Perioperative mental health intervention bundle for older surgical patients: protocol for an intervention development and feasibility study

Joanna Abraham, Katherine J Holzer, Emily M Lenard, Kenneth E Freedland, Bethany R Tellor Pennington, Rachel C Wolfe, Theresa A Cordner, Ana A Baumann, Mary Politi, Michael Simon Avidan, Eric Lenze, Joanna Abraham, Katherine J Holzer, Emily M Lenard, Kenneth E Freedland, Bethany R Tellor Pennington, Rachel C Wolfe, Theresa A Cordner, Ana A Baumann, Mary Politi, Michael Simon Avidan, Eric Lenze

Abstract

Introduction: The perioperative period is high risk for older adults. Depression and anxiety are common perioperative problems, frequently coexisting with cognitive impairment. Older patients with these conditions are more likely than younger patients to experience postoperative delirium, long hospital stays, poor quality of life and rehospitalisation. These experiences can, in turn, exacerbate anxiety and depressive symptoms. Despite these risks, little is known about how to treat perioperative anxiety and depression among older adults.

Methods and analysis: We designed a feasibility study of a perioperative mental health intervention bundle to improve perioperative mental health, specifically depression and anxiety. The overarching goals of this study are twofold: first, to adapt and refine an intervention bundle comprised of behavioural activation and medication optimisation to meet the needs of older adults within three surgical patient populations (ie, orthopaedic, oncological and cardiac); and second, to test the feasibility of study procedures and intervention bundle implementation. Quantitative data on clinical outcomes such as depression, anxiety, quality of life, delirium, falls, length of stay, hospitalisation and pain will be collected and tabulated for descriptive purposes. A hybrid inductive-deductive thematic approach will be employed to analyse qualitative feedback from key stakeholders.

Ethics and dissemination: The study received approval from the Washington University Institutional Review Board. Results of this study will be presented in peer-reviewed journals, at professional conferences, and to our perioperative mental health advisory board.

Trial registration number: NCT05110690.

Keywords: GERIATRIC MEDICINE; MENTAL HEALTH; SURGERY.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Adaptation process of the perioperative mental health intervention bundle. IAB, internal advisory board.
Figure 2
Figure 2
Behavioural activation model for the perioperative setting. (A) Behavioral activation – symptom cycles. (B) Behavioral activation – interrupting symptom cycles.
Figure 3
Figure 3
Patient recruitment paths.

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