Abstract
Introduction: national reports have highlighted deficiencies in care provided to older surgical patients and suggested a role
for innovative, collaborative, inter-specialty models of care. The extent of geriatrician-led perioperative services in the UK (excluding
orthogeriatric services) has not previously been described. This survey describes current services and explores barriers
to further development.
Methods: an electronic survey was sent to clinical leads for geriatric medicine at all 161 acute NHS health care trusts in the
UK. Reminders were sent on three occasions over an 8-week period. The survey examined preoperative and postoperative care
and organisational issues. Responses were analysed descriptively.
Results: there were 130 respondents (80.7%). One-third (38) of respondents described providing some geriatric medicine
input in older surgical patients. Preoperative services existed in 15 (12%), where 14 provided risk assessment and 13 preoperative
optimisation. Twenty-six respondents (20%) delivered care postoperatively, of them 10 took a reactive approach, 11 a proactive
approach and 5 provided a combination of reactive and proactive care. Barriers to establishing perioperative geriatric
medicine services included funding, workforce issues and a lack of inter-specialty collaboration.
Conclusion: a national appetite exists to provide geriatrician-led services to older surgical patients yet the majority of existing
services remain reactive and do not use comprehensive geriatric assessment as an organising principle. This survey suggests
that funding for geriatricians in perioperative care has not yet been universally established. Future efforts should focus on dissemination
of experiential knowledge and published resources, collaboration with commissioners and empirical research to
overcome the barriers described.
for innovative, collaborative, inter-specialty models of care. The extent of geriatrician-led perioperative services in the UK (excluding
orthogeriatric services) has not previously been described. This survey describes current services and explores barriers
to further development.
Methods: an electronic survey was sent to clinical leads for geriatric medicine at all 161 acute NHS health care trusts in the
UK. Reminders were sent on three occasions over an 8-week period. The survey examined preoperative and postoperative care
and organisational issues. Responses were analysed descriptively.
Results: there were 130 respondents (80.7%). One-third (38) of respondents described providing some geriatric medicine
input in older surgical patients. Preoperative services existed in 15 (12%), where 14 provided risk assessment and 13 preoperative
optimisation. Twenty-six respondents (20%) delivered care postoperatively, of them 10 took a reactive approach, 11 a proactive
approach and 5 provided a combination of reactive and proactive care. Barriers to establishing perioperative geriatric
medicine services included funding, workforce issues and a lack of inter-specialty collaboration.
Conclusion: a national appetite exists to provide geriatrician-led services to older surgical patients yet the majority of existing
services remain reactive and do not use comprehensive geriatric assessment as an organising principle. This survey suggests
that funding for geriatricians in perioperative care has not yet been universally established. Future efforts should focus on dissemination
of experiential knowledge and published resources, collaboration with commissioners and empirical research to
overcome the barriers described.
| Original language | English |
|---|---|
| Pages (from-to) | 721-724 |
| Number of pages | 4 |
| Journal | Age and Ageing |
| Volume | 43 |
| Publication status | Published - 4 Aug 2014 |
Keywords
- older adults, perioperative medicine, liaison geriatrics, health services, clinical pathways