A research team at UHN is working to improve surgical outcomes for older adults by highlighting the specific needs and challenges of this group. In three recent studies, the team led by Dr. Frances Chung, a Clinician Investigator at Krembil Brain Institute (KBI), explored how preoperative attitudes, cognition, and mental health affect postoperative recovery.
Older adults—people aged 65 or older—undergo more surgical procedures than younger patients and experience higher rates of adverse outcomes. Previous studies have shown that preoperative factors such as mental health, cognitive function, and stress contribute to these outcomes.
Although the current standard of care includes some preoperative assessments, they often fail to fully capture the complex needs unique to older adults. Without an accurate understanding of these needs, appropriate improvements to care are unlikely, and adverse outcomes may persist.
To address this gap, Dr. Chung and her team conducted three studies in older adults undergoing non-cardiac surgery—two longitudinal, prospective studies and one single-time point, survey-based study:
● The first study used a 15-question survey in 307 patients to examine the role of depression.
● The second study assessed cognition in 394 patients using several short, clinically relevant cognitive tools, including the Montreal Cognitive Assessment (MoCA)—a 30-question assessment that can identify cognitive impairment.
● The third study surveyed 236 patients on five domains: surgery, anesthesia, functional disability, cognition, and finances.
Findings from the first two studies reinforced existing evidence linking mental and cognitive health to surgical outcomes. Notably, they revealed how many older adults are affected by depression and cognitive impairment. Preoperative depression affected 20% of participants, while cognitive impairment affected up to 35%. If left unaddressed, both conditions that may contribute to poor outcomes. Indeed, patients with cognitive impairment were found to have higher rates of adverse events such as emergency room visits 90-days post-surgery.
Despite the prevalence and clear impact of depression and cognitive impairment found in the first two studies, the third study found that many patients expressed limited concern about cognitive issues and showed low interest in preoperative assessments even though such screening before surgery could help guide care and prevent adverse outcomes.
Dr. Chung and her team’s research highlights the need to better align clinical care with patients’ needs and values. Improving patient education about the benefits of these interventions is critical. Without patient buy-in, even enhanced care standards may not improve outcomes.
Incorporating assessments for mental health and cognition into standard care offers a chance to intervene early and prevent complications. As the older adult population grows in Canada and beyond, reducing adverse outcomes may improve quality of life and reduce pressure on the health care system.
The first author of the study assessing depression, published in the British Journal of Anaesthesia, is Yasmin Alhamdah, a medical student at St. George’s University and a former master’s student in Dr. Chung’s lab.
The first author of the study assessing preoperative concerns and prehabilitation, published in the Journal of Clinical Anesthesia, is Melanie Li, a medical student at the University of Toronto.
The first author of the study assessing the role of cognitive impairment—presented as an abstract at the 2025 IARS & SOCCA Annual Meeting—is Ellene Yan, a PhD candidate at the Institute of Medical Sciences at the University of Toronto.
The senior author of all three publications is Dr. Frances Chung, a Krembil Clinician Investigator with the Krembil Brain Institute, ResMed Chair in Anesthesia, Sleep and Perioperative Medicine Research at UHN, and a Professor in the Department of Anesthesiology and Pain Medicine in the Temerty Faculty of Medicine at the University of Toronto.
This work was supported by the Ontario Long-Term Care Innovation Fund, the ResMed Foundation, Canadian Institutes of Health Research, and UHN Foundation.
For a complete list of competing interests, see the publications.
Alhamdah Y, Yan E, Butris N, Kapoor P, Lovblom LE, Rajji TK, Fischer CE, Mah L, Wong J, Islam S, Saripella A, He D, Chung F. Depression in older surgical patients: a multicentre prospective longitudinal study. Br J Anaesth. 2025 May 21. doi: 10.1016/j.bja.2025.04.016.
Li M, Yan E, Saripella A, Alhamdah Y, Nabipoor M, Alibhai SMH, Wong J, Chung F. Understanding preoperative concerns and attitudes towards prehabilitation in older surgical populations: A survey study. J Clin Anesth. 2025 Jun 5. doi: 10.1016/j.jclinane.2025.111895.
Yan E, Alhamdah Y, He D, Lovblom LE, Campbell S, Wong J, Chung F. Is poor performance on ultra-rapid cognitive screening tools associated with clinical outcomes? Findings from the Detection of Cognitive Impairment (Detect CI) study. Abstract presented at: 2025 Annual Meeting. 14th Annual Meeting of the International Anesthesia Research Society (IARS) & Society of Critical Care Anesthesiologists (SOCCA); 2025 Mar 20-23; Honolulu, Hawaii, USA.
A list of other publications from Dr. Chung’s group can be found here.