Project Details
Overview
Despite the evidence of increased day surgery in older adults and the high risk of POCD, minimal importance is given to cognitive assessment and discharge planning. The guidelines for day surgery (Bailey et al 2019), published by the Association of Anaesthetists and the British Association of Day Surgery, highlight that patient selection should not be based on physical status, age, or body mass index (BMI), but rather on functional status. However, there are no recommendations regarding cognitive assessment or routine follow-up for elderly patients. There is no post-operative discharge pathway or specific pathway for high-risk patients such as older adults. Instead, patients or their carers are expected to manage the recovery by themselves (Berg, Årestedt and Kjellgren 2013). Cognitively impaired patients may be unable to do this, potentially causing surgical complications, falls, or emergency admissions.
As a first step into the pathway development, an investigation to identify the immediate (in the recovery room, before the discharge) cognitive decline was conducted. This research project was fully funded by National Institute of Health Research (NIHR) and Health Education England (HEE) as part of my Masters in Clinical Research. The Cognitive Assessment in day-case surgical Recovery of Elderly patients – the CARE study (REC reference: 18/WA/0028 Protocol number: FHHS-232668-AS-185 IRAS project ID: 232668) was performed under the supervision of Prof Jos Latour (Professor in Nursing & Midwifery, School of Nursing and Midwifery, University of Plymouth). This study was conducted among 99 patients aged 60 years and over who underwent day-surgery procedures in a local NHS Trust.
A second stage of the CARE study assessing the cognitive status specifically in day surgery on the 3rd day and one month is necessary to assess the trajectory of cognitive health outcomes to develop a discharge pathway. Additionally, it is often the relative/carer detects the cognitive changes first (Nilsson et al 2019), thus exploring their experience is vital in the development of the discharge pathway.
As a first step into the pathway development, an investigation to identify the immediate (in the recovery room, before the discharge) cognitive decline was conducted. This research project was fully funded by National Institute of Health Research (NIHR) and Health Education England (HEE) as part of my Masters in Clinical Research. The Cognitive Assessment in day-case surgical Recovery of Elderly patients – the CARE study (REC reference: 18/WA/0028 Protocol number: FHHS-232668-AS-185 IRAS project ID: 232668) was performed under the supervision of Prof Jos Latour (Professor in Nursing & Midwifery, School of Nursing and Midwifery, University of Plymouth). This study was conducted among 99 patients aged 60 years and over who underwent day-surgery procedures in a local NHS Trust.
A second stage of the CARE study assessing the cognitive status specifically in day surgery on the 3rd day and one month is necessary to assess the trajectory of cognitive health outcomes to develop a discharge pathway. Additionally, it is often the relative/carer detects the cognitive changes first (Nilsson et al 2019), thus exploring their experience is vital in the development of the discharge pathway.
Project Aims
The aim of this PhD project is to identify the cognitive outcomes after discharge in older adults following general anaesthetic day surgeries.
Objectives
1. To undertake a scoping review to explore factors influencing cognition and emotional health of elderly patients after discharge from the day surgery unit.
2. To undertake a qualitative systematic review to explore the experiences of carers regarding the cognitive changes in older patients who have undergone general anaesthesia (GA) day surgery.
3. To investigate the cognitive outcomes of patients, ≥60 years, in the first one month after discharge from the day surgery under GA.
4. To understand the trajectory of health recovery after day surgery under GA.
5. To explore the experiences of care givers of patients who have POCD post-surgery under GA.
Objectives
1. To undertake a scoping review to explore factors influencing cognition and emotional health of elderly patients after discharge from the day surgery unit.
2. To undertake a qualitative systematic review to explore the experiences of carers regarding the cognitive changes in older patients who have undergone general anaesthesia (GA) day surgery.
3. To investigate the cognitive outcomes of patients, ≥60 years, in the first one month after discharge from the day surgery under GA.
4. To understand the trajectory of health recovery after day surgery under GA.
5. To explore the experiences of care givers of patients who have POCD post-surgery under GA.
| Acronym | the CARE study-2 |
|---|---|
| Status | Active |
| Effective start/end date | 1/01/25 → … |