Mass General Brigham Geriatrics for Surgical Clinicians 2024

Geriatric Surgery • Age-Friendly Care • 5Ms • Delirium • Frailty • Polypharmacy • Deprescribing • Falls • Mobility • Perioperative Geriatrics • Goals of Care • Care Transitions

The Mass General Brigham Geriatrics for Surgical Clinicians 2024 course provides a focused, evidence-based review of geriatric principles specifically applied to surgical and trauma care.

Held virtually on March 14–15, 2024, the program addresses the growing need for surgical clinicians to develop greater expertise in caring for older adults with medical complexity, frailty, cognitive impairment, mobility limitations, polypharmacy, and increased vulnerability to adverse postoperative outcomes.

The course is structured around the 5Ms of Age-Friendly Care — Medication, Mobility, What Matters, Mentation, and Multicomplexity — and demonstrates how these principles can be incorporated into surgical decision-making before, during, and after hospitalization.

Major areas include delirium prevention and management, dementia, polypharmacy, deprescribing, falls and fractures, rehabilitation and prehabilitation, goals-of-care conversations, caregiver support, perioperative evaluation, pain management, frailty, transitions of care, and implementation of geriatric surgery care models.

Course Details

• Course: Geriatrics for Surgical Clinicians
• Provider: Mass General Brigham
• Department: Brigham and Women’s Hospital Department of Surgery / Mass General Brigham
• Year: 2024
• Dates: March 14–15, 2024
• Original Format: Virtual Course
• Primary Focus: Geriatric Surgical Care and Age-Friendly Surgery
• Language: English
• Official CME: Up to 9.50 AMA PRA Category 1 Credits™
• Nursing Credit: Up to 9.50 ANCC Contact Hours
• Physician Assistant Credit: Up to 9.50 AAPA Category 1 CME Credits
• Course Directors: Zara Cooper, MD, MSc; Rachelle Bernacki, MD, MS; Julia Loewenthal, MD; Andrea Wershof Schwartz, MD, MPH

Target Audience

The official target audience includes:

• Surgical Clinicians
• Nurses
• Physician Assistants
• Advanced Practice Providers
• Surgical Trainees
• Surgical Attendings

The course is intended for clinicians both within and outside the Mass General Brigham system.

It is also particularly relevant to:

• General Surgeons
• Trauma Surgeons
• Acute Care Surgeons
• Surgical Intensivists
• Colorectal Surgeons
• Orthopedic Surgeons
• Surgical Oncologists
• Anesthesiologists
• Geriatricians
• Nurse Practitioners
• Physician Associates
• Perioperative Clinicians
• Surgical Residents and Fellows
• Clinical Pharmacists
• Rehabilitation Specialists
• Nurses caring for older surgical patients
• Clinicians involved in preoperative optimization
• Professionals involved in geriatric trauma care

Program Overview

Older adults represent an increasingly large proportion of patients undergoing surgical and inpatient procedures.

The official Mass General Brigham course notes that nearly 40% of inpatient procedures in the United States are performed in adults aged 65 years and older, while older adults account for more than half of injured patients treated at MGB trauma centers, many of whom are frail.

Older surgical patients may be especially vulnerable to:

• Delirium
• Falls
• Fractures
• Functional decline
• Medication-related complications
• Infections
• Prolonged ICU stays
• Extended hospitalization
• Readmission
• Cognitive decline
• Caregiver strain
• Adverse postoperative outcomes

The course therefore emphasizes systematic geriatric assessment and age-friendly care pathways that can be incorporated into surgical practice.

Mass General Brigham’s broader Surgery for Older Adults Program likewise emphasizes individualized multidisciplinary care before, during, and after surgery, including preoperative optimization and coordinated geriatric support.

The 5Ms of Age-Friendly Surgical Care

A central framework throughout the course is the 5Ms:

Medication

Focuses on identifying medications that may increase risk in older surgical patients.

Important concepts include:

• Medication reconciliation
• Polypharmacy
• Potentially inappropriate medications
• Deprescribing
• Medication-related delirium
• Fall-risk medications
• Perioperative medication management

Mobility

Addresses the preservation and restoration of physical function.

Topics include:

• Fall risk assessment
• Fracture prevention
• Mobility optimization
• Rehabilitation
• Prehabilitation
• Functional decline prevention
• Postoperative mobility
• Safe discharge planning

What Matters

Focuses on understanding individual patient goals, values, and treatment priorities.

Areas include:

• Shared decision-making
• Surgical goals
• Patient priorities
• Serious illness conversations
• Advance care planning
• Quality-of-life considerations
• Patient-centered surgical planning

Mentation

Focuses on cognition and neuropsychiatric risks.

Important areas include:

• Delirium
• Dementia
• Cognitive screening
• Delirium prevention
• Identification of precipitating factors
• Safe care planning
• Postoperative cognitive concerns

Multicomplexity

Addresses the interaction between multiple medical, functional, social, and psychosocial factors.

Topics include:

• Frailty
• Multimorbidity
• Functional limitations
• Social complexity
• Caregiver burden
• Transitions of care
• Healthcare utilization
• Payment models
• Interdisciplinary care

Learning Objectives

Upon completion of this activity, participants should be able to:

• Describe the 5 Ms — Medication, Mobility, What Matters, Mentation, and Multicomplexity — of caring for older surgical patients.
• Perform an assessment for delirium, initiate evaluation for precipitating factors, treat underlying causes, and develop a safe care plan.
• Recognize risk factors for falls and fractures and create a plan for optimizing mobility.
• Perform a full medication reconciliation and identify potentially inappropriate medications.
• Summarize how to coordinate a safe and effective care transition for older patients, caregivers, and families.
• Assess what matters most to older patients and apply these priorities to surgical planning.
• Associate geriatric syndromes such as frailty and dementia with adverse postoperative outcomes.

Official Program Topics

Day 1 – Age-Friendly Surgical Care

Introduction to Day 1 – Surgery in Older Adults: An Age-Friendly Approach

Zara Cooper, MD, MSc

Introduces the Age-Friendly Health Systems framework and its application to the unique risks and needs of older adults undergoing surgery.

Mentation: Preventing & Addressing Delirium in Surgical Patients

Sevdenur Cizginer, MD, MPH, AGSF

Reviews recognition, prevention, evaluation, and management of delirium in older surgical patients.

Clinical areas include:

• Delirium screening
• Precipitating factors
• Medication triggers
• Environmental contributors
• Cognitive assessment
• Nonpharmacologic prevention
• Treatment of underlying causes
• Safe postoperative care

Medications: Polypharmacy & Deprescribing for Surgical Patients

Laura Frain, MD, MPH

Examines medication-related risk in older surgical patients.

Topics include:

• Polypharmacy
• Medication reconciliation
• Potentially inappropriate medications
• Deprescribing
• Drug-related falls
• Medication-associated delirium
• Perioperative medication safety

Case-Based Workshops – Delirium, Dementia, and Medication Management

Delirium & Dementia Surgical Cases

Sharon Levine, MD; Deborah Lee, MD

Uses clinical cases to explore decision-making in older surgical patients with cognitive impairment.

Medications: Geriatric Surgical Cases

Andrea Wershof Schwartz, MD, MPH; Lynne O’Mara, MPAS, PA-C

Provides practical medication-review cases involving older surgical patients.

Rehab, Prehab & Falls: Optimizing Mobility Throughout the Surgical Continuum

Julia Loewenthal, MD; Nancy Latham, PhD, PT

Reviews strategies to maintain and restore mobility before and after surgery.

Topics include:

• Prehabilitation
• Rehabilitation
• Falls
• Fracture prevention
• Functional assessment
• Mobility optimization
• Postoperative recovery

What Matters Most: Addressing Goals & Priorities for Surgical Patients

Elizabeth Lilley, MD, MPH

Focuses on aligning surgical care with patient preferences and personal priorities.

Topics include:

• Goals of care
• Patient priorities
• Surgical decision-making
• Quality of life
• Serious illness
• Shared decision-making

Serious Illness Conversations: A Guide for Communication About Goals of Care

Rachelle Bernacki, MD, MS; Elizabeth Lilley, MD, MPH

Reviews structured communication strategies for discussing serious illness and treatment goals with older surgical patients.

Supporting Caregivers & Surrogates Before, During & After Surgery

Tamryn Gray, PhD, RN, MPH; Zara Cooper, MD, MSc

Addresses caregiver and surrogate involvement throughout the surgical journey.

Topics include:

• Caregiver burden
• Surrogate decision-making
• Family communication
• Discharge planning
• Postoperative support

Take Home Lessons for Geriatric Care

Andrea Wershof Schwartz, MD, MPH

Summarizes practical strategies for implementing age-friendly principles in surgical practice.

Day 2 – Multicomplexity and Perioperative Geriatrics

Navigating Multicomplexity in Older Surgical Patients

Rachelle Bernacki, MD, MS

Introduces the challenges created by overlapping medical, functional, cognitive, and social complexity in older surgical patients.

Peri-Operative Evaluation for Geriatric Surgery Patients

Rachelle Bernacki, MD, MS; Christy Cauley, MD, MPH

Reviews preoperative evaluation and risk assessment in older adults.

Topics include:

• Surgical risk
• Geriatric assessment
• Functional status
• Comorbidities
• Frailty
• Cognitive status
• Patient goals
• Perioperative optimization

Anesthesia & Pain Management in Older Surgical Patients

Stacie Deiner, MD, MS

Reviews anesthetic and pain-management considerations unique to older adults.

Topics include:

• Perioperative analgesia
• Opioid risk
• Multimodal pain management
• Cognitive effects
• Delirium risk
• Medication sensitivity
• Postoperative pain control

Pre-Operative Evaluation & Pre-Habilitation

Christy Cauley, MD, MPH; Esteban Franco Garcia, MD, AGSF

Uses case-based learning to explore preoperative optimization and preparation for surgery.

Surgical Pain Management for Older Adults

Stacie Deiner, MD

Focuses on safe and individualized pain-management strategies in geriatric surgical patients.

Frailty in Older Surgical Patients

Ariela Orkaby, MD, MPH

Examines frailty as an important predictor of postoperative risk.

Topics include:

• Frailty assessment
• Physiologic reserve
• Functional vulnerability
• Postoperative complications
• Mortality risk
• Recovery
• Shared decision-making

Multicomplexity: Considering Transitions of Care & Payment Models for Geriatric Surgery Patients

Esteban Franco Garcia, MD, AGSF

Addresses safe care transitions and broader systems issues affecting geriatric surgical care.

Topics include:

• Hospital discharge
• Skilled nursing care
• Rehabilitation
• Medication reconciliation
• Communication
• Follow-up
• Readmission prevention
• Payment models

Implementing Geriatric Surgery Care Models

Panelists:

• Amy Bulger, RN, MPH, GERO-BC, CPHQ
• Lynne O’Mara, MPAS, PA-C
• Houman Javedan, MD
• Roman Belenkiy, PharmD, BCGP
• Masaya Higuchi, MD, MPH, CMD, AGSF

Discusses practical implementation of structured geriatric surgical care programs and multidisciplinary workflows.

Major Topics Covered

• Geriatric Surgery
• Geriatric Trauma
• Age-Friendly Health Systems
• 5Ms of Geriatric Care
• Medication
• Mobility
• What Matters
• Mentation
• Multicomplexity
• Delirium
• Dementia
• Frailty
• Polypharmacy
• Deprescribing
• Medication Reconciliation
• Potentially Inappropriate Medications
• Falls
• Fractures
• Mobility Assessment
• Prehabilitation
• Rehabilitation
• Functional Decline
• Perioperative Geriatrics
• Preoperative Assessment
• Surgical Risk Assessment
• Pain Management
• Geriatric Anesthesia
• Goals of Care
• Serious Illness Conversations
• Shared Decision-Making
• Advance Care Planning
• Caregiver Support
• Surrogate Decision-Making
• Care Transitions
• Discharge Planning
• Readmission Prevention
• Multimorbidity
• Functional Assessment
• Cognitive Assessment
• Surgical Outcomes
• Postoperative Complications
• Geriatric Care Models
• Interdisciplinary Surgical Care

Course Directors

Zara Cooper, MD, MSc

Michele and Howard J. Kessler Distinguished Chair of Surgery and Public Health
Kessler Director, Center for Surgery and Public Health
Director, Center for Geriatric Surgery
Brigham and Women’s Hospital
Professor of Surgery, Harvard Medical School

Rachelle Bernacki, MD, MS

Director of Care Transformation and Postoperative Services
Center for Geriatric Surgery, Brigham and Women’s Hospital
Director of Quality Initiatives, Psychosocial Oncology and Palliative Care
Dana-Farber Cancer Institute
Associate Professor of Medicine, Harvard Medical School

Julia Loewenthal, MD

Geriatrician, Division of Aging
Brigham and Women’s Hospital
Assistant Program Director, Internal Medicine Residency Program
Instructor in Medicine, Harvard Medical School

Andrea Wershof Schwartz, MD, MPH

Geriatrician, Division of Aging
Brigham and Women’s Hospital
Associate Professor of Medicine, Harvard Medical School
Associate Director, New England Geriatric Research Education and Clinical Center

Faculty

Faculty include:

• Roman Belenkiy, PharmD, BCGP
• Christy Cauley, MD, MPH
• Sevdenur Cizginer, MD, MPH, AGSF
• Stacie Deiner, MD, MS
• Laura Frain, MD, MPH
• Esteban Franco Garcia, MD, AGSF
• Tamryn Fowler Gray, PhD, RN, MPH
• Masaya Higuchi, MD, MPH, CMD, AGSF
• Houman Javedan, MD
• Nancy Latham, PhD, PT
• Deborah Lee, MD
• Sharon Levine, MD
• Elizabeth Lilley, MD, MPH
• Ariela Orkaby, MD, MPH

Accreditation

The official live virtual activity offered:

• 9.50 AMA PRA Category 1 Credits™
• 9.50 ANCC Nursing Contact Hours
• 9.50 AAPA Category 1 CME Credits
• 9.50 Participation Credits
• Eligible credit toward relevant ABA MOCA, ABS Continuous Certification, and ABOHNS Continuing Certification requirements where applicable.

Mass General Brigham is jointly accredited by the:

• Accreditation Council for Continuing Medical Education (ACCME)
• Accreditation Council for Pharmacy Education (ACPE)
• American Nurses Credentialing Center (ANCC)

Important: These credits applied to participation in the official Mass General Brigham educational activity and required completion through the authorized provider.

Why This Course Is Relevant

The Mass General Brigham Geriatrics for Surgical Clinicians 2024 course addresses one of the most important challenges in modern surgery: providing safe, individualized, and evidence-based care to an increasingly older and more medically complex surgical population.

The program is especially relevant for clinicians seeking education in:

• Age-friendly surgical care
• 5Ms implementation
• Delirium prevention
• Dementia assessment
• Frailty evaluation
• Polypharmacy
• Deprescribing
• Fall prevention
• Mobility optimization
• Prehabilitation
• Rehabilitation
• Preoperative geriatric assessment
• Pain management
• Goals-of-care conversations
• Shared decision-making
• Caregiver support
• Transitions of care
• Geriatric trauma
• Surgical outcome optimization
• Implementation of geriatric surgical pathways

Mass General Brigham’s broader geriatric surgery program similarly emphasizes individualized, multidisciplinary care before, during, and after surgery to improve outcomes in older adults.

Short Description

Mass General Brigham Geriatrics for Surgical Clinicians 2024 provides an evidence-based, age-friendly approach to surgical care for older adults, covering the 5Ms, delirium, dementia, frailty, polypharmacy, deprescribing, falls, mobility, prehabilitation, perioperative evaluation, pain management, goals of care, caregiver support, transitions of care, and implementation of geriatric surgical care models.

+ Topics:

• 01 Age-Friendly Surgery – Applying the 5Ms Framework to Older Adults Before, During, and After Surgical Care
• 02 Mentation and Delirium – Screening, Prevention, Precipitating Factors, Treatment, and Safe Care Planning in Older Surgical Patients
• 03 Dementia and Surgery – Cognitive Impairment, Perioperative Risk, Decision-Making, and Postoperative Care Considerations
• 04 Polypharmacy in Surgical Patients – Medication Reconciliation, Potentially Inappropriate Drugs, and Medication-Related Risk Reduction
• 05 Deprescribing Before and After Surgery – Identifying High-Risk Medications and Optimizing Pharmacotherapy in Older Adults
• 06 Mobility and Falls – Fall-Risk Assessment, Fracture Prevention, Rehabilitation, and Functional Optimization Across the Surgical Continuum
• 07 Prehabilitation in Older Adults – Improving Physical Function and Resilience Before Surgery
• 08 What Matters Most – Integrating Patient Goals, Values, Quality of Life, and Treatment Priorities Into Surgical Planning
• 09 Serious Illness Conversations – Communication Strategies for Goals of Care and Shared Surgical Decision-Making
• 10 Caregiver and Surrogate Support – Supporting Families and Decision-Makers Before, During, and After Surgery
• 11 Multicomplexity in Geriatric Surgery – Managing Multimorbidity, Functional Limitations, Cognition, and Social Complexity
• 12 Perioperative Geriatric Assessment – Evaluating Frailty, Cognition, Function, Comorbidities, and Patient Priorities Before Surgery
• 13 Anesthesia in Older Surgical Patients – Age-Related Medication Sensitivity, Cognitive Risk, and Perioperative Safety
• 14 Geriatric Surgical Pain Management – Multimodal Analgesia, Opioid Risk, Delirium Prevention, and Individualized Pain Control
• 15 Frailty and Surgical Outcomes – Assessing Physiologic Reserve and Predicting Postoperative Complications, Recovery, and Mortality
• 16 Care Transitions – Medication Reconciliation, Discharge Planning, Rehabilitation, Communication, and Readmission Prevention
• 17 Geriatric Trauma – Applying Age-Friendly Principles to Frail Older Adults With Acute Surgical Injury
• 18 Functional Recovery After Surgery – Preventing Loss of Independence and Supporting Rehabilitation in Older Adults
• 19 Geriatric Surgical Care Models – Implementing Multidisciplinary Age-Friendly Pathways and Systems of Care
• 20 Postoperative Risk Reduction – Preventing Delirium, Falls, Functional Decline, Complications, Prolonged Stay, and Readmission
• 21 Shared Decision-Making in Geriatric Surgery – Balancing Surgical Risk, Patient Priorities, Functional Outcomes, and Quality of Life
• 22 Medication Safety in Older Adults – Identifying Drug-Related Risks, High-Risk Therapies, and Opportunities for Optimization
• 23 Caregiver Strain in Surgical Care – Recognizing and Addressing Family and Caregiver Needs Throughout the Surgical Episode
• 24 Surgical Planning for Frail Older Adults – Integrating Frailty, Dementia, Functional Status, and Goals of Care Into Treatment Decisions
• 25 Geriatrics for Surgical Clinicians – Practical Integration of Medication, Mobility, Mentation, What Matters, and Multicomplexity Into Surgical Practice

 

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Thursday, March 14, 2024 | 11:00 AM – 4:00 PM ET

11:00am	Introduction to Day 1 – Surgery in Older Adults: An Age-Friendly Approach | Zara Cooper, MD, MSc
11:15	Mentation: Preventing & Addressing Delirium in Surgical Patients | Sevdenur Cizginer, MD, MPH, AGSF
12:00pm	Medications: Polypharmacy & Deprescribing for Surgical Patients | Laura Frain, MD, MPH
12:45	Parallel Case-Based Workshops A) Delirium & Dementia Surgical Cases | Sharon Levine, MD & Deborah Lee, MD B) Medications: Geriatric Surgical Cases | Andrea Wershof Schwartz, MD, MPH & Lynne O’Mara, MPAS, PA-C
1:15	Break
1:45	Rehab, Prehab & Falls: Optimizing Mobility throughout the Surgical Continuum | Julia Loewenthal, MD & Nancy Latham, PhD
2:30	What Matters Most: Addressing Goals & Priorities for Surgical Patients | Elizabeth Lilley, MD, MPH
3:15	Parallel Case-Based Workshops A) Serious Illness Conversations: A Guide for Communication about Goals of Care | Rachelle Bernacki, MD, MS & Elizabeth Lilley, MD, MPH B) Supporting Caregivers & Surrogates Before, During & After Surgery | Tamryn Gray, PhD, RN, MPH & Zara Cooper, MD, MSc
3:45	Take Home Lessons for Geriatric Care | Andrea Schwartz, MD, MPH
4:00pm	Adjournment

Friday, March 15, 2024 | 11:00 AM – 4:30 PM ET

11:00am	Introduction to Day 2: Navigating Multicomplexity in Older Surgical Patients | Rachelle Bernacki, MD, MS
11:15	Peri-Operative Evaluation for Geriatric Surgery Patients | Rachelle Bernacki, MD, MS & Christine Cauley, MD, MPH
12:00pm	Anesthesia & Pain Management in Older Surgical Patients | Stacie Deiner, MD
12:45	Parallel Case-Based Workshops A) Pre-Operative Evaluation & Pre-Habilitation | Christine Cauley, MD, MPH & Esteban Franco Garcia, MD B) Surgical Pain Management for Older Adults | Stacie Deiner, MD
1:15	Break
1:45	Frailty in Older Surgical Patients | Ariela Orkaby, MD, MPH
2:30	Multicomplexity: Considering Transitions of Care & Payment Models for Geriatric Surgery Patients | Esteban Franco Garcia, MD
3:15	Panel Discussion: Implementing Geriatric Surgery Care Models | Amy Bulger, RN, MPH, GERO-BC, CPHQ, Lynne O’Mara, MPAS, PA-C, Houman Javedan, MD, Roman Belenkiy, PharmD, BCGP & Masaya Higuchi, MD, MPH, CMD, AGSF
4:15	Course Wrap-Up | Andrea Schwartz, MD, MPH & Julia Loewenthal, MD
4:30pm	Adjournment