3 min
Surgery past 65? Brain health screening can aid recovery
Before surgery, your doctor will order evaluations to identify any health problems that may need to be addressed before the procedure. This typically includes medical histories, laboratory tests and checking blood pressure, heart rate and temperature. There’s one vital sign that is often not on the list, but is crucial for older adults: screening for mental and cognitive health. “There is an overwhelming amount of evidence that presurgical brain health predicts complications after surgery,” said Catherine Price, Ph.D., a professor in the University of Florida College of Public Health and Health Professions Department of Clinical and Health Psychology and the UF College of Medicine Department of Anesthesiology. “For example, individuals with weaknesses in memory and attention and people with neurodegenerative diseases, such as Parkinson’s, have higher rates of confusion and memory complications that affect their recovery from surgery.” Research by Price and others has shown that a patient’s cognitive, memory and mental health status before surgery is an excellent indicator of whether they will experience cognitive problems such as delirium, a common complications in older adults after surgery. Delirium, characterized by confusion, disorientation and impaired awareness, can lead to longer recovery times, increased dementia risk, higher mortality rates and health care costs. Price founded and directs the University of Florida Perioperative Cognitive Anesthesia Network, or PeCAN, a first-of-its-kind, multidisciplinary program that seeks to identify older adults who may be at risk of developing cognitive problems after surgery so that clinicians can intervene. In recent findings published in the journal Anesthesia and Analgesia, Price and her colleagues report on two years of PeCAN patient data. Of the thousands of patients over age 65 who received presurgical screening, 23% were found to have issues with their cognitive performance, yet only 2% of the patients screened had a previous note in their medical charts indicating they had a cognitive impairment. “It’s so important to know when an individual has cognitive complications because that changes their care path,” Price said. “From medication to monitoring, the patient’s care is more complex for the perioperative team and family.” For PeCAN patients identified as being at risk for postsurgery cognitive problems, Price and her team will share tailored recommendations with the patient’s care team before, during and after surgery. These may include more monitoring during anesthesia and medication adjustments, such as using medications for nausea and pain management less likely to contribute to delirium. The PeCAN team also might offer the surgical care team specific communication strategies. For example, health care providers should repeat information several times for patients who have trouble remembering new material and ask them to write it down. Recently published research by Price and colleagues found PeCAN patients reported the focus on brain health improved confidence in their surgical team and care plan. Health care systems are only starting to incorporate preoperative brain health teams like PeCAN. Until they are offered more frequently, Price offers a few steps anyone can take to help protect brain health, including a focus on reducing inflammation in the body prior to surgery. To help achieve this: Optimize nutrition. Reduce your intake of added sugars and refined carbohydrates, like white bread. Get good sleep. Improve sleep hygiene so you are well-rested. “Sleep is essential for the brain for a number of reasons,” Price said. Reduce alcohol intake to limit inflammation and dehydration. Pay attention to your medications. Follow your care team’s instructions. Enlist a family member or caregiver to help you keep tabs on what you’re taking, how much and how often. Practice techniques to limit anxiety, such as visualization and deep breathing. The box breathing method is an easy one to remember: Breathe in slowly for four seconds. Hold your breath for four seconds. Slowly exhale for four seconds. Wait four seconds before inhaling again.
