discuss all scenarios with your proxy and your wishes. For example, you should let them know what procedures you are comfortable with and which you are not. You should also discuss what your end of life wishes are.
3. Follow all preoperative directions. Your doctor will give you a list of things you need to do before your operation. You will need to cut off food and beverages a set number of hours before the operation. There will also be certain medications you will not be able to take leading up to the surgery. Stop taking those but make sure you take any medications you have to take.
   • If your doctor gives you any medications to take before the surgery, make sure you take all of those.
4. Undergo a physical exam. Before you have surgery, you should go to your doctor and have a physical exam. This exam will help the doctor determine the state of your health so they can determine the appropriate and safest anesthesia for you.
   • During this visit, your doctor will also take a pain history, which will help them design the right analgesic plan for you.

Making Arrangements for Your Care

1. Arrange your transportation. Prior to your surgery, talk to family, friends, or caregivers about transportation to and from the hospital. You won't be able to take public transportation, so you should find someone who can help you get to and from the hospital.
   • The person who agrees to take you home should be available to come get you within a few hours of being called about your discharge. They should also be able to take you to get your prescriptions filled.
2. Plan for help at home. Talk to family, friends, or caregivers about helping you after your surgery. The amount of care you need may depend on the type of surgery you have and how long you remain in the hospital after your surgery. Figure out who will help you and how long they can stay. Set up a schedule if you need to.
   • Care that you need at home may include getting out of bed, moving around the house, and getting your meals.
3. Prepare your home. You should get things ready in your home for after your surgery before you go to the hospital. This may include cleaning, setting up your bed, and moving necessary things into your room near your bed. You should also set up any mobility aids in your home, like handrails or secure pieces of furniture. If you won't be able to make it up the stairs, then set up an area to sleep on the ground floor.
   • If you need to set up safety measures around the house, like non-slip mats in the tub or night lights, you should do that.
4. Buy foods for your postoperative diet. After some surgeries, you may need to follow a special diet. Go to the grocery store and stock up on foods you will need to eat during your recovery. If possible, do meal prep like washing and chopping vegetables and freezing casseroles.
5. Arrange any professional care. Depending on your after surgery needs, you may need to hire a home health professional to help you after your surgery. Your doctor and caregivers can help you determine if you need a nurse, physical therapist, or other professional to help you during your recovery.

Addressing Postoperative Delirium

1. Have caregivers near you. After your surgery, you are at risk of postoperative delirium. Postoperative delirium is a sudden confusion and change in mental state. This may cause you to be agitated, sleepy, aggressive, or inactive. To help with this, you should ask a caregiver or trusted family member or friend to be by your bedside. Having a person there can help reduce the symptoms of delirium.
2. Practice good sleep hygiene. Not getting enough sleep or quality sleep can also contribute to delirium. You should discuss with your doctor the best protocol for getting sleep after your operation. Sleeping without sleep aids like pills can help decrease your risk of delirium.
   • You should also try to practice good sleep hygiene. For example, try to go to bed and get up at the same time each day. Sleep in a room with few distractions, like light and television. Try to sleep at least seven hours if possible.
3. Promote a calm environment. Stress can lead to delirium. You should be placed in a calm environment. Even if you are in the hospital, the area should be free from loud noises and too much activity. The amount of people coming in and out should be limited until you are not delirious.
   • You should have limited devices restraining you. If possible, all cords and machines should be removed from you and your body.
   • You should be surrounded with familiar and comforting objects. This might include photographs, pillows, blankets, or knickknacks.
   • Calendars and clocks should be placed so you can find them and orient yourself. This helps keep you calm so you are reminded where you are and when it is.

Avoiding a Fall

1. Keep needed items within reach. There is a heightened risk of falling after a surgery. Move all the things that you need close to you so that you can reach them without getting up. Place a table or tray beside your bed to make it more convenient.
   • You may want to put your phone, the remote, a beverage, medication, glasses, or a book on the table so you can get to it easily.
2. Place things to hold on to around you. You will have to move around after your surgery, like when you go to the bathroom. If you are able to walk, you should place things like handrails or secure things to hold on to along the path you will walk. You may ask a caregiver, family member, or friend to help set up a path for you to walk.
   • If you don’t have handrails, you can set up solid, secure tables or other furniture along the path to hold on to as you walk.
3. Wear secure clothing. Clothing may also contribute to your fall risk. To make sure you stay as safe as possible, avoid wearing overly large or long clothing that you could trip over or step on. You should also wear non-slip footwear that fits your feet.
4. Keep walkways well lit. Trying to walk in the dark can also cause a fall. Make sure that there are night lights along hallways or in dark rooms, like bathrooms. You may also choose to keep lamps on in all rooms during the night so you can see to navigate your way around.

Taking Care of Yourself

1. Discuss all new medication with your doctor. You or your caregiver should talk to the doctor about new medications that should be continued when you go home. You should be aware of how many new drugs you have, what they are called, and why you are taking them. Make sure you understand how you should take each new medication and ask any questions if you don’t understand.
   • Talk to the doctor about any possible side effects.
2. Get a list follow-up appointments. When you are discharged, make sure you get a list of all future appointments. This may include appointments with your doctor or surgeon. You may also need additional medical treatments or lab tests.
   • Ask the person in charge of your discharge to write everything down for you so you can easily remember.
3. Stay elevated after your surgery. To help reduce any pulmonary complications, try to stay as upright as possible after your surgery. Keep the head of your bed elevated at different heights. If possible, get out of bed to eat your meals and move around.
   • Make sure you sit up when you eat to avoid any problems swallowing and digesting. You should also stay upright for at least an hour after you finish a meal.
4. Turn yourself every few hours. Bed sores and pressure ulcers can occur after surgery. To help with this, make sure to switch sides every one to two hours to relieve pressure on your body. You should also avoid sliding along the bed if possible.
   • If you cannot turn yourself, get a nurse, caregiver, or family member to help turn you every couple of hours.

Sources and Citations

See also

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• Live Happily During Old Age
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• Enhance Daily Life for a Person with a Disability
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