Providing mental health coaching and optimizing high-risk medications before surgery reduces post-operative anxiety and depression in older surgical patients.
RT’s Three Key Takeaways:
- Integrated Surgical Care: Starting an intervention before surgery that combines mental health coaching with high-risk medication reviews significantly reduces post-operative anxiety and depression in older adults.
- Targeting High-Risk Medications: Proactively managing medications such as sedatives and muscle relaxants helps prevent adverse outcomes like post-surgery confusion, dangerous falls, and long-term physical pain.
- Practical Clinical Delivery: Clinicians found that remote mental health coaching and pharmacist-led medication optimization easily integrated into existing surgical workflows without burdening hospital systems.
Starting an intervention before surgery that pairs personalized mental health coaching with medication optimization reduces post-surgery depression and anxiety in older adults, according to a clinical trial published in JAMA Network Open.
Led by led by researchers at Washington University School of Medicine in St Louis, the randomized clinical trial analyzed 306 adults aged 60 and older scheduled for cardiac, oncologic, or orthopedic surgery across the BJC HealthCare system who reported mild to moderate symptoms of depression and anxiety.
“The time around surgery is a window of both risk and opportunity,” said Joanna Abraham, PhD, professor in the department of anesthesiology at WashU Medicine and the study’s first author. “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.”
Addressing Emotional Distress and Medication Risks
According to the study authors, up to 33% of older surgical patients in the US experience depression, and 22% experience anxiety before undergoing surgery. Additionally, older adults frequently take multiple medications affecting the brain, such as sedatives, muscle relaxants, or over-the-counter sleep aids. When unmonitored, these drugs can accumulate and increase the risk of post-surgery confusion, falls, long-term physical pain, and sedation, the researchers noted.
“We recognize the importance of getting the body into shape before surgery, but preparing the mind and the brain is just as important,” said Eric J. Lenze, MD, the Wallace and Lucille K. Renard professor of psychiatry, head of the WashU Medicine department of psychiatry, and senior author of the study. “Patients undergoing major surgery hope for a better life afterward, and our study shows that taking care of emotional well-being and optimizing medications can help deliver that outcome.”
Trial Findings and Clinical Delivery
Conducted through WashU Medicine’s Center for Perioperative Mental Health, the study randomized patients into two cohorts. The intervention cohort received educational materials on mindfulness, sleep, and brain health, spoke with a trained mental health professional over eight to 12 phone sessions, and underwent a personalized medication review by doctors and pharmacists to optimize doses of high-risk drugs. The control cohort received only the educational materials, reflecting the standard approach to pre-surgical care.
Three months after surgery, patients in the intervention group experienced a 2.2-to-2.5-point greater reduction in symptoms of anxiety and depression on a 48-point scale compared with the control group, according to the findings. Patients who underwent cancer surgery demonstrated the greatest mental health improvements, scoring nearly 5 points lower than controls.
“What makes this care model so promising is that it’s practical to deliver,” said 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.”
“Today’s perioperative care models do not adequately address mental health needs and challenges faced by older adults,” said Michael S. Avidan, MBBCh, the Dr Seymour and Rose T. Brown professor of anesthesiology and center co-director. “The results of this trial suggest that anesthesiology and psychiatry can unite to treat surgical patients more holistically, pioneering a practical blueprint that hospital systems nationwide can use to improve recovery after invasive procedures.”
