Investigating ways to optimize health care for elders is important to maximize quality of life and reduce the burden of comorbid disease, functional and cognitive impairment on society. In the next 35 years, 1 in 4 North Americans and Europeans will be over the age of 65 years. These changing demographics need to alter the way we think about and how we deliver healthcare. There are an increasing proportion of elderly patients presenting to our acute care hospitals who often also have multiple comorbidities; unfortunately most current models of health care delivery do not take into account the aforementioned. In order to provide health care specific to the elderly, accurate data on outcomes from acute emergency surgical interventions is needed. There has to date been limited attempts to measure change in the quality of life of the elderly following surgery and few reports that considers return to home and normal function following acute surgical intervention [19, 20]. These factors are probably the most important to consider in this group. How early patients return home, their level of physical and cognitive function, the amount of support they need and their discharge destination are of critical importance to healthcare planners who need to allocate resources in a political and social environment where expectations are high and where costs and resource limitations need to be taken into consideration.
Results from our mid-term follow-up revealed that greater than half of patients greater than 80 years who underwent emergency surgery survived up to 3 years post-operatively. Post-operative functional status appeared to be stable across the 3 cohorts of patients, regardless of time of assessment post surgery. This evidence supports that good surgical outcomes is possible even in the elderly, and that much more must be considered than simply age alone. Although there was a cognitive decline at 3 years post-operatively compared to 1 and 2 years following surgery, this difference was not statistically significant.
Overall, there was moderate variability in the reported limitations in functional capacity of our sample of elderly patients, underlining the diversity of this acute care population. With age, losses in functional capacity become more common and are increasingly severe. Most people with a limitation in functional capacity, when younger than 85 years, report only mild limitations. However, 25% of seniors 85 years and over report a moderate (15%), severe (5%), or total (5%) limitation in functional capacity . Our sample reported no decline in their HRQOL following surgery but also had a significantly better HRQOL compared to the general elderly population of Alberta (greater than75 years), this most likely can be explained by multiple factors. One of the most important being, patients with better HRQOL are more likely to undergo an emergency surgical intervention when compared to those with lower HRQOL at baseline. Additionally, patients with better HRQOL are more likely to respond to our study surveys.
There are several limitations to this study including the retrospective nature of the study that will limit the data available for analysis, the presence of selection and survivor biases. As well, we specifically only examined the outcomes of those elderly patients who had a surgical intervention. We did not include those patients with acute surgical conditions who were treated conservatively. Other factors such as socioeconomic status, type of residence (rural vs. urban), and professional background might have a confounding effect on the results of this analysis and were not accounted for in this analysis.
Our study also was not designed to measure pre- to post-acute care changes in cognitive impairment, functional status, or quality of life. Rather, the intent was to get a “snapshot” of how elderly patients fare after surgery and assess the feasibility of collecting data from this elderly, more vulnerable group. For this reason, it is not possible to assess what impact ACS might have had on our patients’ level of independence and quality of life. We are currently undertaking a prospective study, which addresses these limitations in order to provide greater insight on the effects of ACS on this elderly population.