ALIGNing-CARE in Geriatric Surgery Co-Management: Pre-operative Phase

TL;DR

A pilot program called ALIGN-CARE assesses and supports older, frail patients before surgery to improve outcomes through comprehensive geriatric care.

Contribution

ALIGN-CARE introduces a pre-operative co-management model for older adults using a structured framework to address geriatric and frailty domains.

Findings

ALIGN-CARE enrolled 51 older patients, with 42% classified as clinically frail.

Over half of patients received recommendations for physical therapy or pre-rehabilitation, and nearly half completed healthcare proxy forms.

The program highlighted the need for interprofessional care in geriatric surgery co-management.

Abstract

Older patients comprise more than half of surgeries, with greater risk for death, loss of function and quality of life. Geriatric Surgery Co-Management programs aim to assess peri-operative risks and improve surgical outcomes, via comprehensive assessments and interprofessional interventions. Our ALIGN-CARE pilot explored the outcomes and potential for pre-operative intervention in older frail adults. Surgical candidates 65+ years screened pre-frail or frail by surgeons were included. Enrolled patients underwent a comprehensive geriatric and frailty assessment, and an ALIGN-CARE framework of measurements (“7Ms”) to assess and intervene on important geriatric domains. Patients were offered pre-operative interventions and followed to surgery. Data was collected from January 2022 to May 2024. ALIGN-CARE enrolled 51 patients, mean age 78.5 years, 45.1% female, 49% reported primary spoken language other than English. Surgeons from 7 specialties were included with Urology comprising majority (58.5%) of referrals. Of those enrolled, 42% were clinically frail. Of the 7Ms framework, recommendations and interventions included 19% of PCPs outreached by ALIGN-CARE, 50.8% recommended for medication adjustment, 54% advised for physical therapy or pre-rehabilitation, 15.9% newly diagnosed with MCI or dementia, 22.2% recommended for further cognitive testing, 46.0% completed healthcare proxy form, 20.6% discussed advance care planning, and 44.4% scheduled for a social work visit. ALIGN-CARE assessment and interventions spanned important domains of geriatric care, signaling need for interprofessional incorporation of medical and psychosocial care in older frail persons. Further data on patient and provider experience in this co-management model, combined with extension into post-operative phases of co-management, is needed.