Geriatric Models of Surgical Care: A Scoping Review

Area of Science:

• Geriatric Medicine
• Surgical Care
• Health Services Research

Background:

• Older adults undergoing surgery represent a growing population with complex care needs.
• Existing hospital-based models of care for this demographic require synthesis to understand current practices and identify gaps.
• The operationalization of geriatric surgical care models is not well understood globally.

Purpose of the Study:

• To synthesize existing literature on hospital-based geriatric models of care specifically for older adults undergoing surgery.
• To examine the structures, team composition, governance, and nursing contributions within these models.
• To identify opportunities for expanding and improving geriatric surgical care.

Main Methods:

• A scoping review was conducted following Joanna Briggs Institute (JBI) methodology.
• Eligibility criteria included adults aged 65 years and older, multidisciplinary geriatric surgical care models, and acute hospital settings.
• Data from 81 included studies, identified across six databases (January 2015-February 2025), were charted for descriptive synthesis.

Main Results:

• Models are often co-managed by surgical and geriatric teams, with variable implementation points across surgical pathways; orthopaedics dominated (57%).
• Geriatricians were involved in 90% of models, while 38% included advanced practice or specialist gerontological nurses.
• Comprehensive Geriatric Assessment was utilized in nearly half of the studies, predominantly preoperatively, revealing significant heterogeneity in model design and care settings.

Conclusions:

• Integrated geriatric perioperative care is increasing globally but remains concentrated outside of orthopaedics.
• There is an underutilization of nursing expertise, particularly advanced practice nurses, and limited expansion beyond orthopaedics.
• Future research should focus on rigorous implementation of nurse-led models for sustainable transformation, critically evaluating outcomes beyond hospital flow.