Here’s the scene: You’re 75 years old or older, and the body just isn’t the same as it used to be. Maybe cancer has been detected. Perhaps you can’t get around like you once did. You’ve got pains where you never had pains. And after a battery of tests and trying other remedies, the docs tell you it’s time to operate.

In the last fiscal year alone, 307 patients age 75 or older underwent inpatient surgeries at Kent Hospital. Of that number, 121 patients were 85 or older, reports Dr. Melissa Murphy, executive chief of surgery at Care New England and director of the Geriatric Surgery Program.

That number only promises to grow.

Census data shows the population of Americans 65 and older has grown 34% in the last decade, and by 2030 will make up one in five Americans. The data for Rhode Island shows that about 9% of the state’s population is at least 75 year old, and that by 2040 that is forecast to jump to 14%.

During the pandemic, when Kent was stretched to serve the community, Murphy questioned how the hospital might improve surgical outcomes for the increasing number of elder patients. Her research led her to the American College of Surgeons Geriatric Surgery Verification Program, GSV.

She believed Kent could meet the procedures and standards set forth in the program, although it would take a sizable commitment and resources at a point when the hospital staff was already under considerable stress. She went to Kent’s president at the time, Dr. Paari Gopalakrishnan. Gopalakrishnan saw the possibility of adding the GSV program alongside the Acute Care for Elders (ACE) Unit. He gave Murphy the green light and she set about building a team.

She first recruited her first lieutenants: Amanda Walker as geriatric program coordinator and Dr. Kadesha Collins-Fletcher as GSV geriatric medicine director. From there the team eventually grew to more than 30 members with a core group of 12. The goal was to build a fabric of steps and promote a culture that would enhance surgical procedures and elderly care.

That sounds good, but how might the surgical experience change for patients?

Murphy explains that before GSV, as a surgeon you would generally assess a patient’s readiness for surgery. With GSV this is now a standardized preoperative process to screen patients in key areas contributing to frailty, including nutrition, mobility, cognition and social support. But just screening patients doesn’t improve results. Kent’s GSV program then designed interventions for patients who screened positive, including nutrition referral/counseling, mobility assessment and physical therapy evaluation, home environment assessment with VNA and recommendations to decrease fall risk. A personalized care plan is developed for each patient so when they undergo surgery there is a clear multidisciplinary care plan from the moment they arrive. Implementation of the GSV program at Kent has led to a decreased hospital length of stay and decreased rates of delirium for patients in the program.

The 4 Ms

“You need to be strong for surgery,” Murphy says adding “the goal is to get them through safely.”

Murphy looks at the process as the “four Ms.”

The first step is what “matters” or looking the desired outcome of the surgery. Then it’s evaluating the patient’s mobility, medications and mentation, or mental activity. As described in a release issued by the hospital, the GSV Program improves surgical care and outcomes for older adults by: Promoting comprehensive patient- and family-centered care, encouraging interdisciplinary collaboration and communication, and facilitating evidence-based practices.

“We want great outcomes for our patients,” says Murphy. To deliver comprehensive multi-disciplinary care, she adds “we all need to be rowing in the same direction.”

On May 20, Murphy and the team delivered to the American College of Surgeons Geriatric Surgery a presentation of their program with outcome data and how they met 32 GSV standards The presentation keyed on the need to address seniors in a state where 23% of the population is 60 or older, and on actions being taken to identify at-risk adults 65 and older through standardized screening. It also looked at risk factors including balance, medications and home safety, and at efforts to tailor delivered, evidence based interventions to prevent falls.

Among 25 US hospitals with certification

Kent’s system was recognized. On the eve of Dr. Gopalakrishnan departure from Kent to assume the job of president and CEO of the Greater Baltimore Medical Center in September, the hospital became the 25th in the country and the only community hospital in New England to attain the Geriatric Surgery Verification certification from the American College of Surgeons.

Citing the aging population, Gopalakrishnan applauded the certification.

“Kent Hospital has made a strategic investment in older adult care. We have placed great emphasis on our Acute Care for Elders (ACE) Unit, the Silver-Level 2 Geriatric Emergency Department Accreditation (GEDA), and now the GSV designation, all part of our commitment to excellence in senior care,” Gopalakrishnan wrote. “Caring for our community is our mission at Kent Hospital, and as our community ages, we are fully prepared to meet their evolving health care needs.”

Dr. Murphy called certification “a proud milestone,” adding, “This achievement, along with the ACE Unit and (geriatric emergency department accreditation), reinforces our vision to lead in age-friendly surgical care.”

She said last week she aims to extend the program to patients 65 and older when the team is comfortable with the system and with regulatory approvals.

“We want [patients] to get back home and maintain their quality of life,” she said.