Mass General Brigham Geriatrics for Surgical Clinicians 2024

In the United States, almost 40% of all inpatient procedures are performed on patients aged 65 and older; at MGB trauma centers over 50% of injured patients are older adults, the majority of whom are frail. To prepare our healthcare system to care for growing numbers of older adults who have increasing medical and psychosocial complexity, front line clinicians including Advanced Practice Providers (APPs), surgical trainees, nurses, and surgical attendings urgently need more training in geriatric syndromes and the 5 pillars of Age-Friendly care (Medication, Mobility, what Matters, Mentation and Multicomplexity). This training will address the needs of the growing number of geriatric patients, and avoid hazards of hospitalization such as delirium, falls, infections, and loss of function, and reduce caregiver strain. These issues are particularly relevant in surgery and trauma where mortality, complications, and other adverse outcomes are consistently higher for older patients than their younger counterparts. Moreover, national stakeholders including CMS and the American College of Surgeons are setting standards for geriatric surgical care that clinicians must be prepared to meet. Evidence suggests that geriatric-focused clinical pathways can reduce delirium, ICU stays, length of stay, and readmissions in older surgical patients. Clinicians will benefit from in depth training in geriatric care to enable the implementation of structures and processes to improve outcomes.

Target audience

This activity is intended for surgical clinicians, nurses, and physician assistants internal & external to the Mass General Brigham system.

Learning objectives

Upon completion of this activity, participants will be able to:

• Describe the 5 Ms (Medication, Mobility, what Matters, Mentation, and Multicomplexity) of caring for older surgical patients.
• Perform an assessment for delirium, initiate work-up for precipitating factors, treat underlying causes, and develop a safe care plan.
• Recognize risk factors for falls and fractures and create a plan for optimizing mobility.
• Perform a full medication reconciliation and identify medications that are potentially inappropriate.
• Summarize how to coordinate a safe and effective care transition for older patients, caregivers, and families
• Assess what matters most to older patients and apply these priorities into surgical planning.
• Associate geriatric syndromes such as frailty and dementia with adverse postoperative outcomes.