Many elderly people may lack financial security or family support, making decisions about surgery not just based on medical reasons, but also social factors. — 123rf
As Malaysia prepares to become an ageing nation by 2030, questions surrounding elderly healthcare are becoming increasingly urgent.
This demographic shift places greater emphasis on healthcare decisions that affect the quality of life in later years, with one of the most challenging questions many families face being: to operate or not to operate?
Surgery can be a lifesaving and life-changing option.
Yet, many older patients are denied the option of surgery because of perceived notions based solely on age.
“About half of people over the age of 65 will require surgery at least once in their lives,” says consultant geriatrician and internal medicine physician Dr Chin Ai-Vyrn.
The most common causes are fractures from falls, head injuries and cancer.
However, the decision to proceed with surgery is rarely straightforward.
“It is not a one-size-fits-all situation.
“We assess frailty, physical and mental health, the patient’s priorities, and the level of support they will receive after surgery.
“What matters most is how the decision affects the person’s quality of life,” he explains.
For example, a frail patient with poor mobility may not benefit from a high-risk procedure that requires a long recovery.
In contrast, a relatively active 75-year-old with good functional status may regain many productive years from surgery.
Consultant neurosurgeon Dr Vickneswaran Mathaneswaran often sees this dilemma in his field, where elderly patients develop conditions like intracranial haemorrhages (bleeds), brain tumours or degenerative spinal disease.
“Older patients are more fragile and often have other health problems or are on long-term medication that complicates surgery,” he shares.
“In my experience, elderly patients do not tolerate complications well, and they also do not cope with long operations or prolonged hospital stays.
“That is why preparation is key, and operations must be done as safely and efficiently as possible.”
He adds: “Sometimes, not offering surgery can be a mistake because many older Malaysians today are still active, healthy, and can expect to live many more fruitful years.
“At the same time, pushing ahead with surgery in the wrong context can leave a patient in a more difficult condition.
“It is about balance, and about seeing the whole person, not just the disease.”
Dr Chin also notes that age-related conditions like frailty, cognitive decline or sensory impairment can increase the risk of post-surgical complications such as delirium.
“But knowing these conditions in advance allows us to prepare better and tailor both the surgery and recovery plan,” he says.
When a condition first arises, the process often begins with conversations that involve both the patient and their caregivers.
“We focus on understanding their concerns and expectations.
“Families need to know the possible risks, the outcomes if surgery is avoided, and what the road to recovery will look like,” says Dr Chin.
He emphasises that conservative approaches may initially be preferred.
For instance, a patient with knee osteoarthritis may manage their condition better with phy- siotherapy, pain relief, braces and/or weight loss, rather than immediate surgery.
The goal is always to align medical recommendations with the patient’s own values and wishes.
The good news is that advances in surgical techniques are expanding the possibilities for older patients.
But Dr Vickneswaran offers a note of caution.
“The term ‘minimally invasive’ is often overused.
“While access may be small, the surgery itself can still be extensive.
“What truly matters is having skilled surgeons, careful pre- operative preparation and strong support after the operation.”
Both doctors agree that what happens after surgery is as important as the procedure itself.
“Rehabilitation is critical in helping older patients regain independence,” says Dr Chin.
“Without proper rehabilitation, even a successful surgery may not translate into a better quality of life.”
Dr Vickneswaran adds: “Getting patients out of intensive care and back on their feet quickly is essential.
“Physiotherapy, early mobilisation and sending them home sooner rather than later, make a big difference.
“A strong, holistic team caring for the patient is what ensures long-term success.”
