Mental health support before surgery improves recovery in older adults

A clinical trial led by Washington University School of Medicine researchers found that older adults had fewer symptoms of anxiety and depression after major surgery when they received mental health support and a review of potentially risky medicines before the operation.

The findings, reported by medicine.washu.edu and published Sept. 9 in JAMA Network Open, suggest that emotional care and medication management could become part of standard preparation for surgery. The intervention began before surgery and continued afterward, combining telephone coaching with help from pharmacists and doctors.

The study involved 306 people aged 60 and above who were preparing for cardiac, cancer-related or orthopedic operations at hospitals within the BJC HealthCare system. Participants who screened positive for mild to moderate anxiety or depression were randomly placed in either an intervention group or a control group.

A broader approach to surgical preparation

Both groups received written information about mindfulness, sleep and brain health. The control group relied on those materials alone, reflecting the usual approach to preparing patients for surgery.

Those assigned to the intervention received eight to 12 telephone conversations with a wellness coach. The coaches were trained mental health professionals, including social workers and mental health counselors. Each participant also underwent an individualized medication assessment conducted by pharmacists and physicians, who sought to adjust or remove drugs that could pose unnecessary risks.

Three months after surgery, the intervention group showed a reduction in depression and anxiety symptoms that was 2.2 to 2.5 points greater than the control group’s improvement on a 48-point scale. The difference was largest among people who had cancer surgery: their scores were nearly five points lower than those of comparable patients who received educational materials only.

Patients also responded favorably to the additional support. They reported positive experiences with both the wellness professionals and the pharmacists involved in reviewing their prescriptions.

Joanna Abraham, the study’s first author and a professor in WashU Medicine’s Department of Anesthesiology, said patients and clinicians considered the program manageable and compatible with existing surgical routines. She argued that proactive mental health care can be added without placing an excessive demand on hospitals.

Why anxiety, depression and medication matter

Major surgery can be physically demanding and emotionally disruptive. Among older people in the United States who are preparing for surgery, as many as 33% experience depression and 22% experience anxiety, according to the article reported by medicine.washu.edu.

These problems may become more difficult during the surgical period and can interfere with recovery. Yet conventional perioperative care — the treatment provided before, during and after an operation — has generally emphasized physical healing. Emotional distress may therefore go unidentified or untreated.

Medication use adds another concern. Older adults often take several drugs that affect the brain, including sedatives, muscle relaxants and nonprescription sleep remedies. If those medicines are not regularly reassessed, they can contribute to drowsiness, confusion and falls. The article also notes that medications carrying higher risks may increase the likelihood of confusion after surgery, serious falls and persistent physical pain.

Eric J. Lenze, the study’s senior author and chair of the WashU Medicine Department of Psychiatry, said preparing the mind and brain deserves the same attention as preparing the body. He said the goal for many surgical patients is a better quality of life afterward, and that addressing emotional health and medication safety may help support that goal.

A model requiring closer teamwork

The trial was conducted through WashU Medicine’s Center for Perioperative Mental Health, which was created to bring comprehensive mental health treatment and medication optimization into ordinary surgical care. Its approach depends on cooperation between psychiatry, anesthesiology, pharmacy and other clinical teams.

That coordination may require hospitals to move beyond separate specialties working independently. Michael S. Avidan, a co-director of the center and professor of anesthesiology at WashU Medicine, said existing perioperative models do not sufficiently meet the mental health needs of older adults.

The researchers say the results offer a practical model that could be adopted by hospital systems elsewhere. The study does not present counseling and medication review as replacements for physical preparation; instead, it adds them to the established process so that patients’ psychological well-being and medication-related risks are considered alongside their surgical needs.