How your program can meet needs of the elderly
More elderly patients are entering same-day surgery programs, and managers are becoming more aware of their unique needs to help them recover, while maintaining their dignity and independence.
"Thirty years ago, when people were age 80 or older, physicians generally did not operate," says Suzanne Beyea, PhD, RN, CS, co-director of perioperative nursing research at the Association of periOperative Registered Nurses (AORN) in Denver. "Physicians thought there was no point, that if a patient broke a hip, he could just live the rest of his life in a wheelchair. Today, physicians will operate when it is indicated, regardless of the patient’s age. The determining factor is the patient’s health status."
Overall, the elderly require more surgery than any other group. "It has been noted, that patients over the age of 75 require one-third more surgery than any other group," says Beyea. "These adults often have three or four chronic illnesses such as arthritis, coronary artery disease, or pulmonary disease, which make the surgeries more complex."
To provide every elderly patient with the best odds for recovery and resuming life to the fullest potential, a thorough assessment is essential in formulating the patient’s care plan.
"Be aware of all things, intervene early, and prevent complications," says Beyea. "You need to know the overall functional status of the patient before he or she developed a need for surgery." (See recommendations for developing a thorough patient profile, p. 145.)
Elderly patients often fear that they will lose their independence, particularly due to declining health. Before surgery, make sure that the patient fully understands the postoperative impact, including the recovery period and limits on activities.
Carol Orr, RN, BSN, MHR, CNOR, formerly clinical manager of the Ambulatory Surgery Center at Saint Francis Health Care System in Tulsa, OK, suggests you tell them how they might feel coming out of anesthesia, what their restrictions might be, and the importance of following their postoperative instructions carefully. (See story on how medications are often misunderstood, p. 146.)
"Encourage them to ask you questions no matter how trivial. Carefully discuss the risks and benefits. Don’t talk in a demeaning way, such as too loud or as when speaking to a child." Allow ample time for questions and answers, she suggests.
When Saint Francis developed its freestanding same-day surgery center in the Warren Clinic, one of the priorities was to provide an environment that didn’t rush patients, particularly the elderly.
"We don’t want patients to ever get the impression that we want them out of our way," says Orr. "Our center provides easy access, not only in parking and entering the system, but in scheduling as well. We work collaboratively with physician offices to provide the patient with efficient, one-stop service for all of their preoperative tests."
Providing elderly people with videotapes to review on their own is not an acceptable means of communication.
"We can’t assume what works in our world, works in theirs," says Beyea. "There are a lot of elderly individuals that do not have access to a VCR. One-on-one conversation proves most effective, especially for individuals who are alone."
Many times, patients are embarrassed to admit that they have no one to help them. "They may think that their children will take care of them after surgery, but if one lives in Iowa and one lives in California, this won’t help Mom or Dad in Ohio," says Deborah G. Spratt, RN, MPA, CNOR, CNAA, nurse manager of the operating room at Strong Memorial Hospital in Rochester, NY. "In other instances, their children may live locally but have active busy lives that prohibit them from providing adult day care."
If a patient experiences complications during surgery or postoperatively in a freestanding facility, there should be a tried-and-true contingency plan to maintain the patient’s continuum of care.
Saint Francis has developed a system that saves the patient a $700 ambulance ride. If the patient is stable enough to sit in a wheelchair, staff use the hospital shuttle that is equipped with a wheelchair lift. The patient is transported two blocks from the clinic to the hospital with a technician and registered nurse, depending on the severity of the patient’s condition, says Orr.
"We maintain the patient’s continuum of care by calling the hospital for the patient’s room number, telling the family, and calling the physician to make sure that he or she knows the patient’s room number," she says. "The patient is taken directly to his or her room, and a report is given to the nurses."
Developing processes to better meet the needs of the elderly is a must, sources say. "We know that the demand for treating elderly patients is increasing steadily," says Beyea. "This provides a great opportunity for us as health care providers to come up with creative ideas for the appropriate care of the elderly while maintaining their dignity and independence." n
For more on concerns of the elderly and same-day surgery, contact:
• Suzanne Beyea, PhD, RN, CS, Co-director, Perioperative Nursing Research, Association of periOperative Registered Nurses, 2170 S. Parker Road, Denver, CO 80231-5711. Telephone: (800) 755-2676 Ext. 8277. Fax: 603-286-2049. E-mail: [email protected]
• Carol Orr, RN, BSN, MHR, CNOR, 7032 E. 70th St., Tulsa, OK 74133. Telephone: (918) 494-2042.
• Deborah G. Spratt, RN, MPA, CNOR, CNAA, Nurse Manager, Operating Room, Strong Memorial Hospital, 601 Elmwood Ave., Rochester, NY 14642. Telephone: (716) 275-5676. Fax: (716) 273-1078. E-mail: dspratt@ smhor.urmc.rochester.edu.
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