"There's So Much That They're Enduring": Experiences of Older Adults Undergoing Major Elective Surgery.

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.

Multisite Implementation of an American College of Surgeons Geriatric Surgery Quality Improvement Initiative.

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.

Public Opinions About Surgery in Older Adults: A Thematic Analysis.

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.

Preoperative Depressive Symptoms Associated with Poor Functional Recovery after Surgery.

Background/objectives: Depression screening and treatment for older adults are recommended in Age-Friendly Health Systems. Few studies have evaluated the association between depressive symptoms and postoperative functioning. We aimed to determine the association between varying levels of depressive symptoms in the preoperative setting with postoperative functional recovery.

Anxious, Depressed, and Planning for the Future: Advance Care Planning in Diverse Older Adults.

Objectives: To determine whether depression and anxiety are associated with advance care planning (ACP) engagement or values concerning future medical care.

Design: Cross-sectional.

Participants: English- and Spanish-speaking patients, aged 55 years and older, from a San Francisco, CA, county hospital.

Advance Care Planning Prior to Death in Older Adults with Hip Fracture.

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.

Association of Functional, Cognitive, and Psychological Measures With 1-Year Mortality in Patients Undergoing Major Surgery.

Importance: More older adults are undergoing major surgery despite the greater risk of postoperative mortality. Although measures, such as functional, cognitive, and psychological status, are known to be crucial components of health in older persons, they are not often used in assessing the risk of adverse postoperative outcomes in older adults.

Objective: To determine the association between measures of physical, cognitive, and psychological function and 1-year mortality in older adults after major surgery.

What Matters? The Valued Life Activities of Older Adults Undergoing Elective Surgery.

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.

Optimizing the Feasibility and Scalability of a Geriatric Surgery Quality Improvement Initiative.

Background: The American College of Surgeons Coalition for Quality in Geriatric Surgery is a multidisciplinary stakeholder group that aims to systematically improve the surgical care of older adults by establishing a verifiable quality improvement program with standards based on best evidence. Prior work confirmed the validity of a preliminary set of 308 standards to improve the quality of geriatric surgery, but concerns exist as to whether the standards are feasible for hospitals to implement.

Objective: Our aim was to utilize data gained from a multi-institutional survey and interview to improve the scalability and generalizability of a geriatric quality improvement program.

Advance Care Planning in Older Adults With Multiple Chronic Conditions Undergoing High-Risk Surgery.

This study conveys data on the prevalence of advanced care planning documentation in elderly individuals undergoing high-risk surgery.

Increasing Advance Care Planning Using a Surgical Optimization Program for Older Adults.

Objectives: To describe an innovative model of care, the Surgery Wellness Program (SWP), that uses a multidisciplinary team to develop and implement preoperative care plans for older adults, and its effect on engagement in advance care planning (ACP).

Design: Retrospective analysis of clinical demonstration project.

Setting: Preoperative optimization program for older adults undergoing surgery at a 796-bed academic tertiary hospital.

Age, comorbidity, life expectancy, and pulmonary nodule follow-up in older veterans.

Background: Pulmonary nodule guidelines do not indicate how to individualize follow-up according to comorbidity or life expectancy.

Objectives: To characterize comorbidity and life expectancy in older veterans with incidental, symptom-detected, or screen-detected nodules in 2008-09 compared to 2013-14. To determine the impact of these patient factors on four-year nodule follow-up among the 2008-09 subgroup.

Application of the RAND-UCLA Appropriateness Methodology to a Large Multidisciplinary Stakeholder Group Evaluating the Validity and Feasibility of Patient-Centered Standards in Geriatric Surgery.

Objectives: To explore (1) differences in validity and feasibility ratings for geriatric surgical standards across a diverse stakeholder group (surgeons vs. nonsurgeons, health care providers vs. nonproviders, including patient-family, advocacy, and regulatory agencies); (2) whether three multidisciplinary discussion subgroups would reach similar conclusions.

Postoperative Functional Outcomes in Older Adults.

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.

Hospital Standards to Promote Optimal Surgical Care of the Older Adult: A Report From the Coalition for Quality in Geriatric Surgery.

Objective: The aim of this study was to establish high-quality, valid standards to improve surgical care of the older adult.

Background: The aging population increases demand for high-quality surgical care. Building upon prior guidelines, quality indicators, and pilot projects, the Coalition for Quality in Geriatric Surgery (CQGS) includes 58 diverse stakeholder organizations committed to improving geriatric surgery.

Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study.

Background: Knowledge about expected recovery after hip fracture is essential to help patients and families set realistic expectations and plan for the future.

Objectives: To determine rates of functional recovery in older adults who sustained a hip fracture based on one's previous function.

Design: Observational study.

Clinician Factors Associated With Prostate-Specific Antigen Screening in Older Veterans With Limited Life Expectancy.

Importance: Despite guidelines recommending against prostate-specific antigen (PSA) screening in elderly men with limited life expectancy, PSA screening remains common.

Objective: To identify clinician characteristics associated with PSA screening rates in older veterans stratified by life expectancy.

Design, Setting, And Participants: Cross-sectional study of 826 286 veterans 65 years or older eligible for PSA screening who had VA laboratory tests performed in 2011 in the VA health care system.

Statin medications are associated with a lower probability of having an abnormal screening prostate-specific antigen result.

Objective: To investigate how statin use is associated with the probability of having an abnormal screening prostate-specific antigen (PSA) result according to common PSA thresholds for biopsy (>2.5, >4.0, and >6.

Predictors of rehospitalization after admission for pneumonia in the veterans affairs healthcare system.

Introduction: Although some factors associated with rehospitalization after community-acquired pneumonia have been identified, other factors such as medical care utilization and medication usage have not been previously studied. We investigated novel predictors of rehospitalization in patients admitted with pneumonia.

Methods: Using Department of Veteran Affairs (VA) administrative data from October 2001 to September 2007, we examined a cohort of patients 65 years old and older, who were hospitalized with pneumonia, in 150 VA acute care hospitals.

Trends in hospice referral and length of stay at a veterans hospital over the past decade.

Introduction: Hospice decreases the fear of dying alone, reduces the agony of death, and helps in maintaining dignity at the end of life. Physicians are encouraged to offer hospice to terminally ill patients early on in their end-of-life care to maximize these benefits. However, there is limited data on the changes and characteristics of hospice utilization.