Long-term Changes in Pain, Depression, Function and Informal Caregiving after Major Elective Surgeries Among Seriously Ill Older Adults

Objective: To compare differences in pain, depression, function, and informal caregiving pre-major and post-major elective surgery among older adults with and without serious illness; and determine whether serious illness was independently associated with increasing pain, depression, assistance in activities of daily living (ADLs) and informal caregiving postsurgery. Background: The American College of Surgeons has endorsed the integration of palliative care (PC) into surgical care in adults with serious illness but targets for PC during surgical episodes such as pain, depression, function, and informal caregiving are understudied. Methods: We used Health and Retirement Study-linked Medicare data (2008 to 2018) to identify older (≥66 years) adults with and without serious illness who had major elective surgery. We performed difference-in-difference analysis to measure changes in pain, depression, function, and informal caregiving presurgery and postsurgery between groups. We tested associations between serious illness and changes in pain, depression, function, and informal caregiving using multivariable regression. Results: Among 1896 adults who had major surgery, 1139 (60%) were seriously ill. Compared with adults without serious illness, those with serious illness had greater baseline pain (43% vs 38%), depression (22% vs 13%), assistance with ADLs (12% vs 0%,) and informal caregiving (18% vs 4%); and, greater increases in assistance with ADLs presurgery and postsurgery (difference-in-difference: 6%, 95% CI: 3.7 to 8.3). Serious illness was independently associated with increasing pain [odds ratio (OR): 1.6, 95% CI: 1.1 to 2.2], depression (OR: 1.5, 95% CI: 1.1 to 2.2), assistance with ADLs (OR: 2.1, 95% CI: 1.3 to 3.4), and informal caregiving (OR: 2.1, 95% CI: 1.4 to 3.1) postsurgery. Conclusions: Most older adults having elective surgery are seriously ill. Pain, depression, function, and caregiving are targets for PC to improve post-surgical outcomes.