Discussion
Our study highlights the key experiences of older adults who undergo an emergency general surgery, as perceived at 1 year following the index admission. Key thematic findings we derived from analysis focus on patients relying heavily on family caregivers for support throughout the recovery period, and patients sharing a common goal of ‘going back to normal’. The specifics of recovery from the patient perspective were wide-ranging. Patients’ reflections were often shaped by their memories of leaning on their family to fill their instrumental and emotional needs.
There has been one prior qualitative study reported on older adults’ perspectives 3 months after emergency general surgery.11 Their findings were similar to ours and found that patients shared a common treatment goal of ‘getting back to normal’, and many relied on informal caregiving from family.11 This study noted that, based on their evaluation, a potential opportunity to improve postoperative recovery would be to develop methods to include caregivers more deliberately into the discharge planning for transitions of care. Social ties and support is known to be critical for psychological and physical well-being, and our study demonstrates the importance of family for postoperative recovery in EGS.12 Notably, all of the individuals we interviewed had family who provided support at some level; critically, future inquiry might examine the recovery process for individuals who do not have family for support.
Our study was designed to identify potential opportunities for improvement for postoperative recovery. As such, our study inclusion and exclusion criteria were crafted to focus on these patients. We only included patients who had a hospital stay of 7 days or longer, to identify patients who either had a complex hospital course or perhaps would have difficulty with discharge planning, as we believed that these criteria would identify patients with a high likelihood for identifying opportunities for improvement. In addition, we also included patients who survived at least 1 year, which likely identified patients who were healthier and perhaps less frail at the time of admission. While these inclusion criteria perhaps narrowed our population, we believed that this population would provide high-quality first-person accounts of facilitators and barriers to recovery.
Indeed, our study indirectly highlights experiences from patients who did not meet our inclusion criteria: our study generally included patients with positive outcomes, interviewing survivors who were cognitively intact 1 year after surgery. All our patient participants had family on which they could rely. Our findings thus pose the critical question: what happens during recovery if one does not have someone who is willing and/or able to provide instrumental and emotional support? Researchers who reached out to enroll and consent patients noted having spoken briefly to caregivers of patients who were not eligible (due to death or mental status). Researchers additionally spoke to caregivers who would have been willing to be interviewed except that their loved one had passed away; fruitful future research might qualitatively examine the experiences of those who had poorer outcomes.
A future improvement in care could be to systematically identify and include key caregivers throughout the entire treatment process even when an older adult is competent and making their own decisions. Involvement of caregivers for key discussions about medical decision making, discussions about advanced directives, and for discharge planning could help smooth the transition home and mollify some of the emotional distress of recovery, and may give caregivers an improved understanding of their role expectations during the patient’s recovery. This discussion could include time to recovery, specific expectations about need for assistance, and realistic expectations about functional recovery. This way, if caregivers are unable or unwilling to assist, other avenues or resources can be considered.
Another possible avenue to help bridge gaps for patients with instrumental and/or emotional needs could be peer support groups, which have been used in other complex medical conditions with promising results.13–16 Within the field of acute care surgery, trauma peer mentors and peer support groups have been used, and utilisation of these and similar services have been demonstrated to have positive effects on adherence to care plans.13 17 Social support has also been demonstrated to be key to recovery after cardiac surgery and cardiac interventions.18 19 Although these populations differ from the older emergency general surgery population, these patients share some parallels including the disruption to their daily lives related to an unexpected life-threatening illness.
Our study revealed that, although the timing and quality of recovery varied, a key recovery facilitator for older patients was reliance on spouses, other family, and friends for support for daily tasks and emotional support. There is an opportunity in healthcare to better align patients and caregivers throughout the process about posthospital discharge needs and expectations to bolster successful recovery. One participant (caregiver of 80s, female) said it best: “In a real sense, we are team players, the medical people and myself, with a common objective. And that’s to see an individual be restored.”