This seminar will be highly relevant for the NASPOG audience because gynecological surgery in older women is a very high-risk setting for persistent distress and disability. Depression and anxiety are common in this setting – much higher than in community samples of older adults – and have a negative impact on postoperative outcomes. Depression and anxiety put older women at high risk for delirium, longer hospital stays, poor functional recovery, rehospitalization, and requirement for institutional nursing care.

The increasing number of older adults undergoing surgery requires innovation in perioperative management, beyond an emphasis only on surgical success and anesthetic safety to a holistic view which integrates mental health care. These talks will summarize existing research and propose a framework for improving womens’ gynecological perioperative outcomes through effective, integrated mental health care.

The first speaker, Eric Lenze, M.D., is a geriatric psychiatrist whose research focuses on treatments for depression and anxiety in older adults. He will discuss: (1) unique challenges to effective interventions for the perioperative population of often frail, multimorbid older adults, in perioperative settings notable for their rapid transitions and complexity. (2) A combined behavioral and pharmacological intervention is needed that targets depression and anxiety. Pharmacological management consists of medication optimization and deprescribing, while behavioral activation benefits the depression or anxiety symptoms. Finally, patient-centered engagement is needed to encourage older adults in perioperative settings to focus on their mental health.

The second speaker, Tanya Wildes, M.D., is a geriatric oncologist. Her research focuses on improving geriatric outcomes after oncological surgery, particularly by recognition and treatment of depression and anxiety. In one study, 75% of older adults with cancer who met criteria for depression were untreated. Untreated depression increases the risk of surgical complications, delirium and cancer recurrence. Depression and anxiety increase the risk of falls: insomnia, hypnotics, benzodiazepines and polypharmacy all contribute to this increased risk. Falls in turn increase the risk of chemotherapy toxicity and contribute to functional decline, poor quality of life and increased risk of death. In this session, we will cover these downstream consequences of untreated depression and anxiety, and approaches to mitigate them.