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India has had a significant increase in older adults over the years. This number is only going to increase exponentially in the future. Successful surgeries in the elderly have become a reality, as compared to a few decades ago. The factors contributing to older adults opting for surgeries include better medical facilities, longer life, and secure finances. The common surgeries include cataract surgery, joint replacement surgeries, hernioplasties, and spine surgeries. As the surgeon would readily agree, the surgery is only the beginning. Post-operative care is very important in achieving the best results after any surgery in older adults.

The common problems which can be of significant concern in post-operative care in the elderly consist of uncontrolled pain, confusion/delirium, dehydration, decreased food intake, and wound care.

**Uncontrolled Pain:**
Pain can be common after surgery, but it should be anticipated in the post-surgical period. It is one of the most distressing symptoms for older adults and can make the recovery period very uncomfortable. Periodic assessment of pain, monitoring its severity, and providing adequate pain management is essential for a great post-surgical outcome in older patients. 

**Confusion or Delirium:**
Confusion or postoperative delirium is encountered quite frequently. It should be recognized at the earliest and the cause should be treated. The signs to watch include distraction, disorientation, inability to say certain words, temporary memory loss, hallucinations, and lack of awareness.

Anti-delirium measures should be a part of post-operative care. If there is delirium, then the cause should be treated. Thereafter reorientation of the older adult should to time, place, and person be initiated. Pharmacological interventions are only to be given when agitation is present.

**Dehydration:**
Fluid management helps in the prevention of dehydration. It is critical to prevent dehydration as it can have adverse outcomes. Depending upon the intake oral or intravenous fluids should be administered to maintain hydration.

**Food intake:**
The provision of proper nutrition plays a role in post-operative recovery of older adults. Diet plans tailored to the individual should be followed. The dentation should also be considered. Post-operative malnutrition must be prevented.

**Wound care:**
Surgical wound dressing to be done as per directives. Balanced nutrition helps in improving the wound healing.


**Prevention-**
Preventive measures form an important part of post-operative care.

**Fall Risk Assessment and Prevention**

Multicomponent interventions including exercises under supervision, environmental modifications, assistive technology, and sensors help in decreasing the risk of falls.

**Urinary Tract Infection prevention**

If immobilized, older adults are at maximum risk of UTIs. If an older adult patient has an indwelling catheter, daily review and documentation of its indication should be completed and attempts are made to remove the catheter as soon as possible. Indwelling catheters should not be used as a substitute for nursing care for older adult patient who is incontinent.

**Pressure Ulcer prevention and treatment**

Health care teams should assess pressure ulcer risk in all older adult post-operative patients. There are several validated scales stratifying patients at risk by assessing sensory perception, moisture, activity level, mobility, nutrition, and the potential for friction and shear.


**Rehabilitation-**
Rehabilitation forms a strong pillar of post-operative care in older adults. Sessions with physiotherapists for physical and cardiopulmonary rehabilitation regimes improve the functionality of an older adult. Continued mobility is important for preventing DVT  

One of the cornerstones of post-operative care in the elderly is structured preoperative and intraoperative care. Multidisciplinary assessment and intervention should be done.

An assessment by a geriatrician forms an essential component of the comprehensive holistic post-operative care of the elderly. The key to successful post-operative care is nursing. Nursing care depending upon the level of independence of the elderly individual should be planned.

Post-operative care for older adults is a structured program with the collaboration of the surgeon, geriatrician, and care team (consisting of nurses, physiotherapists, caretakers) to provide holistic care to improve their quality of life.



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Importance of post-operative care in the elderly

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There’s the music of sarod playing in the background while I write this, helps me write my memoirs!

When I was a child, I used to write diaries. What’s enticing to me at that point in time was the smell of new vintage-looking pages, and a unique feeling to ink it down. It all started then. Who knew the passion for writing would grow so strongly on me!

Hi, I’m Sneha, Business Assistant & Content Writer at Epoch. Yes, I own these words and wear them with pride. The journey to earn this was pretty savage, and I’ll like you to be a part of this! Hence, sharing a page from my memoir.

It was the dawn of the year 2020 when I promised myself to come out of the University with a Mass Communication and Journalism degree in one hand and a placement in other. Things started turning upside down when the covid wave came along and washed away all the aspirations I had of starting my career in a corporate world. Later that year, after graduating, I started freelancing.

Little did I know that the universe had something else up in its sleeves.  On 1st Feb, I started my journey at Epoch, and it’s already a year now! I’ll need pinches from myself to believe so. When I stepped out of my comfort zone, came to a new city, I met amazing people, especially women, who inspired me in the most unusual ways. It is my sheer luck and fortune that I landed in Epoch right after college. The journey of amazement and learning didn’t stop for me, I would say.

How often does it happen that a CEO of an organization holds your hand, mentors you, and walks you through your journey? Well, happened to me and to all those who started anew! Here, at Epoch, I saw myself under the guidance of domain experts. From each one of them, I learnt something, both applicable in personal and professional lives. My team pushed me one notch beyond my threshold, surprisingly that brought different colours to my work. To date, I am told to be the owner of not only my projects, but also my decisions, successes, and failures. I am learning.

Epoch has played a vast role in shaping me into Sneha 2.0. If you know me and don’t believe, let’s go out for a cup of coffee! A confident and radiant Sneha, you’ll see.

Epoch homes abode elderly those who need dementia care and assisted daily living support. When I started, I was briefed about dementia but the understanding of the daily life of a senior 75+, came to me when I was in their presence. Recently through one of the Epoch webinars, I heard a doctor/geriatrician say, and I quote, “there’s a person still behind the dementia patient”, and this made me realize how naïve are we to not notice this in our elderly loved ones!

Amidst the pandemic, there were fewer interactions with our elderly residents, regarding their own safety. But whenever I got the chance, covered in PPE kit, I would jump to know each one of them. With some I sang era old songs, with some I recited poems of Harivansh Rai Bachchan, Dinkar, Nirala, with some I learnt the concept of perspective, with some I learnt fashion, some taught me to live life with a bang, and that’s what I am doing!

Epoch in a way turned out to be a blessing in disguise. I would like to stop the roller coaster of my emotions here by simply being grateful. One day, when I close my eyes, I would love the memories with Epoch to roll in the cassette of my life. 

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To Epoch, a cassette of my life

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I want to share my unique professional journey with you. Personally, I have been someone who is always up for trying new things.

In August 2014, after completing my training as a General Duty Assistant, I got placed at Epoch Elder Care as a care attendant.  Even though I had prior care training, being a care attendant in an assisted living home was new for me and there was much to learn, especially about dementia care. At Epoch, everyone is encouraged to ask questions whenever they do not understand, your colleagues and seniors will answer them patiently and help you understand your issues. I realised how tough life can be with dementia and at Epoch I was able to increase the quality of life of elders with dementia and this was very satisfactory for me. 

Given my inclination to try new roles, back in 2018, I was chosen for the role of Admin Assistant which was a huge change for me professionally as I was moving from  care to an administrative role. With much support of senior colleagues, I was able to manage this role with confidence. Here I learnt new skills like vendor management, maintenance planning, and working with multiple departments. Being an ex-care attendant, I was able to understand the importance of this role where I had to ensure the upkeep of Epoch homes and how crucial it was for our care attendants to take care of our residents. Iss dauran maine apni life ko bahut hadd tak personally, professionally and financially grow bhi kiya hai (During this time, I was able to grow personally, professionally and financially). 

Then in January 2020, I saw an opportunity to move to a new role within Epoch as a Human Resource (HR) assistant and I confidently took the leap. Given my prior experience as a care attendant, I was quickly able to connect to prospective candidates for Care Attendant role and understand who could be a good fit at Epoch, and I learnt the aspect of people management. Ab dedication and guidance of my manager and colleagues ke sath grow kar raha hun or hope aage bhi yun hi grow karta rahunga. (With the dedication and guidance of my manager and colleagues, I am learning & growing  ,and will continue doing so!)

Thanks to Epoch, I have been able to understand this industry well and grow myself professionally in many different perspectives by gaining many new skills.

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Trying new roles and gaining new skills at Epoch

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I want to share my journey so far with Epoch Elder Care. I started my journey as a care attendant with Epoch’s Monet house at Pune location on 15th May 2016 and sab kuch naya tha mere liye (everything was new to me). It was a great year well spent at Monet house; and bohot kuch sikhne ko mila (great learnings came along). Under the guidance of our Facility Managers and Facility Nurses and other care attendants, I was properly trained to look after our residents. Epoch work culture bohot welcoming and unique tha mere liye (Epoch culture was welcoming and unique for me) - where the team was great & they treated me like a family member. Not only this, the relationship and bond I developed with residents was an amazing feeling. The concept of dementia and its management was something jo mujhe dhire dhire samajh aya. (The concept of dementia and its management was something I learned over a period of time).

After the completion of one year, the management decided to transfer me to Epoch’s other home (Vermeer House) in Gurugram. I was happy with the decision for two reasons. Firstly, my learning was about to expand and secondly, my hometown was nearby. After working as a care attendant for a year and a half at the Vermeer House, the management decided to promote me to the role of Head Care Attendant. Finally, my dedication & honesty paid off. My responsibilities increased and I had to oversee all errands related to our residents, other care team members, and the house overall, which I enjoyed throughout.

Then again on 1st May 2019, I was offered a role change based on my skills and eagerness to work. This time the management decided to offer me the role of Admin Assistant, which I accepted confidently. It was challenging at first, but with the constant guidance of the then corporate team, I managed with quite ease.

Epoch has not only helped me professionally but also personally. It is here that I met Sarita (Care Attendant at Vermeer House), married her and started another chapter of my life. She is always there to support & motivate me. 

During the outbreak of COVID-19, around Feb 2020, I was handed over the role & responsibilities of an Office Assistant in the new Vermeer house at Gurgaon. Covid ke first wave me hume bohot kuch naya experience karne ko and samajhne ko mila. Ye time humare liye bohot difficult tha but hum sabne milkar Epoch and ek doosre ko sambhala. (New learnings came along whilst managing and experiencing the first wave of coronavirus. It was a difficult time, but we managed to pull through). I was presented with the COVID warrior award. Epoch ke saath ab itne memories jud gaye hain ki yahan har koi apna sa lagta hai. 

Epoch me hamesha kuch na kuch naya sikhne ko and samajhne ko milta hi hai and mere liye bohot unique experience banta raha hai.

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My journey of multiple roles at Epoch

India has had a significant increase in older adults over the years. This number is only going to increase exponentially in the future. Successful surgeries in the elderly have become a reality, as compared to a few decades ago. The factors contributing to older adults opting...

Importance of post-operative care in the elderly

Dr Naganath Narasimhan Prem , Chief Consultant, Geriatric Medicine

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