Beyond The Operating Room: Deciding When Surgery Is The Right Choice For The Elderly | SJMC
Beyond The Operating Room: Deciding When Surgery Is The Right Choice For The Elderly
As Malaysia prepares to become an ageing nation by 2030, questions surrounding elderly healthcare are becoming increasingly urgent. By 2060, projections indicate that one in five Malaysians will be over 65 years old, with the number of those aged 80 and above expected to triple. This demographic shift places greater emphasis on healthcare decisions that affect the quality of life in later years, and one of the most challenging questions many families face is - 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 Yet, many older patients are denied the option of surgery because of outdated perceived notions based solely on age. At Subang Jaya Medical Centre (SJMC), specialists work closely with patients and families to weigh the benefits against the risks, ensuring that the right decision is made for each individual.
The perspectives of Dr Chin Ai-Vyrn, Consultant Geriatrician and Internal Medicine Physician, and Dr Vickneswaran Mathaneswaran, Consultant Neurosurgeon, highlight the many factors involved in making surgical decisions for elderly patients.
When Surgery Becomes a Question of Quality of Life
“About half of people over the age of 65 will require surgery at least once in their lives,” said Dr Chin. The most common cases include fractures from falls, head injuries, and operations linked to 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 explained.
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.
The Role of Family and Shared Decision-Making
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,” said Dr Chin.
He emphasised that conservative approaches may initially be preferred. For instance, a patient with knee osteoarthritis may manage their condition better with physiotherapy, pain relief, braces, or weight loss rather than undergoing immediate surgery.
The goal is always to align medical recommendations with the patient’s own values and wishes.
Dr Chin Ai-Vyrn, Consultant Geriatrician, SJMC.
Special Risks for Older Adults
Dr Vickneswaran sees this dilemma often in his field of neurosurgery, where elderly patients face conditions such as intracranial haemorrhages, 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 shared. “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.”
Dr Chin added 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 said.
Advances in Modern Surgery
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.”
For patients, this means that while technology provides new opportunities, outcomes are most successful when surgery is part of a coordinated care plan that includes geriatricians, surgeons, nurses, physiotherapists, and family support.
Rehabilitation: The Road Back to Independence
Both doctors agree that what happens after surgery is as important as the procedure itself. “Rehabilitation is critical in helping older patients regain independence,” said Dr Chin. “Without proper rehabilitation, even a successful surgery may not translate into a better quality of life.”
Dr Vickneswaran added, “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.”
Dr Vickneswaran Mathaneswaran, Consultant Neurosurgeon, SJMC.
Looking at the Bigger Picture
As Malaysia faces an ageing population, the broader context cannot be ignored. Many elderly people may also lack financial security or family support. Decisions about surgery are therefore not just medical but social, requiring consideration of costs, caregiver availability, and access to rehabilitation services.
“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,” said Dr Vickneswaran.
“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.”
Beyond the Operating Room
Ultimately, the question of whether to operate is not about age alone. It involves the patient’s life goals, medical condition, risks, and the support available to them.
Dr Chin and Dr Vickneswaran believe that decisions must be individualised and grounded in compassion. “Our role as doctors is to help patients and families make informed choices that align with what matters most to them,” said Dr Chin.
For families navigating these difficult choices, the message is clear - surgery can be life-changing, but it is never the only option. With the right guidance, support, and care, elderly patients can face these decisions with dignity and confidence.
In line with this holistic approach, SJMC has also introduced SeniorConnect, part of its Connected Care ecosystem, to support older patients and their caregivers beyond the hospital walls. Through remote monitoring and preventive care, the service helps families keep track of vital health indicators and access timely interventions when needed. It is another way SJMC ensures that decisions about surgery are not viewed in isolation, but as part of a wider journey of ageing well with the right support at every stage.
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