Prevalence of unpaid caregiving, pain, and depression in older seriously ill patients undergoing elective surgery

• DOI: 10.1111/jgs.18316
• Publication Date: 2023-03-14T02:43:33Z
• Authors: Frances Y. Hu; Yihan Wang; Muhammad Abbas; Evan Bollens‐Lund; Amanda J. Reich; Stuart R. Lipsitz; Tamryn F. Gray; Dae Kim; Christine Ritchie; Amy S. Kelley; Zara Cooper
• Keywords: Depression; Elective surgery

Abstract Introduction Serious illness is a life‐limiting condition negatively impacting daily function, quality of life, or excessively straining caregivers. Over 1 million older seriously ill adults undergo major surgery annually, and national guidelines recommend that palliative care be available to all patients. However, the needs elective surgical patients are incompletely described. Understanding baseline caregiving symptom burden among could inform interventions improve outcomes. Methods Using Health Retirement Study data (2008–2018) linked Medicare claims, we identified ≥66 years who met an established serious definition from administrative underwent using Agency for Healthcare Research Quality (AHRQ) criteria. Descriptive analyses were performed preoperative patient characteristics, including: unpaid (no yes); pain (none/mild moderate/severe); depression (no, CES‐D < 3, yes, ≥ 3). Multivariable regression was examine association between caregiving, pain, depression, in‐hospital outcomes, including hospital days (days admitted discharge date one‐year post‐discharge), complications yes), destination (home non‐home). Results Of 1343 patients, 55.0% female 81.6% non‐Hispanic White. Mean age 78.0 (SD 6.8); 86.9% had ≥2 comorbidities. Before admission, 27.3% received caregiving. Pre‐admission 42.6% 32.8%, respectively. Baseline significantly associated with non‐home (OR 1.6, 95% CI 1.2–2.1, p = 0.003), while not post‐acute outcomes in multivariable analysis. Conclusions Prior surgery, illnesses have high prevalence depression. alone destinations. These findings highlight opportunities targeted throughout encounter.