Describe how frailty, physical and cognitive impairment may increase the risk of poor surgical outcomes.
Evaluate older adults who may be at increased risk for poor surgical outcomes from frailty or physical/cognitive impairment through risk assessment.
Implement communication strategies for shared decision making with the patient and family members in the preoperative setting.
Develop a multidisciplinary approach to preoperative assessment/optimization.
Formulate a plan to incorporate risk assessment tools, shared decision-making, and preoperative optimization for older adults considering surgical intervention in the learner’s practice.
The population of the United States is aging rapidly, and older adults will increasingly need urologic surgical intervention. However, older adults with urologic conditions are often frail, and therefore at increased risk of adverse perioperative events. Achieving optimal outcomes among these frail older adults will require urologists to recognize frailty and deficits in physical and/or cognitive functioning preoperatively and engage in risk assessment, shared decision making and preoperative optimization, ideally as part of a multidisciplinary care team. Utilizing resources from the American Urological Association, American College of Surgeons and the American Geriatrics Society, a multidisciplinary faculty including urology and geriatrics representation will lead the course. Course faculty will include Dr. Anne Suskind (UCSF), a urologic surgeon and health services researcher with funding from the National Institute of Aging and Dr. Chuck Scales (Duke), a urologic surgeon and health services researcher who is part of the Duke Center for Geriatric Surgery.
The course will provide case-based and didactic instruction for urologic surgeons. Course content will focus on risk assessment, share decision making and preoperative optimization for older adults who may require surgical intervention. This proposed structure builds upon the framework jointly developed by the American College of Surgeons and the American Geriatrics Society to enhance surgical outcomes among older adults. As a result of attending this course, learners will return to their practice with increased knowledge and skills. Specifically, participants will gain knowledge regarding 1) risks of surgical complications in older adults, 2) risk assessment, 3) shared decision making frameworks for older adults and 4) multidisciplinary models for optimizing surgical outcomes in frail older adults. In addition to these 4 domains, learners will apply knowledge in case-based risk assessment examples and practice shared decision making skills through small group interactions. In addition, participants will create an implementation plan for applying these skills and knowledge upon return to their own practice setting.