Jugdeep Dhesi, Consultant geriatrician Guy’s and St. Thomas’ NHS Foundation Trust, UK

Biography
Jugdeep Dhesi is a consultant geriatrician working in the innovative and award-winning POPS (Perioperative medicine for Older People undergoing Surgery) service at Guy’s and St Thomas’ NHS Foundation Trust. She is Adjunct Professor at King’s College London (CARICE) and Associate Professor at University College London, with research interests including preoperative assessment and optimisation, health services research focusing on perioperative pathways and postoperative delirium. She has wide education and training portfolio, having established the first Allied Health Professional, Foundation and Specialist Registrar training programmes in perioperative medicine, co-authored e-learning modules, MSc modules and multiple textbook chapters. Her national roles include President of the British Geriatrics Society, Deputy Director for Centre for Perioperative Care and involvement in a variety of steering, advisory and guideline groups (NELA, RCoA, BGS and NICE). Jugdeep is also a member of the Ageing Research at King’s (ARK) Advisory Board.

Summary
Increasing numbers of older people are undergoing emergency and/or elective surgery as a consequence of changing demographics, advances in surgical and anaesthetic technique and evolving patient expectations. Older people presenting to perioperative care often have coexisting physiological decline, multimorbidity and geriatric syndromes such as frailty and cognitive impairment. The resulting complexity can make assessment of risk-benefit of surgery difficult, as it requires an understanding of not only the surgical and anaesthetic issues, but also of outcomes that matter to patients, life expectancy with and without surgery, alternative treatment options and modifiable risk factors. Postoperatively, older patients experience high rates of complications in all surgical settings with impact on short and long term outcomes. In particular, older people are more likely to experience poor functional recovery with consequent need for rehabilitation, complicated hospital discharge and increased home care or new institutionalisation, with resultant high healthcare cost. As such the complex pathophysiological profile of older surgical patients clearly presents challenges throughout the surgical pathway from preoperative decision making through to anaesthetic/medical management in the peri- and postoperative period.

For these reasons, geriatricians are increasingly asked to provide opinion or hands on care for older surgical patients beyond orthogeriatrics. In this session, the need for age-attuned pathways of care to address the needs of today’s surgical population will be outlined. The innovative approaches used by Perioperative medicine for Older People undergoing Surgery (POPS) services to embed clinically and cost-effective perioperative services will be described. We will discuss evidence base for POPS services, and the barriers (including culture, finance and workforce) and enablers that have allowed effective implementation at a local, national and international level over the past 20 years.