Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO; Institute for Informatics (JA, TK, JPM), Data Science and Biostatistics, Washington University School of Medicine, St. Louis, MO.
Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO.
Am J Geriatr Psychiatry. 2024 Feb;32(2):205-219. doi: 10.1016/j.jagp.2023.09.003. Epub 2023 Sep 10.
The perioperative period is challenging and stressful for older adults. Those with depression and/or anxiety have an increased risk of adverse surgical outcomes. We assessed the feasibility of a perioperative mental health intervention composed of medication optimization and a wellness program following principles of behavioral activation and care coordination for older surgical patients.
We included orthopedic, oncologic, and cardiac surgical patients aged 60 and older. Feasibility outcomes included study reach, the number of patients who agreed to participate out of the total eligible; and intervention reach, the number of patients who completed the intervention out of patients who agreed to participate. Intervention efficacy was assessed using the Patient Health Questionnaire for Anxiety and Depression (PHQ-ADS). Implementation potential and experiences were collected using patient surveys and qualitative interviews. Complementary caregiver feedback was also collected.
Twenty-three out of 28 eligible older adults participated in this study (mean age 68.0 years, 65% women), achieving study reach of 82% and intervention reach of 83%. In qualitative interviews, patients (n = 15) and caregivers (complementary data, n = 5) described overwhelmingly positive experiences with both the intervention components and the interventionist, and reported improvement in managing depression and/or anxiety. Preliminary efficacy analysis indicated improvement in PHQ-ADS scores (F = 12.13, p <0.001).
The study procedures were reported by participants as feasible and the perioperative mental health intervention to reduce anxiety and depression in older surgical patients showed strong implementation potential. Preliminary data suggest its efficacy for improving depression and/or anxiety symptoms. A randomized controlled trial assessing the intervention and implementation effectiveness is currently ongoing.
围手术期对老年人来说是具有挑战性和压力的。患有抑郁和/或焦虑症的老年人手术不良结局的风险增加。我们评估了一种围手术期心理健康干预的可行性，该干预由药物优化和一个遵循行为激活和护理协调原则的健康计划组成，适用于老年手术患者。
我们纳入了年龄在 60 岁及以上的骨科、肿瘤和心脏手术患者。可行性结果包括研究范围，即从合格的总人数中同意参加的患者人数；以及干预范围，即同意参加的患者中完成干预的人数。使用焦虑和抑郁患者健康问卷（PHQ-ADS）评估干预效果。使用患者调查和定性访谈收集实施潜力和经验。还收集了补充护理人员的反馈。
28 名符合条件的老年患者中有 23 名（平均年龄 68.0 岁，65%为女性）参加了这项研究，达到了 82%的研究范围和 83%的干预范围。在定性访谈中，患者（n=15）和护理人员（补充数据，n=5）描述了对干预措施和干预者的压倒性积极体验，并报告说改善了对抑郁和/或焦虑的管理。初步的疗效分析表明 PHQ-ADS 评分有所改善（F=12.13，p<0.001）。
参与者报告研究程序是可行的，减少老年手术患者焦虑和抑郁的围手术期心理健康干预具有很强的实施潜力。初步数据表明，它在改善抑郁和/或焦虑症状方面具有疗效。目前正在进行一项评估该干预和实施效果的随机对照试验。
