Objective:

To assess the effectiveness and implementation potential of a perioperative intervention designed to reduce anxiety and depression symptoms in older surgical patients.

Approach:

• Study Design: Three linked randomized clinical trials (RCTs) were conducted involving older surgical populations undergoing cardiac, oncologic, or orthopedic procedures.
• Participant Selection: Eligibility screening involved 3159 patients, with 326 enrolled and randomized. Inclusion criteria included age ≥60 years and clinically meaningful anxiety and/or depression symptoms.
• Intervention Components: The intervention integrated psychological management and pharmacologic optimization, including behavioral activation and deprescribing inappropriate medications.
• Implementation Strategy: Wellness partners provided psychological support, while clinical pharmacists directed medication optimization under psychiatrist supervision.
• Data Collection: Quantitative outcomes and qualitative data were integrated using a mixed-methods sequential explanatory approach.

Key Findings:

• Preoperative depression and anxiety symptoms are prevalent among older surgical patients, estimated at 10% to 33% and 22%, respectively, in the US, and at 6% to 52% and 5% to 45%, respectively, worldwide.
• The intervention was designed based on community input and aimed to optimize mental health.
• Participants were screened using the PHQ-4 and PHQ-ADS scales to assess symptoms.

Interpretation:

The study highlights the need for improved perioperative care models that address mental health in older adults undergoing surgery.

Limitations:

• Exclusion criteria included inability to understand English and severe cognitive impairment.
• The study's generalizability may be limited due to specific eligibility requirements.

Conclusion:

The findings indicate that a structured intervention may address mental health needs in older surgical patients.

Sources:

• Washington University School of Medicine