Recovery After Major Surgery in Older Adults

Before discharge: get the information you need

Ask for, and keep in the health file: - A discharge summary: what was done, findings, and complications. - A written medicine list: what is new, what has changed, what has stopped, with reasons and timings. Do not restart or stop any medicine unless the list says so, and call the doctor if unsure; see giving medicines safely at home and polypharmacy and deprescribing: taking fewer, better medicines. - Wound care instructions: dressings, stitches or staples, when they will be removed, when the person can shower. - Activity and lifting limits, and when to return to normal activities, driving and travel. - Diet instructions. - Follow-up appointments and test results due, including pathology reports. - Who to call, day and night, with a phone number, if there is a problem. - What warning signs to watch for. - Equipment and help needed at home; see hospital admission and discharge for older adults: a checklist, monitoring a parent after hospital discharge and hospital room at home: complete setup.

Setting up for the return home

• A comfortable bed with the head raised, pillows or a wedge for propping, a firm chair with arms, and the bed near the toilet; see setting up a hospital bed at home and wedge pillow guide.
• Clear, well-lit paths and night lights; see night safety for a parent alone.
• A commode or raised toilet seat if bending is painful; see commode chair guide and raised toilet seat guide.
• A walking aid if advised.
• Easy-to-eat food and fluids, thermometer, blood pressure monitor and weighing scale for monitoring; see digital thermometers: choosing and using them for older people, how to measure blood pressure at home accurately and weighing scales and unplanned weight loss in older adults.
• A helper for the first days and weeks; see training a new attendant: first week.

Moving early and safely

Lying in bed for long stretches weakens muscles, promotes clots and chest infection, and slows bowel recovery. The surgical team will say when walking should start, usually within a day or two.

• Sit out of bed for meals as soon as allowed.
• Walk short distances several times a day, with a helper, increasing a little each day; see walking programme for older adults.
• Ankle pumps and leg exercises in bed or chair every hour while awake.
• Get up in stages: roll to the side, push up with the arms, sit on the edge of the bed for a minute, then stand; see bed height and getting out of bed and how to lift and transfer safely.
• Support the wound: hold a folded towel or small pillow firmly over an abdominal wound when coughing, sneezing, laughing or moving.
• Avoid lifting, pulling or straining beyond the limits the surgeon sets, often nothing heavier than a few kilograms for several weeks.
• Pace activity: rest between efforts; fatigue is expected; see slow recovery after infection in older adults for pacing ideas that apply here too.
• Prevent falls: weakness, pain medicine and low blood pressure raise risk; see falls risk assessment at home and dizziness when standing: postural hypotension in older adults.
• Physiotherapy at home or an outpatient clinic if advised; see rehabilitation after fracture or surgery: a physiotherapy plan.

Breathing and chest care

• Deep breathing and coughing hourly while awake in the first days, with the wound supported, as taught by the physiotherapist; see breathlessness: positions and breathing techniques that help.
• Sit upright rather than slumped.
• Report fever, cough with coloured sputum, breathlessness, or chest pain; see pneumonia in older adults: prevention and recovery.

Preventing blood clots

Clots in the legs or lungs are a risk after surgery. - Move as advised, and do ankle exercises. - Wear compression stockings or use clot-prevention medicine only as the surgeon instructs, and for as long as instructed; see compression stockings guide and compression stockings: sizing and donning. - Stay hydrated. - Know the signs: a swollen, painful, warm or red calf or leg; sudden breathlessness, chest pain or coughing blood. Call 112 for breathlessness, chest pain or collapse. Report leg swelling or pain to the doctor the same day.

Wound care

• Keep the wound clean and dry as instructed. Wash hands before and after touching it or the dressing.
• Do not remove stitches, staples or tapes yourself or disturb dressings except as shown by the nurse.
• Showering: as the surgeon advises; pat dry; avoid soaking in a bath until cleared; use a shower chair for stability; see bathing safely with a shower chair.
• Do not apply creams, powders, oils or herbal pastes to the wound unless the surgeon advises.
• Look daily (with a helper or mirror if needed) for increasing redness, swelling, heat, leaking pus or a bad smell, wound edges opening, or bleeding.
• A little bruising, tightness and mild clear ooze early on can be normal; ask if unsure.
• Drains or stomas: nurses will teach emptying and care; ask for written instructions and a contact number; see catheter care basics for families for general hygiene principles and wound care at home for older adults.
• Pressure areas: reduce risk with regular position changes and attention to the heels and tailbone; see preventing bedsores at home.

Food, fluids and bowels

• Small, frequent meals, gradually returning to usual food, as the surgeon advises; some operations need a special diet at first.
• Protein helps healing: eggs, dal, curd, milk, paneer, fish, chicken, soft foods; see how much protein do older adults need and indian meals for high-protein seniors.
• Fluids: drink regularly unless restricted; see hydration for older adults: how much and how to remember.
• Weight and appetite: weigh weekly and tell the doctor if weight keeps falling; see loss of appetite in older adults: causes and practical fixes and malnutrition in older adults: signs and prevention.
• Constipation is very common after surgery, from pain medicines, reduced activity and anaesthesia; ask the team what is safe; do not strain; see constipation in older adults: fibre, fluids and movement.
• Nausea, vomiting, swollen belly, inability to pass wind or stool need medical review.
• Diabetes: keep sugar checks and meals as advised; infection risk rises with high sugar; see how to test blood sugar at home.

Pain relief

Pain control helps movement, breathing and sleep. Use only the medicines prescribed for this person, exactly as directed; do not add extras or use leftovers; see painkillers and older adults. Report drowsiness, confusion, constipation, nausea or stomach pain to the doctor. Non-drug comfort measures include positioning, gentle movement, distraction and warmth only if the surgeon allows.

Confusion (delirium) and mood

Delirium, a sudden confusion with changes in attention, sleep and behaviour, is common after surgery in older adults and is usually temporary, but needs medical attention; see delirium in older adults.

• Help prevention: familiar faces and objects, glasses, hearing aids and dentures in place, a clock and calendar, good lighting by day and darkness by night, regular sleep, fluids, early movement, and avoiding unnecessary sedatives.
• Report promptly any new confusion, agitation, drowsiness, hallucinations or sleep reversal.
• Mood: feeling low, anxious or tearful is common; see depression in older adults. If your parent says they do not want to go on, stay with them and seek help the same day; Tele-MANAS (14416) is India's national mental health helpline (check the current number); 112 for emergencies.
• Sleep: limit daytime napping, and keep a regular routine; see insomnia in older adults: sleep hygiene and when to get help.

Monitoring at home

Keep a simple daily record: temperature, pulse, blood pressure, pain, wound appearance, appetite and fluids, bowel and urine, walking distance, sleep, mood and confusion, and medicines taken; see care diary and handover notes.

Red flags

Call 112 or go to the emergency department for: - Chest pain, severe breathlessness, fainting, blue lips. - A suddenly swollen, painful leg with breathlessness. - Heavy bleeding, soaking through dressings, or blood in vomit or stool. - Severe or worsening abdominal pain, a hard swollen belly, persistent vomiting, or inability to pass wind or stool. - New confusion, severe drowsiness or fits. - Stroke signs. - High fever with shaking, cold clammy skin or very low urine. - The wound opening up, or bowel visible.

Call the surgeon or doctor the same day for: fever, increasing wound redness, swelling, pus or smell; worsening pain; calf pain or swelling; cough or breathlessness; diarrhoea or constipation lasting more than a couple of days; poor appetite or drinking; weight loss; reduced urine, burning urine; new rashes or medicine side effects.

When to ask a professional

Ask the surgeon for activity, diet and wound instructions, the physiotherapist for exercises, a dietician for nutrition, and a nurse for wound or stoma care. Ask the family doctor to review other conditions and medicines. Seek urgent help for any red flag.