A new study led by U of T researchers finds that post-surgical recovery time in older adults is much longer than expected, with data showing nearly 20 per cent still have impairments in activities of daily living.
This lengthy recovery experience poses a significant stress for patients, and their caregivers creating an increased risk of negative post-surgical outcomes, including infections, ED visits, and hospital readmission.
Co-author Martine Puts, a professor at the Lawrence Bloomberg Faculty of Nursing says that while previous studies have examined deaths and hospital readmission in older adults’ post-surgery, very few have looked at the recovery experience of patients and their caregivers.
“The health system often assumes that caregivers will know what to expect and what to do to assist the patient in their recovery, but our study found that there is very limited guidance about recovery, and hardly any training on post-surgical wound care,” says Puts who is also the Canada Research Chair in Care of Frail Older Adults. “Many older adults and their caregivers say they were poorly prepared for what to expect post-surgery.”
The study, one of the largest of its kind, included 289 older adults and their caregivers from across 17 different hospital sites in Canada and followed them for 6 months post-elective non-cardiac surgery between 2021 and 2023. The participants, of which 204 were older adults and 85 were caregivers, were assessed for impairments to instrumental activities of daily living or (IADL). These activities include being able to manage household tasks, finances and scheduling appointments. They were also asked to report on their activities of daily living (ADL) which include basic care needs, like bathing, toileting, and eating. At two-months post-surgery, 64 per cent of older adults reported one or more issues being able to perform instrumental daily activities while 33 per cent reported more than one issue with daily activities. At 6 months post-surgery, 42 per cent reported issues with IADL and 19 per cent with ADL respectively.
“These findings are quite startling and highlight the challenges older adults and their caregivers face recovering from surgery. We need to figure out better ways to improve this recovery process,” says study co-author Dr. Shabbir Alibhai, a Senior Scientist at the Princess Margaret Cancer Centre and Professor at Temerty Medicine.
Puts says that many study participants reported that a lack of communication, and knowledge about the recovery period, including wound care, were areas that they need more support. Caregivers she says also reported a bigger than expected impact on their mental health, with many unprepared for the duration of providing care post-surgery. In hindsight many reported they would have liked to have been better prepared and would have asked for more support if they had known their support would be required for a prolonged time after the surgery.
“With an aging population in Canada, we need to be thinking about how to support older adults and their caregivers, which includes providing them with the information necessary to support their recovery,” says Puts.
Michele Chaban is one of the study participants, and she says that better communication between health care staff and patients, as well as proactive planning for post-surgery recovery, would have a significant impact on the recovery experience of older adults like herself.
At 71, Chaban had surgery on her spine, to fix a decades old chronic spinal injury that had left her with severe pain. Chaban, who has a background in social work and healthcare, felt that she had proactively prepared herself for recovery by building a network of support and being relatively fit. She also says she had a positive care experience with her primary surgical team, but during recovery she encountered some challenges.
Her large abdominal incision opened when she stood up to use the bathroom post-surgery. She also was in significant amount of pain, which she felt wasn’t being managed well. She ended up discharging herself early with an open wound to seek better pain care from her own doctor, but ended up back in the ED with complications.
“Communication had been good with my primary surgical team, so it took me by surprise that I hadn’t been told how my incision might open up if I use the bathroom too soon and that my pre-surgical pain management plan was not being followed,” says Chaban. “It felt like I wasn’t being heard and it really speaks to a need for more compassion and communication.”
Changes to pre-operative guidelines including video demonstrations of what to expect post-surgery, and how to respond to issues like wound care or pain challenges is something Chaban would like to see implemented.
“I think there is an aversion to giving too much information before surgery, but I believe that giving more knowledge, and treating seniors with compassion and understanding would benefit not only them but also the health system at large,” says Chaban.
Surgery
10.1001/jamanetworkopen.2026.0692
Recovery Experiences of Older Adults and Their Caregivers After Major Elective Noncardiac Surgery
13-Mar-2026