New Study Reveals the Greater Risks of Surgery for Nursing Home Residents
As Americans age, the chance of undergoing surgery at some point after the age of 65 rises dramatically. In the U.S. alone, over 15 million surgeries are performed on patients 65 or over each year. Unfortunately, our senior population faces significant risks when undergoing surgical procedures; in some cases, the risks of surgery are greater than the underlying disease being treated. Assisted living and long-term care facilities need to adopt best practices to reduce the risks posed to their patients. In addition to nursing home insurance coverage, careful screening and evaluation of potential surgery risks can help the facility, its staff, and its patients manage the risks inherent in nursing home operations.
Case Study: Breast Cancer Surgery Risks
In a research study published in JAMA Surgery (Journal of the American Medical Association) records of over 6000 patients—patients who were also nursing home residents—that had received breast cancer surgery over a ten-year period were reviewed. A staggering number of deaths were discovered; within a year of surgery, 31 to 42 percent of patients in the research group had died. This high number is made even more alarming by its comparison to typical mortality rates in nursing homes, which hovers around 25% annually.
While exact causes of death were not reported in the JAMA-published study, researchers suspect that several underlying causes, such as additional health problems, complications from the surgery, and aging factors contribute to the high death rate post-surgery. The high number also indicates that nursing home facilities must do everything they can to mitigate risks to the patients in their care.
General Risks of Surgery in Elderly Patients
In general terms, surgery is relatively safe. Advances in medicine and infection control have made many surgeries a routine occurrence with few real risks. In the elderly population, however, surgery poses significant risks. As we age, our organs and bodily systems are not as resilient as they were in our youth. Surgery can compromise weakened organs and systems, hastening complications or even death after surgeries that include outpatient procedures. Medications that interfere with anesthesia or increase the risk of excessive bleeding may be discontinued before surgery, potentially creating further complications and risks. In simple terms, surgery may be risky for our elderly population, and may present even greater risks than the underlying disease itself.
Reducing Patient Risks in Nursing Home Facilities
Best practices for reducing patient risks have been adopted in nursing homes across the country. Nursing home insurance coverage is one leading risk management factor, protecting the facility and its staff from the losses associated with legal claims. This is only one piece of the risk management puzzle, however – reducing patient complications is another. For patient safety, careful screening and evaluation are required to help mitigate potential surgery risks. Screening can include preoperative testing, such as laboratory analyses, x-rays, or electrocardiograms (EKGs).
The patient’s ability to perform certain tasks must also be taken into account. Many nursing home facilities use an assessment tool called Activities of Daily Living (ADL), which include the patient’s ability to perform five activities without assistance. The activities are dressing, eating, using the toilet, walking and movement (transfer) between toilet and bed or chair, and bathing. This tool helps the facility to determine whether or not the patient is a good candidate for surgery and may hint at additional care needed if surgery is performed.
Careful review of any medications the patient is using, any health histories that may suggest risks, and surgery clearance from specialists may all help to reduce mortality rates associated with surgery in elderly patients. With these best practices, nursing homes can reduce the risks their patients face while protecting the facility itself and its staff from legal complications.
About Caitlin Morgan
Caitlin Morgan specializes in insuring assisted living facilities and nursing homes and can assist you in providing insurance and risk management services for this niche market. Give us a call to learn more about our programs at 317.575.4440.