Loss of independence after pancreatic surgery

Loss of independence (LOI) is defined as a decline in functional status, deterioration in mobility, or new requirements for special services such as new home care or skilled nursing facility needs. 1 Berian J.R. Mohanty S. Ko C.Y. Rosenthal R.A. Robinson T.N. Association of loss of independence with readmission and death after discharge in older patients after surgical procedures. JAMA Surg. 2016; 151e161689https://doi.org/10.1001/jamasurg.2016.1689 Crossref Scopus (112) Google Scholar Compared with younger individuals, more older adults value functional independence over morbidity when rating factors important to their general well-being. 2 Hofman C.S. Makai P. Boter H. et al. The influence of age on health valuations: the older olds prefer functional independence while the younger olds prefer less morbidity. Clin Interv Aging. 2014; 10: 1131-1139https://doi.org/10.2147/CIA.S78698 Crossref Scopus (40) Google Scholar Many older patients associate a lower quality of life with LOI. LOI is different from loss of autonomy, which is defined as loss of the ability to make personal decisions such as those pertaining to goals of care. Although morbidity and mortality do not sufficiently reflect the values of the growing number of older individuals who undergo surgical procedures, most of the current surgical literature focuses on those two outcomes as measures of surgical quality rather than LOI. The frequency of LOI is often underestimated. 1 Berian J.R. Mohanty S. Ko C.Y. Rosenthal R.A. Robinson T.N. Association of loss of independence with readmission and death after discharge in older patients after surgical procedures. JAMA Surg. 2016; 151e161689https://doi.org/10.1001/jamasurg.2016.1689 Crossref Scopus (112) Google Scholar However, a recent study using new geriatric-specific variables from the American College of Surgeons National Quality Improvement Program Geriatric Surgery Pilot Project showed that LOI occurred in 59.6% of surgical patients older than 65 years. 1 Berian J.R. Mohanty S. Ko C.Y. Rosenthal R.A. Robinson T.N. Association of loss of independence with readmission and death after discharge in older patients after surgical procedures. JAMA Surg. 2016; 151e161689https://doi.org/10.1001/jamasurg.2016.1689 Crossref Scopus (112) Google Scholar