New-onset Depression in Older Surgical Patients: Risk Factors, Mechanisms, and Outcomes
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PROJECT SUMMARY / ABSTRACT An increasing number of older adults are undergoing surgery, and post-operative depression is a common and comorbid condition in this population, particularly among those who are frail. In addition, mental well-being represents a highly valued and meaningful aspect of recovery for older adults in the post-surgical setting. Despite being increasingly studied in the younger and middle-aged adult population, less is known about new-onset post-operative depression in older adults. Lastly, it is imperative to describe new-onset post-operative depression sequelae in older adults. The overarching research objective is to improve patient-centered outcomes for all older adults undergoing surgery. The objective of this proposed study is to identify geriatric-specific risk factors, examine potential mechanisms linking surgery to depression, and describe new-onset post-operative depression outcomes in a representative sample of community-dwelling older adults across diverse surgical procedures. The central hypothesis of this project is that geriatric-specific risk factors (e.g., multimorbidity, lack of social support, geriatric syndromes, frailty, physical and cognitive impairment) are associated with new onset pre-operative depression. We will further evaluate perioperative mechanisms commonly observed in older adults (e.g., persistent pain, functional and cognitive decline, sleep disturbance). Finally, we will assess long-term outcomes among older adults who develop postoperative depression, including functional decline, mortality, and chronicity of depressive symptoms. We will test this hypothesis by leveraging a nationally representative longitudinal surgical cohort using Health and Retirement Study (HRS) and Medicare claims data to address the following specific aims: (1) determine geriatric-specific risk factors associated with new-onset depression within a year of surgery; (2) assess peri-operative mechanisms common in older adults that may help to explain the development of new-onset depression; (3) describe new-onset post-operative depression outcomes. This study is innovative because it will be the first national cohort study to comprehensively capture a vast range of operations, focusing on new-onset depression through Medicare diagnostic data and HRS's symptomatology data. In addition, the research findings will directly inform geriatric surgical guidelines as a target for prevention and treatment. The proposed research is significant because an increasing number of older adults are undergoing surgery and are at risk of worsening mental-wellbeing and meets the call to action by organizations, such as the World Health Organization, Age Friendly Health Systems, and American College of Surgeons for strategies to improve the quality of life in older adults.
