What Every Older Adult Should Know Before Surgery Becomes the Only Choice
The Grey Fox Portal | thegreyfoxportal.com
As We Get Older, Surgery Becomes More Common. But Is It Always Inevitable?
You have probably heard it from a friend, neighbor or family member:
“I’m having my knee replaced.”
Maybe it is a hip replacement. Perhaps it is cataract surgery, heart surgery or another major procedure.
For many of us, surgery eventually becomes part of the conversation as we grow older. But before simply accepting an operation as another consequence of aging, there is an important question worth asking:
Could some of these surgeries have been prevented, or at least delayed?
The honest answer is sometimes, but not always.
Some conditions leading to surgery are associated with aging, genetics, accidents or diseases that we cannot control. In other situations, modifiable risk factors may play a role.
The important distinction is this:
Reducing your risk is not the same as guaranteeing prevention.
And needing an operation does not mean you failed to take care of yourself.
Surgery After 65: How Common Is It?
A nationally representative study of community-living, fee-for-service Medicare beneficiaries age 65 and older estimated an overall incidence of 8.8 major surgeries per 100 person-years. The study included 5,571 participants and used data from 2011 through 2016. Researchers classified major operations into several categories, including musculoskeletal, abdominal/gastrointestinal, vascular, neurologic and cardiothoracic procedures.
Major Surgery Among Older Americans
| Surgery Category | Rate per 100 Person-Years |
|---|---|
| Musculoskeletal | 3.6 |
| Abdominal/Gastrointestinal | 1.7 |
| Cardiothoracic | 0.7 |
| All major surgeries combined | 8.8 |
The study reported musculoskeletal surgery as the most frequent category, followed by abdominal/gastrointestinal surgery among the categories for which rates were specifically highlighted. Important: These categories do not represent the complete breakdown of the 8.8 overall rate. The study also included vascular, neurologic and other types of major surgery.
Knee Replacement: One of the Big Ones
For many older adults, the knees are among the places where arthritis and previous injuries can eventually interfere with everyday activities.
Walking may become painful.
Stairs may become difficult.
Getting out of a chair or walking through a grocery store may become challenging.
Eventually, some people are told that it may be time to consider knee replacement.
Historical data from the CDC/National Center for Health Statistics illustrate how strongly knee replacement has been associated with age. In 2010, people 65 and older had a total knee-replacement rate of 92.1 per 10,000, compared with 37.8 per 10,000 for people ages 45 to 64. The mean age for total knee replacement among hospitalized patients age 45 and older decreased from 68.9 years in 2000 to 66.2 years in 2010.
Could Knee Replacement Have Been Prevented?
In many cases, delayed may be a better question than prevented.
Some people can manage joint problems for a period of time without surgery. But severe arthritis can progress even when a person has tried to take care of their health.
That means needing a knee replacement should not automatically be viewed as evidence that someone did something wrong.
And knee replacement can produce significant improvement for many patients.
The American Joint Replacement Registry, operated by the American Academy of Orthopaedic Surgeons, reported that 86% of patients achieved a meaningful improvement on the KOOS, JR. outcome measure following total knee arthroplasty in data highlighted in its 2023 annual report.
What Happens to Our Hips and Knees as We Age?
Research estimating the number of Americans living with total hip and knee replacements shows a striking relationship with age.
Hip and Knee Replacement by Age
| Age | Living With Hip Replacement | Living With Knee Replacement |
|---|---|---|
| Under 50 | 0.11% | 0.08% |
| 50–59 | 0.91% | 1.48% |
| 60–69 | 2.12% | 4.59% |
| 70–79 | 4.10% | 8.80% |
| 80–89 | 5.69% | 10.13% |
| 90+ | 5.77% | 7.40% |
These are 2010 prevalence figures, meaning the percentage of people in each age group estimated to be living with a previous total hip or knee replacement. They do not mean that this percentage of people underwent surgery during that year. Look closely at the knee numbers.
An estimated 4.59% of Americans ages 60 to 69 were living with a total knee replacement. That increased to 8.80% among people ages 70 to 79 and 10.13% among those ages 80 to 89. That’s approximately one out of every ten people ages 80 to 89 in the study’s population estimate.
What About Hip Replacement?
Hips can also deteriorate to the point where pain and mobility become major issues.
The same research estimated that 2.12% of Americans ages 60 to 69 were living with a total hip replacement in 2010. That increased to 4.10% among people ages 70 to 79 and 5.69% among those ages 80 to 89.
Could Hip Surgery Have Been Prevented?
Not every hip replacement can be prevented.
The underlying reasons for surgery differ from one patient to another. The important point is not to assume that every hip replacement is the result of something a person did, or failed to do, earlier in life.
For older adults, the conversation about protecting mobility should include discussions with healthcare professionals about joint health, bone health and individual risk factors.
Cataract Surgery: When Aging Affects Our Eyes
Not all age-related surgery involves our bones and joints.
Our eyes change, too.
A study published in the American Journal of Ophthalmology examined cataracts among Medicare beneficiaries age 65 and older between 2014 and 2021. Cataract prevalence increased from 36.38% in 2014 to 37.03% in 2021, while the estimated national burden increased from 15.7 million to 19.6 million cases. The researchers reported that annual cataract surgeries plateaued at approximately 1.4 million.
Could Cataract Surgery Have Been Prevented?
Cataracts are strongly associated with aging, so it would be misleading to tell older adults that every cataract operation could have been prevented.
Instead, the practical message is to take changes in eyesight seriously and discuss them with a qualified eye-care professional.
It’s Not Just Hips, Knees and Eyes
Major surgery among people 65 and older extends well beyond joint replacements.
The national study of major surgery categorized operations as:
- Musculoskeletal
- Abdominal/Gastrointestinal
- Vascular
- Neurologic
- Cardiothoracic
- Other major operations, including several additional surgical specialties Some operations are planned well in advance.
Others happen unexpectedly.
That difference becomes particularly interesting as we look at age.
Does Surgery Keep Becoming More Common as We Age?
You might assume the answer is automatically yes.
It isn’t that simple.
The national study found that the adjusted incidence of major surgery peaked at 10.8 per 100 person-years among people ages 75 to 79. Among people age 90 and older, it was 6.4 per 100 person-years. Researchers also found a shift between elective and non-elective operations. Elective surgery rates were highest in the younger age groups studied, while non-elective surgery rates were highest in the oldest three groups, ages 80–84, 85–89 and 90+.
Surgery and Age at a Glance
| Age | What the Research Found |
|---|---|
| 65–69 | Elective surgery among higher-rate age groups |
| 70–74 | Elective surgery among higher-rate age groups |
| 75–79 | Overall major-surgery rate peaked at 10.8 per 100 person-years |
| 80–84 | Non-elective surgery among higher-rate age groups |
| 85–89 | Non-elective surgery among higher-rate age groups |
| 90+ | Overall major-surgery rate was 6.4 per 100 person-years |
So, Could Your Surgery Have Been Prevented?
There isn’t one answer that fits everybody.
Sometimes Risk May Be Reduced
This is where prevention and routine healthcare matter.
Discussing physical activity, weight, smoking, blood pressure, diabetes, bone health, balance and other individual risk factors with your healthcare professionals may help identify areas where you can improve your overall health.
That does not mean doing these things guarantees that you will never need surgery.
Sometimes Surgery Cannot Reasonably Be Avoided
Disease, severe joint deterioration, accidents and other medical conditions can lead to operations despite someone’s best efforts to remain healthy.
There should be no automatic assumption of blame.
Sometimes Surgery Is the Treatment, Not the Failure
This may be the most important point of the entire discussion.
Avoiding surgery at all costs isn’t necessarily the right goal.
Instead, the discussion should center on questions such as:
Will this operation reduce my pain or improve my health?
Could it improve my ability to walk or perform normal activities?
What are the risks if I have the surgery?
What are the risks if I don’t?
Those are discussions to have with your surgeon and healthcare team.
10 Questions to Ask Before Saying Yes to Surgery
If you are considering an elective operation, take these questions with you to your appointment.
1. Why do I need this operation now?
2. What could happen if I wait?
3. Are there reasonable nonsurgical alternatives?
4. What improvement should I realistically expect?
5. How do my age and existing medical conditions affect the risks?
6. What does recovery usually involve?
7. Is going directly home after surgery realistic for me?
8. Will I need rehabilitation, physical therapy or help at home?
9. How could the operation affect my independence?
10. Would getting a second medical opinion be reasonable?
Save This List
Print these questions, write them down, or save them on your phone before your surgical consultation.
And if your doctor uses a term you don’t understand, ask what it means.
It’s your body. It’s reasonable to understand what is being recommended and why.
The Grey Fox Bottom Line
Major surgery is not unusual later in life.
The national study estimated a 13.8% five-year cumulative risk of at least one major operation among the continuously enrolled fee-for-service Medicare population studied, representing an estimated nearly five million older Americans. But statistics like these aren’t a reason to be frightened.
They’re a reason to pay attention.
Take care of the joints that carry you.
Talk with your healthcare professionals about protecting your bones and reducing fall risks.
Stay as physically active as your health safely allows.
Pay attention to changes in your eyesight.
Work with your healthcare professionals to manage chronic medical conditions.
And don’t assume that every new symptom is simply something you have to accept because you’re getting older.
Most importantly, if surgery becomes part of the conversation, ask questions.
Growing older may change our bodies.
It doesn’t take away our right to understand our choices.
Share This With Someone Who May Need It
Do you have a spouse, friend, neighbor or family member considering a hip replacement, knee replacement, cataract surgery or another operation?
Consider sharing this article with them.
A little information today may help someone ask better questions tomorrow.
THE GREY FOX PORTAL
Information for the generations that have lived, learned and still have plenty of living left to do.
Medical Disclaimer
This article is provided for general educational and informational purposes only and is not medical advice. It should not replace consultation with a physician, surgeon or other qualified healthcare professional. Decisions about whether to have surgery should be made based on an individual’s medical condition, risks, alternatives, circumstances and goals.
Sources & Further Reading
- The Incidence and Cumulative Risk of Major Surgery in Older Persons in the United States, Annals of Surgery, using National Health and Aging Trends Study and Medicare data. – Prevalence of Total Hip and Knee Replacement in the United States, Journal of Bone and Joint Surgery. – Hospitalization for Total Knee Replacement Among Inpatients Aged 45 and Over: United States, 2000–2010, CDC/National Center for Health Statistics. – American Joint Replacement Registry Releases 10th Annual Report, American Academy of Orthopaedic Surgeons. – Prevalence, Surgical Trends, and Economic Burden of Cataract in Medicare Population in the United States, American Journal of medicine