What to consider when facing surgery later in life

(Aging Untold) — When a major medical procedure is on the table later in life, the question about whether to have it isn’t just about survival — it’s about what life looks like afterward.

The Aging Untold experts are breaking down what families should weigh before saying yes to surgery.

“What means the most to you?”

Aging-well coach Katherine Ambrose opened the conversation by asking what families should be thinking about before making a decision.

Aging expert Amy O’Rourke shared a story of a man who changed her thinking.

“I remember this guy who fell and broke his hip. I think he was 87, and he was sitting in his wheelchair, and he said, ‘If I have this hip surgery, am I going to lose my mind? Is the anesthesia going to take my brain?’” O’Rourke said. “And I said, ‘There’s a chance it could happen.’ And he opted out of the surgery because he knew what a meaningful life meant for him.”

O’Rourke said that is the foundation of any decision like this for her.

“What means the most to you? Will you be able to walk, eat?,” O’Rourke said. “And the other is how fragile are you? Like, how is your physical well-being, and get that assessed by somebody that can say, you know, you’re pretty sturdy.”

O’Rourke said a clear assessment of strength and personal values should guide the decision.

“You know there’s people out there that are really sturdy at 90, and, you know, God bless them. But there are others that aren’t,” O’Rourke said. “So a clear assessment of how strong you are, and then what you value, and will you lose it if you have the surgery.”

Quality versus quantity

Gerontologist Sam Cradduck said the decision often comes down to weighing pain relief against risk.

“Quality versus quantity always comes into play. You know, do I want to have a pain-free life? Do I want to have that higher quality? And is that worth that risk?” Cradduck said. “It wasn’t for your gentleman, but I can certainly see where it could be worth it for someone else.”

Dr. Rhea Rogers, a board-certified physician, also pointed to whether the surgery is elective as part of that calculation.

“You also have to look at what’s the indication for the surgery. Some of them are elective and some of them are not so elective,” Rogers said. “So you have to look at that, and you have to look at the risk of surgery.”

The medical side: anesthesia, genetics and clearance

Rogers said the clinical picture adds another layer, particularly around anesthesia.

“You have to look at anesthesia, especially in any population where it’s getting to the brain. And people have different genetic SNPs to where they’re going to respond differently to anesthesia,” Rogers said. “So that’s also, if they can afford that testing, you know, your genes are not going to change, to know that.”

Rogers said recovery and mobility also factor into the medical assessment.

“Then the recovery — their mobility, as you get older your mobility is not as good. And being in the hospital, you know, or how long you have to be in there, depends on any kind of injuries or things that are occurring,” Rogers said. “And what is that environment going to do to you? What is your baseline?”

Rogers said chronic conditions can change the entire process, even for younger patients.

“Even at 40s and 50s, if you have certain chronic medical conditions, you’re going to have to get a medical clearance because that puts it to a whole different ballgame,” Rogers said.

Memory and cognitive function are also part of that clearance conversation, according to O’Rourke.

“If you’re cognitively impaired and you’re older and you’re going to have surgery, will you be able to follow the instructions of a therapist? How well will you do with recovery?” O’Rourke said.

Cradduck said that a prior history of adverse reactions can also be a factor in decision-making.

“I think sometimes if you’ve had an adverse reaction in the past, even if it’s a mild adverse reaction in the past to a surgery and anesthesia, then that’s something to really clue in that the older you get, that’s not going to get better,” Cradduck added.

A daughter’s perspective

Aging-well coach Katherine Ambrose shared her own family’s experience weighing hip surgery for her mother.

“I’d be really careful about just making an assumption, though, because I actually was terrified of my mother getting hip surgery. She was in pain, and I really thought that might impact dementia, and that would be maybe just too risky,” Ambrose said. “Well, the family decided — she decided she really wanted to do it, and it has been the best thing ever.”

Ambrose said her mother experienced brief delirium after surgery but recovered.

“She did have a little delirium at the hospital, but she recovered quickly. And, you know, I am so glad that I wasn’t in the way of her decision, because it was the best thing ever,” Ambrose said. “And she’s just motoring around and going out for walks outdoors and loving life.”

Rogers said that story underscores the importance of informed consent.

“Boils down to informed consent. You have to put that out there so everybody can look at it. For some people, they’re not willing to even risk it,” Rogers said. “But when you’re in enough pain, you know, you have to weigh that, because that’s a depression in itself. And so really you have to look at what longevity means for you. Is it pain-free, or is it suffering, or what does that look like?”

Cradduck also encouraged families to stay close during recovery.

“I think if your loved one’s going to be in the hospital and they’re going to be in the rehab, try and do a family schedule, if you can, to be there and be beside them and keep that familiarity and that person that they know,” Cradduck said. “Make sure they have their glasses. Make sure there’s all those things in place to offset that delirium.”

Ambrose added that age alone shouldn’t determine a person’s outlook on treatment.

“I really feel sorry for older people when they think, oh, they’re probably not going to treat me because of my age,” she said.

Rogers raised the question of whether the surgery is to live longer or to live better.

“If you’re living and you’re suffering and without quality, that’s still suffering,” Rogers said.

Watch out for outside noise

O’Rourke cautioned about family pressure during the decision-making process.

“You’ve got family, and family might have strong opinions about you doing one thing or the other. So how influenced is the older person by a daughter that says, don’t have the surgery, or have the surgery?” O’Rourke said. “So be very careful about the outside noise you hear in making that decision.”

Key takeaways

• Base surgery decisions on personal values first.
• Get a clear physical assessment of frailty and strength from a professional before deciding.
• Cognitive impairment can affect a patient’s ability to follow recovery instructions, which should factor into the decision.
• Informed consent means weighing pain and quality of life against risk — untreated pain can carry its own toll.

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