SHM Converge Scientific Abstract ePoster Gallery-Extrapolating the Risk of Non-Surgical Intervention via Perioperative Geriatrics Expertise

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This poster presents a case in which perioperative geriatrics expertise helped guide a highly frail older adult away from a risky non-surgical hospital treatment.<br /><br />An 87-year-old woman with a large right adrenal pheochromocytoma with lymph node metastases was being considered for non-operative management with iobenguane-131 (Azedra), a radiopharmaceutical that requires hospitalization and, after administration, limits staff contact because of exposure precautions. Although surgery was high risk, the inpatient geriatrics and perioperative teams recognized that hospitalization for this treatment also carried major danger.<br /><br />Her medical and geriatric risk factors were substantial: chronic diastolic heart failure, COPD, pulmonary fibrosis, multiple recent hospitalizations, moderate-to-severe dementia, prior inpatient delirium, frailty, recurrent falls, nursing home residence, and very limited mobility. Physical therapy also noted poor insight, impulsivity, and inability to follow directions reliably.<br /><br />Because of these concerns, the surgical team proactively consulted perioperative geriatrics specialists. Their assessment predicted a high likelihood of cognitive and functional decline, delirium, falls, inability to use the call button, and harm from prolonged isolation and minimal contact during admission. The team concluded that the hospital course itself could be more dangerous than expected benefit from treatment.<br /><br />Through interdisciplinary communication, the teams helped the patient and family make a patient-centered decision to forego cancer treatment. Palliative care was also involved, though the family’s decision was made independently of that consultation. Over the following month, the patient was admitted twice for cardiopulmonary issues, transitioned to hospice on the second admission, and died in the hospital.<br /><br />The poster emphasizes that perioperative medicine can serve as a hub for integrating care across specialties and highlights the value of teamwork, situational awareness, and systems thinking in caring for frail older adults.

Asset Subtitle

Avital O'Glasser

Meta Tag

Author List Alaina Ena, Avital O'Glasser, Christopher Benjamin, Elizabeth Hays, Ella Bowman, James Lim, Jessica Wright, Nicholas Kinder, Rachel Schafer

Category Clinical Vignettes

Concept Frail Older Adult

Concept Geriatric Syndrome

Concept Cognitive impairment

Concept Impaired Functioning

Concept Delirium

Distinguished Non-Finalist

Presenter Organization Ohsu

Presenting Author Avital O'Glasser

Track Adult

Keywords

perioperative geriatrics

frail older adult

pheochromocytoma

Azedra

iobenguane-131

hospitalization risk

delirium prevention

dementia

interdisciplinary care

palliative decision-making

Frail Older Adult

Geriatric Syndrome

Cognitive impairment

Impaired Functioning

Delirium