A few decades have passed since I was last wheeled into an operating room for surgery, so I can’t really recall how anxious I might have been feeling prior to the procedure — or how well I managed my emotions during the ensuing recovery. These days, however, I can’t quite imagine contemplating such an adventure without some level of existential dread.
Just sitting in a doctor’s office spikes my blood pressure, and the only way I can handle even a routine dental checkup is with a liberal dose of nitrous oxide. This “white-coat effect” and other, more serious, mental health challenges are not uncommon among older adults — especially when we’re facing surgery. By some estimates, more than one in five seniors report anxiety symptoms and as many as one in three copes with depression prior to a surgical procedure.
And as physicians increasingly counsel their patients to prepare themselves physically for surgery, a new study by researchers at the Washington University School of Medicine suggests that patients could also benefit from preparing themselves mentally and emotionally.
“The time around surgery is a window of both risk and opportunity,” notes coauthor Joanna Abraham, PhD. “The stress of surgery can worsen anxiety and depression symptoms and affect patients’ recovery and overall health, but it also offers a critical opportunity to identify these concerns proactively and connect patients with the support they need.”
Abraham and her team reviewed a roster of patients 60 years old and older who were scheduled for cardiac, oncologic, or orthopedic surgery at facilities across a large healthcare system. For their study, they selected 306 of those who, on a mental health questionnaire, reported mild to moderate symptoms of depression and anxiety prior to the surgery.
“The stress of surgery can worsen anxiety and depression symptoms and affect patients’ recovery and overall health, but it also offers a critical opportunity to identify these concerns proactively and connect patients with the support they need.”
Half of the patients received the standard handouts on mindfulness, sleep, and brain health prior to their surgery, while the other half received as many as a dozen counseling sessions with a trained mental health professional, a review of their medications by pharmacists and physicians to determine safe postsurgical dosages of high-risk drugs, as well as the educational handouts.
Using the same 48-point questionnaire, researchers measured each patient’s depression and anxiety symptoms three months after their surgery. Those in the intervention group showed an overall 2.2- to 2.5-point greater decline in symptoms than those in the control group. The decline in symptoms was even more pronounced among those undergoing cancer surgery, dropping more than five points lower than oncology patients in the control group.
“What makes this care model so promising is that it’s practical to deliver,” says Abraham. “Patients and healthcare providers found the program manageable and easy to integrate into existing surgical workflows. Proactive mental health care doesn’t have to burden the hospital system.”
It would, however, require a major commitment among specialists to a coordinated-care approach, a shift that faces long odds in our hidebound healthcare industry. And with nearly 5 million seniors undergoing surgery each year, I suspect that Abraham’s model — even if enthusiastically adopted — would be available to only a tiny percentage of these patients.
Of course, not all of us need that sort of help. I was chatting with one of my colleagues about this the other day after she announced her looming hip-replacement surgery. Was she anxious about the procedure? I wondered, noting that I’d be a nervous wreck under the same circumstances.
“No, I’m excited!” she proclaimed. “I can’t wait to be able to move again.”
Maybe that’s how I felt back in the day when awaiting repairs to my torn meniscus. Maybe focusing on a positive outcome rather than on the unnerving procedure is the key to overcoming the white-coat effect. Maybe I can try to keep that in mind if I ever have to go under the knife again, or even the next time I find myself sitting in the dentist’s chair — before the nitrous kicks in.
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