{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:03:06Z","timestamp":1788498186068,"version":"build-2803163510"},"reference-count":49,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n An increasing number of older adults living with frailty are undergoing surgery, yet scarce data on postoperative functional recovery, care needs after surgery, and extent of caregiver supports exist.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To characterize older adults\u2019 and caregivers\u2019 recovery experiences in the first 6 months after surgery.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This mixed-methods, multicenter, prospective nested cohort study included 17 hospitals in Canada. Participants included adults aged 65 years or older with a Clinical Frailty Scale score of 4 or more, who were recovering after major elective noncardiac surgery between March 16, 2021, and June 13, 2023, and their caregivers.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Surveys included functional status via basic and instrumental activities of daily living, care needs, and care received or provided. A subset of patients and caregivers were invited to participate in semistructured interviews about their experiences and were analyzed using interpretive descriptive qualitative analysis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n There were 289 individuals, including 204 older adults (mean [SD] age, 72.8 [5.6] years; 108 males [52.9%]) and 85 caregivers (mean [SD] age, 68.2 [12.2] years; 50 females [59.5%]), who participated in surveys, and 63 individuals (43 older adults and 20 caregivers) who participated in interviews. Older adults had a median (range) Clinical Frailty Score of 4 (3-6), indicating mild frailty, and 190 (93.1%) had 1 or more chronic diseases. Caregivers had a median (range) of 2 (0-8) chronic diseases, and 69 (82%) were spouses. Two months postoperatively, 129 of 203 older adults (64%) had more than 1 instrumental activities of daily living impairment, decreasing to 84 of 198 (42%) at 6 months after surgery; 68 of 203 (33%) had more than 1 activities of daily living impairment 2 months postoperatively, and this decreased to 38 of 198 (19%) at 6 months after surgery. Themes related to the recovery experiences were: (1) inadequate patient and caregiver education, preparation for surgery, and discharge; (2) the association of reduced independence with patient and caregivers; (3) the association of surgery with mental health; and (4) postoperative support from the health care team. All participants indicated that they wanted to be better prepared for surgery and discharge.<\/jats:p>\n <\/jats:sec>\n \n Conclusion and Relevance<\/jats:title>\n In this mixed-methods cohort study, functional recovery in the first 6 months after noncardiac major elective surgery was associated with daily living impairment for older adults and their caregivers. Targeted interventions including preoperative education, caregiver-inclusive discharge planning (eg, wound-care teaching, how to recognize complications and what to do for support, and more rehabilitation), and early follow-up after discharge may optimize recovery experiences.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.0692","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T15:30:30Z","timestamp":1773415830000},"page":"e260692","source":"Crossref","is-referenced-by-count":6,"title":["Recovery Experiences of Older Adults and Their Caregivers After Major Elective Noncardiac Surgery"],"prefix":"10.1001","volume":"9","author":[{"given":"Nelly","family":"Toledano","sequence":"first","affiliation":[{"name":"Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Legacy","sequence":"additional","affiliation":[{"name":"Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duminda N.","family":"Wijeysundera","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, St Michael\u2019s Hospital-Unity Health Toronto, Toronto, Ontario, Canada"},{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nai-Wen","family":"Ku","sequence":"additional","affiliation":[{"name":"Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen R.","family":"Haase","sequence":"additional","affiliation":[{"name":"School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Pitters","sequence":"additional","affiliation":[{"name":"Patient partner"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fay","family":"Bennie","sequence":"additional","affiliation":[{"name":"Older adult team member"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Stephens","sequence":"additional","affiliation":[{"name":"Family caregiver team member"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianni R.","family":"Lorello","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"The Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada"},{"name":"Women\u2019s College Research Institute, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerry","family":"Kuluski","sequence":"additional","affiliation":[{"name":"Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel I.","family":"McIsaac","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler R.","family":"Chesney","sequence":"additional","affiliation":[{"name":"Department of General Surgery, St Michael\u2019s Hospital-Unity Health Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keying","family":"Xu","sequence":"additional","affiliation":[{"name":"Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital-Unity Health Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naveed","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Anesthesia and Pain Management, Sinai Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim S.","family":"Ladha","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, St Michael\u2019s Hospital-Unity Health Toronto, Toronto, Ontario, Canada"},{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Anesthesia, Women\u2019s College Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. 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