Information and Counseling Gaps on Perioperative Neurocognitive Disorders Among Older Adults

Perioperative neurocognitive disorders (PNDs) are among the most common complications in older adults after surgery. Awareness of PNDs is important as they often can be prevented, and early recognition can improve recovery. We sought to understand what older adults know about PNDs, the information provided, and the counseling provided to guide recovery when PND symptoms occur. We hypothesized that older adults rarely receive information regarding PND before surgery or counseling after experiencing symptoms.

We conducted a mixed methods study by (1) employing a survey to better understand the information patients received before surgery and (2) conducting semi-structured interviews in patients who subjectively experienced PNDs to better understand what counseling they received after experiencing symptoms. Surveys were distributed preoperatively to older adults undergoing elective surgery. Semi-structured interviews were conducted with older adults who had undergone surgery and experienced symptoms of PND. The quantitative data were summarized using descriptive statistics, and qualitative data were analyzed using a hybrid inductive and deductive approach.

The response rate for survey participants was approximately 19%. Among survey participants (n = 312), 58% of participants were between 65 and 69 years of age, 24% were between 70 and 79 years of age, and 18% were ≥ 80 years of age. Before their scheduled elective surgery, 7% (n = 22) indicated a healthcare provider discussed the risk of PNDs during their preoperative visit. None of the patients received educational material regarding PNDs. Ten older adults participated in the semi-structured interviews, which revealed that 9 (90%) participants attempted to discuss symptoms after they occurred with a healthcare provider, but none received counseling or information on what to do next, and all were instructed to wait to see if symptoms persisted.

Our findings underscore that discussions about PND risk and symptom management do not occur as part of routine perioperative care, leaving patients without important information and guidance.