Recent research highlights that the decision-making process for older adults regarding elective surgery encompasses far more than the anticipated pain and recovery time. A significant portion of this demographic also weighs the financial burdens, potential loss of income, and the risk of COVID-19 infection within healthcare facilities. The study, which delves into these concerns, discovered that many individuals, particularly those expressing heightened worries regarding these factors, ultimately decided against proceeding with surgeries they had initially considered.
This research, published in JAMA Network Open by the University of Michigan Institute for Healthcare Policy and Innovation (IHPI), aims to shed light on the broader considerations that influence surgical decisions among older adults. It builds on data from the National Poll on Healthy Aging, revealing in 2022 that nearly half of the older adults contemplating surgery were apprehensive about costs, time off from work, and COVID-19 exposure. Funded by AARP and Michigan Medicine, IHPI’s poll underscores the multifaceted concerns that can deter individuals from pursuing necessary medical interventions.
Dr. Nicholas Berlin, a key figure in this study, emphasizes how these insights have transformed patient consultations. He now incorporates discussions around surgeries’ financial and employment implications into his routine advisories, acknowledging that even insured patients may forgo necessary procedures due to unaffordable out-of-pocket expenses or the inability to take time off for recovery.
The study illuminates the stark contrast in surgery completion rates between those alarmed by financial and employment concerns versus those worried about pain and recovery. Nearly half of the respondents were very concerned about costs, and a majority worried about missing work opted out of surgery they had considered, unlike those primarily anxious about pain, who proceeded at rates comparable to those without such concerns.
Dr. Berlin has noted that federal policymakers have tried to mandate price transparency in hospitals and curtail unexpected billing. However, he argues that such measures fall short of addressing the loss of wages or health insurance-related costs, which are significant deterrents for many, especially in an era where employment beyond 60 is increasingly common, alongside the growth of Medicare Advantage and high-deductible health plans.
The study also touches on the impact of the COVID-19 pandemic on elective surgeries, reflecting on data collected during heightened apprehension about virus transmission in medical settings. Patients’ resumption of elective surgeries post-initial cancellations was cautious, especially those at greater risk of severe COVID-19 complications or particularly wary of recent spikes in cases and changes in infection-prevention protocols.
Jeffrey Kullgren, M.D., M.S., M.P.H., the poll director and study’s senior author, calls for further research to understand better the factors influencing surgical decisions. This understanding could enhance healthcare providers’ ability to advise their patients more effectively, considering both the medical and non-medical implications of undergoing surgery.
The poll, involving over two thousand adults aged between 50 and 80, indicated that a third had contemplated elective surgery in the past five years, with two-thirds considering going through the procedures. The operations deemed to be ranged from medically necessary procedures like hip or knee replacements and cataract surgery to entirely out-of-pocket cosmetic surgeries.
In conclusion, the study highlights the complexity of decision-making among older adults contemplating surgery and signals a need for a more holistic approach to patient counselling. By addressing medical and broader socioeconomic factors, healthcare providers can better support their patients in making informed decisions that reflect their health needs and personal circumstances.
More information: Nicholas L. Berlin et al, Preoperative Concerns of Older US Adults and Decisions About Elective Surgery, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2023.53857
Journal information: JAMA Network Open Provided by Michigan Medicine – the University of Michigan
