ALIGN
‐
CARE
: An Age‐Friendly Surgical Co‐Management Model Guided by the
7Ms
Framework: Preliminary Data
Ko Harada, Yuka Shichijo, Yihan Wang, William Hung, Abigail Baim‐Lance, Fred Ko, Stephanie Chow ABSTRACT
Background
Frail older adults undergoing surgery are at increased risk for postoperative complications, functional decline, and prolonged hospitalization. Although comprehensive geriatric assessment (CGA) is increasingly recognized as valuable in surgical care, feasible approaches for ambulatory preoperative assessment remain limited.
Methods
We conducted a prospective cohort study of patients aged 65 years and older referred to an ambulatory preoperative geriatrics program at a large academic medical center between January 2022 and May 2024. Patients underwent CGA guided by the 7Ms framework, which extends the American Geriatrics Society 5Ms framework by incorporating Maintaining Care and Meals. Outcomes included the prevalence and patterns of geriatric syndromes, the types and frequency of preoperative recommendations, and process measures assessing program feasibility.
Results
Sixty‐three older surgical patients were enrolled (mean age 81.7 years). Geriatric syndromes were common, including use of assistive walking devices in 60.3%, mild to terminal illness on the Clinical Frailty Scale in 22.2%, polypharmacy in approximately 90%, and mild cognitive impairment or dementia in 54.1%. Nutritional assessment identified 42.6% of patients at risk for malnutrition and 9.8% as malnourished. CGA guided by the 7Ms framework generated a mean of 11.2 individualized recommendations per patient, most commonly related to coordination with primary care clinicians (73.0%), physical therapy (54.0%), medication deprescribing or dose adjustment (50.8%), and delirium prevention (49.2%). Among enrolled patients, 40 patients (63.5%) ultimately proceeded with surgery, with a median of 11.5 days from initial visit to surgery.
Conclusions
A structured comprehensive geriatric assessment guided by the 7Ms framework is feasible and clinically useful in the ambulatory preoperative setting. By explicitly incorporating care coordination and nutritional assessment, the 7Ms framework offers a pragmatic approach to identifying geriatric vulnerabilities and supporting preoperative optimization in older surgical patients.