A clinical trial led by researchers at Washington University School of Medicine in St. Louis found that incorporating targeted mental‑health support and medication optimisation into preoperative care reduces symptoms of anxiety and depression in older adults after major surgery. The findings, published Sept. 9 in JAMA Network Open, argue for routine attention to emotional well‑being alongside traditional medical preparation for surgery.
Study design and main outcomes
The trial combined two interventions beginning before surgery: structured mental‑health coaching and a review to optimise medications that can affect the brain, including sedatives and other high‑risk drugs commonly used by older people. Investigators report the combined approach led to reduced postoperative anxiety and depression compared with usual care.
Researchers emphasised that the period around a major operation is both risky and an opportunity to intervene. As the study’s first author, Joanna Abraham, PhD, noted, this is a time when symptoms can worsen but also when clinicians can proactively identify and address mental‑health concerns.
“The time around surgery is a window of both risk and opportunity,” said 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.”
Why this matters for older surgical patients
Older adults face particular vulnerability. The trial team highlighted published estimates that up to 33 per cent of older surgical patients in the United States experience depression before an operation and about 22 per cent experience anxiety. Multiple medications that affect cognition and mood are also common in this group, raising potential risks around the perioperative period.
| Preoperative symptoms or risks | Reported prevalence |
|---|---|
| Depression | Up to 33% |
| Anxiety | 22% |
Combining psychological coaching with a deliberate medication review aims to address both emotional distress and the pharmacological contributors to postoperative complications. The senior author, Eric J. Lenze, MD, said preparing the mind and brain is as important as preparing the body for surgery.
“We recognise 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.
Implications for clinical practice
The trial supports adding mental‑health screening and medication optimisation to standard preoperative pathways for older adults. Practical elements that could be applied in Canadian settings include:
- Routine screening for anxiety and depression during preoperative assessment;
- Access to short‑term mental‑health coaching for patients identified at risk;
- Medication reconciliation focused on drugs that affect cognition, with adjustments where appropriate.
Such steps align with broader efforts to reduce postoperative complications, shorten recovery times and improve quality of life after major procedures. The trial’s authors framed their approach as an opportunity to help patients achieve better outcomes from surgery, not solely by optimising physical health but by addressing emotional well‑being and medication safety.
Limitations and next steps
The published report presents evidence from the trial but does not claim universal applicability to every surgical population or setting. Local adaptation — including availability of mental‑health professionals, perioperative pathways and medication management resources — will be necessary for implementation. Further research could examine cost, scalability and long‑term effects on recovery, functional outcomes and health‑system usage.
For clinicians and health planners, the study offers a clear signal: preoperative care that includes mental‑health and medication review may reduce postoperative anxiety and depression in older patients and should be considered as part of comprehensive surgical preparation.
Note: The study was conducted by Washington University School of Medicine and published in JAMA Network Open on Sept. 9.
