Clinical Scorecard: Management of Depression and Anxiety in Older Surgical Patients: Results from a Randomized Clinical Trial
At a Glance
Category
Detail
Condition
Depression and Anxiety in Older Surgical Patients
Key Mechanisms
Psychological management and pharmacologic optimization
Target Population
Older adults (aged 60 and above) undergoing orthopedic, oncologic, or cardiac surgery
Care Setting
Hospital network encompassing academic and community practices
Key Highlights
Preoperative depression and anxiety symptoms are prevalent in older surgical patients, with estimates of 10% to 33% for depression and 22% for anxiety in the US.
The intervention integrated psychological management with pharmacologic optimization to address mental health needs.
Eligibility required a PHQ-ADS score of ≥10, indicating clinically meaningful anxiety and/or depression symptoms.
Guideline-Based Recommendations
Diagnosis
Initial screening with the Patient Health Questionnaire 4 (PHQ-4) for depression and anxiety symptoms.
Management
Implementation of a structured intervention combining behavioral activation and pharmacologic optimization.
Monitoring & Follow-up
Tracking responses to medication modifications and evaluating mental health symptoms pre- and post-surgery.
Risks
Increased postoperative complication risks associated with untreated depression and anxiety, including delirium and delayed recovery.
Patient & Prescribing Data
Older adults scheduled for surgery with clinically meaningful anxiety and/or depression symptoms.
Involves deprescribing potentially inappropriate medications and optimizing antidepressant doses.
Clinical Best Practices
Utilize a community-based participatory research approach to incorporate patient perspectives.
Employ a structured, manualized approach for psychological management by trained wellness partners.
by Joanna Abraham, Katherine J. Holzer, Simon Haroutounian, Bethany Pennington, Ana Baumann, Ryan Calfee, Theresa Cordner, Kenneth E. Freedland, Thomas Kannampallil, Benjamin Kozower, Emily Lenard, J Philip Miller, Mary Politi, Michael Yingling, Michael S. Avidan, Eric J. Lenze
