Age-Friendly Surgical and Perioperative Care for Older People in Viet Nam: Building a Coordinated Pathway from Preoperative Assessment to Recovery and Discharge

AGE-FRIENDLY CARE QUALITY · MEASUREMENT, IMPLEMENTATION & LEARNING

Last reviewed: October 2026

An older woman in Viet Nam is advised to undergo major abdominal surgery. The surgeon explains the procedure, its expected benefits and possible complications. Her medical investigations suggest that an operation may be appropriate. Yet she is concerned about whether she will be able to walk independently afterward. She lives with her husband, who has health problems of his own, and worries about becoming dependent on her children for everyday activities.

In another hospital, an older man is admitted with an acute surgical condition requiring urgent treatment. He has several chronic illnesses and was already finding it difficult to move around before admission. The surgical team must act quickly, but there is little time for an extensive assessment of his usual functioning or the support he may need after the operation.

These situations present different challenges within the same care pathway. For the woman considering planned surgery, the immediate question is whether the expected benefits justify the risks and potential burden of treatment. For the man requiring urgent intervention, clinicians must address a time-sensitive surgical problem while recognizing vulnerabilities that may influence his care and recovery.

In both cases, a technically successful operation may be only one part of a successful outcome. An older person may survive surgery and recover from the immediate surgical condition but experience prolonged weakness, confusion, reduced mobility or a new dependence on others. Such outcomes can substantially affect everyday life, even when the operation has been completed without a major technical complication.

Age-friendly surgical care therefore requires more than an additional assessment before an operation or a separate postoperative protocol. It calls for coordination across the entire perioperative pathway, beginning with the decision to operate and continuing through preparation, anesthesia, surgery, postoperative care, rehabilitation and discharge.

For hospitals in Viet Nam, this raises an important question: How can a surgical service translate geriatric assessment into safer perioperative decisions, coordinated care and reliable recovery planning?

The challenge is not to introduce every available assessment tool or establish a new specialist service in every hospital. It is to ensure that information about an older person's health, functioning, preferences and support needs influences what clinicians decide, how the team prepares and what happens during recovery.

Age-Friendly Surgical Care Begins With the Decision to Operate

The first decision in an age-friendly surgical pathway is not how to prepare an older patient for an operation. It is whether surgery is the most appropriate treatment for that person.

This distinction matters because the existence of a surgically treatable condition does not automatically mean that an operation is the best option in every circumstance. The expected benefit depends on the underlying disease, the urgency of treatment, available alternatives, the person's overall health and the outcomes that matter most to them.

For some older people, surgery may offer substantial benefits, including relief of symptoms, treatment of serious illness, improved mobility or a greater chance of survival. For others, the anticipated benefit may be uncertain, or the treatment burden may be considerable in relation to their health, functional reserve and personal priorities.

These decisions should not be based on chronological age alone. Two people of the same age may have very different physical capabilities, cognitive function, medical conditions and recovery prospects. An older adult who remains active and independent may face a different risk profile from someone who already requires extensive assistance with daily activities.

A meaningful preoperative discussion should therefore consider both the clinical purpose of surgery and what the individual hopes treatment will achieve.

One person may prioritize being able to walk independently and return home. Another may be willing to accept a difficult recovery for a reasonable possibility of longer survival. Someone else may place greater importance on symptom relief, comfort or avoiding a prolonged period of intensive treatment.

These preferences can influence the choice between surgical and nonsurgical options, the timing of intervention and the acceptable burden of treatment. When more than one clinically reasonable option exists, the discussion should include the expected benefits, limitations and uncertainties of each.

A 2026 consensus statement published in JAMA Network Open identified important components of shared decision-making for older adults considering major surgery. These included understanding baseline physical and cognitive function, discussing treatment alternatives, addressing patient priorities and considering the possible effects of treatment on future functioning and support needs.

The study also identified practical barriers involving time, clinical knowledge, communication skills and the difficulty of explaining uncertain long-term outcomes. As an expert consensus study, it provides a useful framework for improving discussions rather than direct evidence that implementing every component will improve surgical outcomes.

For Vietnamese hospitals, the message is particularly relevant. The aim is not simply to document that surgical risks have been explained or that a consent form has been signed. It is to establish whether the proposed treatment is clinically justified, whether the patient understands the available choices and whether the expected recovery is consistent with what matters to them.

This discussion also needs to recognize uncertainty. Clinicians may be able to estimate the likelihood of major complications or death, but predicting the degree of functional recovery for an individual older person can be more difficult. When evidence is limited, acknowledging that uncertainty is preferable to promising a recovery that cannot be guaranteed.

The outcome of the discussion should be a treatment decision that considers both clinical evidence and the person's priorities. Where surgery is selected, those priorities should remain visible throughout the subsequent perioperative pathway.

Vietnamese Legal Requirements and International Standards Must Be Distinguished

Surgical decision-making and perioperative care in Viet Nam must operate within the country's applicable legal and professional framework.

The Law on Medical Examination and Treatment No. 15/2023/QH15, effective from 1 January 2024, provides an important foundation for patients' rights, professional responsibilities and the organization of medical care.

Article 11 addresses the patient's right to choose a method of examination or treatment after receiving appropriate information, explanation and counseling, subject to the exceptions established by law. Article 13 addresses the right to refuse examination or treatment, including the requirement for a written acknowledgment of responsibility following professional counseling, except in circumstances where treatment is compulsory under the Law.

Article 65 establishes requirements concerning consent for surgery and invasive interventions. Article 15 addresses how the rights of certain patients are exercised when they have lost legal capacity, experience legally recognized difficulties in cognition or behavioral control, have limited legal capacity or fall within other circumstances specified by the Law.

These provisions are relevant to older people, but age or a diagnosis of cognitive impairment should not automatically be treated as proof that a person cannot participate in treatment decisions. Where legal capacity, representation or the validity of consent is in question, the hospital must apply the relevant provisions while respecting the person's lawful rights and previously documented lawful wishes where applicable.

The Law also addresses professional consultation, nursing care, nutrition, rehabilitation and continuity of treatment. Circular No. 19/2013/TT-BYT provides a regulatory foundation for hospital quality management, including responsibilities for monitoring, evaluating and improving the quality of care.

These are important domestic foundations for developing an age-friendly perioperative pathway. However, they should not be interpreted as establishing a nationally mandatory geriatric surgery assessment or verification program identical to those used abroad.

International standards can offer additional guidance, provided their legal status and scope are understood correctly.

The American College of Surgeons (ACS) Geriatric Surgery Verification (GSV) Program provides a structured approach to improving surgical care for older adults. Its Age-Friendly level contains six standards covering leadership, treatment and overall health goals, geriatric vulnerability screening, management plans for positive screens, postoperative protocols and data review.

The ACS program also offers Focused Excellence and Comprehensive Excellence levels with broader organizational requirements. Its Age-Friendly level addresses eligible inpatient surgical patients aged 65 years and older, while the Focused and Comprehensive levels use eligible inpatient surgical populations aged 75 years and older, with additional requirements concerning program implementation and coverage.

These thresholds belong to the ACS verification framework. They are not universal surgical assessment requirements under Vietnamese law.

The Centers for Medicare & Medicaid Services (CMS) Age Friendly Hospital Measure belongs to the United States' Hospital Inpatient Quality Reporting Program. It assesses specified hospital structures and practices relevant to patients aged 65 years and older, including care goals, medication management, vulnerability screening and organizational responsibilities. The measure applies to hospital care more broadly and is not limited to surgical services.

Its reporting requirements began with the 2025 reporting period for hospitals participating in the relevant United States program. They do not automatically impose legal obligations on hospitals in Viet Nam.

Under Viet Nam's Law on Older Persons No. 39/2009/QH12, an older person is defined as a Vietnamese citizen aged 60 years or older. This legal definition does not, by itself, require every patient above that age to undergo an identical geriatric surgical assessment.

Hospitals may use age alongside clinical risk, the proposed procedure and patient characteristics to identify individuals who could benefit from additional perioperative assessment. Such criteria should be clinically justified and appropriate to local resources.

The value of international frameworks lies in their organizational principles. They demonstrate how patient goals, vulnerability assessment, clinical planning, professional responsibilities and quality review can be connected. Vietnamese hospitals can draw on these principles without presenting foreign verification standards or reporting requirements as mandatory domestic regulations.

Geriatric Assessment Must Influence Decisions and Care Planning

Preoperative assessment is already part of surgical care, but conventional evaluation often concentrates on whether a patient can tolerate anesthesia and the physiological demands of an operation.

For older people, these questions remain essential but may not fully describe the likelihood of a difficult recovery.

An individual may have relatively stable cardiovascular and respiratory conditions but limited mobility, poor nutritional reserve or significant dependence on others. Another may manage daily activities independently despite several chronic diagnoses. Such differences can influence treatment choices, postoperative monitoring, rehabilitation needs and the support required after discharge.

Geriatric assessment can help identify these concerns. Relevant areas may include usual functional ability, frailty, cognition, nutritional status, medication-related risks, mobility, sensory difficulties, chronic conditions and available family or social support.

The purpose is not to repeat a detailed explanation of every geriatric syndrome. It is to identify information that could change the proposed treatment or the way care is organized.

A brief initial screen may be sufficient for some patients, while those with identified vulnerabilities may benefit from further assessment or targeted professional consultation. The extent of evaluation should reflect surgical urgency, procedure-related risk, available time and the person's clinical needs.

The 2025 American Society of Anesthesiologists Practice Advisory for Perioperative Care of Older Adults Scheduled for Inpatient Surgery provides guidance on relevant preoperative, intraoperative and postoperative considerations. It supports an individualized approach to assessing older adults, including cognitive and frailty-related concerns, while recognizing limitations in the evidence for some interventions.

The advisory addresses a defined patient population within the United States professional context. Its recommendations can inform clinical judgment but should not replace Vietnamese professional requirements or local hospital policies.

Assessment findings need to be considered alongside the surgeon's evaluation of the disease, the anesthesiologist's assessment of perioperative risk and the patient's preferences.

Reduced mobility, for example, may influence the expected need for postoperative assistance and rehabilitation. Cognitive vulnerability may prompt additional communication support and closer attention to postoperative changes. Nutritional concerns may justify professional review and selected interventions when time permits.

The important step is to connect each significant finding with a decision.

Not every positive screening result requires postponing surgery or consulting a geriatrician. The response depends on clinical relevance, the availability of suitable interventions, the urgency of treatment and whether further assessment is likely to change care.

A hospital can collect many assessment scores and still fail to provide age-friendly surgical care if the results do not influence decisions or reach the clinicians responsible for treatment.

An effective pathway should therefore distinguish between identifying a vulnerability and responding to it. Assessment becomes useful when it helps determine whether surgery should proceed, how the patient should be prepared, what additional support is needed or how recovery should be monitored.

From Assessment Findings to an Actionable Perioperative Care Plan

A practical perioperative care plan should explain how relevant concerns will be addressed, who is responsible for each important action and when reassessment is needed. It should also preserve information about the patient's usual functioning and the goals agreed upon during treatment discussions.

For an older person with limited mobility, the plan may identify expected assistance after surgery, conditions for beginning mobilization and whether rehabilitation assessment should be arranged. For someone with cognitive vulnerability, it may include communication support, appropriate preventive measures and arrangements for recognizing important postoperative changes.

Patients with complex chronic conditions or medication-related risks may need a coordinated management plan involving anesthesiology and other relevant professionals. The details should reflect the clinical situation and applicable guidance rather than a generic protocol applied identically to every older patient.

Baseline information is particularly valuable. Knowing that someone walked independently, managed personal care or lived alone before surgery provides a reference point for evaluating recovery.

Without this information, a significant functional decline may be overlooked because the patient appears medically stable or because staff assume that limited mobility is normal in advanced age.

The care plan should therefore be accessible to the people who need it, including surgeons, anesthesiologists, nurses and relevant supporting professionals. Important actions should have clearly identified owners rather than being expressed only as general recommendations.

For example, documenting that a patient may need rehabilitation is different from determining who will assess that need after surgery and when the assessment should occur. Similarly, noting a potential discharge difficulty is not the same as assigning responsibility for discussing available arrangements with the patient and family.

A short, clearly communicated plan may be more useful than a lengthy assessment whose recommendations remain buried in the medical record.

Preoperative preparation should also be proportionate to the expected benefit. Some patients undergoing planned procedures may have time for selected optimization of medical conditions, nutrition, medication management or physical capacity. Others may require additional assessment to clarify risks or reconsider the proposed treatment.

Prehabilitation, which may include physical, nutritional and other interventions before surgery, is increasingly considered within perioperative care. However, its effectiveness varies according to the population, intervention and outcomes studied. It should not be presented as guaranteeing better recovery or used automatically to justify delaying necessary treatment.

Procedure-specific enhanced recovery pathways provide another reference. The ERAS Society's 2025 recommendations for elective colorectal surgery, subsequently accompanied by a published corrigendum in 2026, offer an example of coordinated care across preparation, surgery and recovery.

These recommendations can inform relevant surgical services, but they do not establish one universal protocol for every operation or every older patient.

The practical question is whether an additional assessment or intervention is likely to improve readiness, influence treatment or make recovery more manageable.

A useful care plan is not a fixed document completed before surgery and then forgotten. It should follow the patient, guide professional responsibilities and be revised when new information or clinical developments require a different response.

Elective and Emergency Surgery Require Different Approaches

An age-friendly perioperative pathway must distinguish between planned and emergency surgical care.

Elective surgery generally provides more time to discuss alternatives, assess vulnerabilities, clarify patient goals and organize support before treatment. Some patients may benefit from a coordinated review involving surgery, anesthesiology, internal medicine or other relevant services.

There may also be time for selected optimization and practical preparation with the patient and family. The opportunity to intervene before surgery should be used when it is likely to improve care, rather than to require additional investigations or consultations without a clear purpose.

Emergency surgery presents a different balance between information gathering and timely treatment.

An older person with an acute abdominal condition may require urgent intervention to prevent serious deterioration or death. Requiring an extensive geriatric assessment before surgery could create avoidable delay, particularly when the findings would not change the immediate need for treatment.

In such circumstances, assessment should be focused and proportionate. Clinicians should obtain essential information about the person's current condition, usual functioning, relevant medications, major comorbidities and other factors that may affect immediate decisions, as far as the clinical situation permits.

A brief assessment can help identify important vulnerabilities without becoming a barrier to emergency treatment. Further evaluation can continue after stabilization, surgery or transfer to the appropriate postoperative setting.

The World Society of Emergency Surgery's 2023 position paper on frailty in emergency laparotomy recognizes the importance of identifying frailty and organizing appropriate multidisciplinary care. Its recommendations concern the population and procedures addressed by that paper and should not be interpreted as requiring every emergency operation to wait for a comprehensive geriatric assessment.

Emergency surgery also requires attention to informed consent and the lawful arrangements for patients who cannot participate in decisions.

Article 65 of Viet Nam's Law on Medical Examination and Treatment addresses consent for surgery and invasive interventions, while Article 15 establishes arrangements for certain patients who cannot exercise their rights independently. Article 61 also provides a mechanism for decisions about urgent emergency measures when the consent of the patient's representative has not yet been obtained, under the conditions specified by the Law.

In those circumstances, the person responsible for professional activities at the healthcare facility or the facility's on-duty leader may make the decision specified by Article 61. This authority must be understood within the conditions of that provision rather than as a general exception to consent requirements whenever an operation is described as urgent.

Age-friendly assessment should support timely and appropriate treatment, not delay an intervention necessary to save life or prevent serious harm.

The pathway should therefore provide different arrangements for elective and emergency patients while maintaining continuity in postoperative monitoring, care planning and communication.

For emergency patients, some information that would ordinarily be collected before a planned operation may need to be gathered later. That difference should be recognized in the pathway rather than treated automatically as a failure to complete the same preoperative process.

Multidisciplinary Coordination Needs Clear Ownership

Perioperative care involves several professional groups, each contributing different expertise and responsibilities.

The surgeon evaluates the surgical condition, explains the clinical purpose and alternatives to an operation, and directs the surgical aspects of treatment. The anesthesiology team assesses anesthesia-related risks, plans anesthesia and perioperative monitoring, and contributes to immediate recovery and pain management.

Nurses have a continuous role in observing the patient's condition, providing care, recognizing changes, supporting recovery and communicating concerns. Their observations may identify problems that are less apparent during brief medical consultations or rounds.

Depending on the patient's needs, internal medicine, geriatrics, cardiology, intensive care, rehabilitation, nutrition, pharmacy, palliative care, social work or other services may also contribute.

Not every Vietnamese hospital has access to a dedicated geriatric surgical team. Smaller facilities may depend on collaboration between existing surgical, anesthesiology, internal medicine and nursing services, supported by specialist consultation when necessary and available.

The absence of a separate geriatrics department does not prevent a hospital from introducing age-friendly practices. It does, however, increase the importance of clear responsibilities and reliable communication.

A recurring problem in multidisciplinary care is that a concern may be identified without anyone being clearly responsible for responding.

A preoperative assessment may recommend rehabilitation, but the postoperative team may not know whether a referral has been arranged. A nurse may notice a new cognitive change but be uncertain who should review the patient. A family may explain that no one will be available to provide support at home, yet this information may not reach the person coordinating discharge.

These problems do not necessarily arise because clinicians lack knowledge. They may reflect weaknesses in how information and responsibilities move across departments.

The hospital should identify who coordinates the overall perioperative plan, who is responsible for specific actions and how unresolved concerns are escalated.

The surgical team must retain clear responsibility for the surgical treatment plan, while other professionals contribute within their assigned and lawful scopes of practice. Multidisciplinary coordination does not mean that everyone has identical clinical authority.

In practice, a designated clinical lead or coordinating role can help ensure that identified needs are addressed and that information remains available as the patient moves from outpatient consultation to preoperative assessment, the operating room, postoperative care and discharge.

The choice of coordinating arrangement may differ between hospitals. One institution may assign responsibility to an existing perioperative team, while another may establish a formal multidisciplinary pathway. The essential requirement is that important actions have clear ownership and that clinical decisions remain with appropriately authorized professionals.

The objective is not to create additional meetings or administrative layers. It is to prevent important decisions and care needs from being lost between departments.

The Operating Room and Immediate Recovery Require Reliable Handover

Once surgery has been selected, the agreed perioperative plan needs to remain visible during the operation and immediate postoperative recovery.

The World Health Organization's Surgical Safety Checklist provides an established approach to strengthening teamwork, communication and safety checks at critical stages of an operation. It addresses risks relating to the patient, procedure, anesthesia and surgical team.

For older patients, the usual surgical safety process may need to be complemented by information about vulnerabilities that could affect anesthesia, monitoring and recovery.

The anesthesiology team should understand relevant preoperative findings and incorporate them into individualized management. Chronological age alone does not determine the appropriate anesthesia technique or medication strategy. Decisions must reflect the procedure, patient condition, available evidence and clinical circumstances.

The 2025 American Society of Anesthesiologists advisory emphasizes individualized perioperative care and does not establish one anesthesia technique as universally superior for preventing adverse cognitive outcomes in older patients.

The level and location of immediate postoperative monitoring should also be considered before surgery when possible. Some patients may require a higher level of observation or support, depending on their preoperative condition, the procedure and the course of the operation.

Handover from the operating room and post-anesthesia care unit should communicate more than the technical details of surgery.

The receiving team may need to know the patient's usual cognition and mobility, major intraoperative events, current clinical concerns, pain management arrangements, expected restrictions and intended postoperative monitoring.

For example, if a patient already needed assistance walking before surgery, this information should reach the ward team responsible for helping them mobilize afterward. If cognitive vulnerability was identified before the operation, the receiving team should know what observations and supportive measures have been planned.

Handover should also make clear which parts of the original plan remain appropriate and whether intraoperative events have created new concerns. A change in the expected level of monitoring, mobility restrictions or recovery needs should not depend on informal communication alone.

A reliable handover allows the postoperative team to continue an agreed plan rather than reconstruct it after a problem becomes apparent.

Postoperative Care Should Protect Recovery and Everyday Function

After surgery, clinical attention naturally concentrates on recognizing and managing complications. For older people, another important question is whether recovery is progressing toward the level of functioning that was anticipated.

A patient may have stable vital signs and satisfactory surgical findings but remain unable to stand, eat adequately or perform basic activities that were possible before admission. Another may develop a new cognitive change affecting communication and participation in rehabilitation.

These concerns should be recognized as part of postoperative care rather than regarded as inevitable consequences of aging.

An age-friendly postoperative plan should establish arrangements for clinical observation, appropriate pain management, mobilization, nutrition, medication review and recognition of significant changes in cognition or functioning.

The details will depend on the operation, clinical condition and applicable professional guidance. The intention is not to apply identical interventions to every older surgical patient, but to ensure that foreseeable risks have been considered and that personnel understand the expected response.

Preventive measures are most useful when translated into ordinary ward practice.

An instruction to encourage early mobility, for example, is insufficient if nobody has determined whether the patient can stand safely, what assistance is required or who will provide it.

Likewise, identifying a risk of postoperative delirium is only the beginning. The care team needs appropriate arrangements for observation, communication, supportive environmental measures, medication review and timely clinical assessment when changes occur.

The same principle applies to nutrition, respiratory care and other aspects of recovery. Hospitals should use relevant professional guidance and procedure-specific protocols rather than treat an age-friendly pathway as a substitute for the clinical management of individual complications.

Recovery should also be reviewed as the patient's condition evolves.

If someone is not progressing as expected, the team needs to reconsider the clinical situation and determine whether the care plan requires adjustment. This may involve additional medical assessment, nursing support, rehabilitation input or discussion with the patient and family about a revised recovery trajectory.

The person's preoperative functional baseline can help make these decisions more meaningful.

An older patient who walked independently before surgery but now requires substantial assistance may need a different recovery arrangement from someone who already depended on mobility support. The immediate clinical findings may be similar, but the implications for discharge and continuing care can differ.

Recovery does not always mean immediate restoration of preoperative function. Some procedures require temporary restrictions, while others involve prolonged recovery or lasting changes.

These possibilities should be discussed before surgery whenever feasible. If the postoperative course differs from expectations, the conversation should continue so that the patient and family understand how the plan is changing.

An effective postoperative pathway therefore needs regular clinical review, recognition of meaningful functional changes and a process for modifying care when the original recovery plan is no longer appropriate.

Discharge Planning Is Part of the Perioperative Pathway

For older surgical patients, discharge should not be treated simply as the final administrative step after an operation.

It is a clinical and organizational decision about whether the patient can continue recovery safely in the next setting, whether at home, in another healthcare facility or through an appropriate rehabilitation or continuing-care service.

Planning should begin before surgery when possible. Information about the patient's living arrangements, usual functioning and available support can help the team anticipate difficulties that may arise after treatment.

For someone living alone, the ability to prepare meals, use the toilet or move safely around the home may be particularly relevant. For a person dependent on a spouse who also has health limitations, additional assistance may be necessary even when the postoperative condition is stable.

After surgery, the team should compare current functioning with the preoperative baseline and the expected stage of recovery.

Clinical readiness and functional readiness are related but not identical. A patient may no longer require acute surgical treatment yet still need rehabilitation, personal assistance or another form of support.

Conversely, full restoration of preoperative independence is not necessarily required before discharge when an appropriate recovery arrangement is available.

The decision should take account of clinical stability, continuing care needs, the patient's preferences, available support and the capabilities of the receiving setting, while remaining consistent with applicable discharge and professional requirements.

If rehabilitation or further treatment is required, the hospital should establish how the referral will be arranged and who will coordinate follow-up. When transfer to another facility is necessary, relevant information should accompany the patient through the appropriate clinical and legal process.

Discharge instructions should explain the continuing treatment plan, medication arrangements, activity restrictions, expected recovery, warning signs, follow-up appointments and whom to contact if concerns arise.

These instructions need to be understandable and practical. Simply handing over a document does not establish that the older person or caregiver can carry out the plan.

For some patients, an explanation with the opportunity to ask questions may be sufficient. Others may need demonstrations, additional communication support or coordination with a healthcare provider who will continue care after discharge.

The hospital should also recognize the limitations of available services. In some areas of Viet Nam, formal rehabilitation, home healthcare or continuing-care arrangements may be limited. Discharge planning should therefore reflect services that can actually be accessed rather than assume that every patient can enter a comprehensive community care pathway.

When the preferred arrangement is unavailable, the team needs to consider feasible alternatives, explain their limitations and establish responsibilities for ongoing care and follow-up.

The goal is to avoid a situation in which someone leaves hospital with a technically satisfactory surgical result but no realistic arrangement for completing recovery.

Family Involvement Should Strengthen Continuity Without Replacing Patient Rights

Families can play an important role in surgical decision-making and postoperative recovery in Viet Nam.

Relatives often know the older person's usual abilities, preferences and daily routines. They may notice changes in cognition, mobility or behavior that are difficult for clinicians to recognize without an understanding of the patient's baseline.

Family participation can also support communication, practical planning and continuity after discharge.

However, the older person should remain central to treatment decisions whenever they can participate. Family preferences do not automatically replace the patient's rights, and a diagnosis of dementia or cognitive impairment does not, by itself, determine the legal arrangements for consent.

Where lawful representation is required, the hospital must follow the applicable provisions of Vietnamese law. Relevant previously documented lawful wishes should also be considered in accordance with those provisions.

Family caregivers need realistic information about what may be expected after surgery. A relative may be willing to help with meals or transportation but unable to provide substantial physical assistance throughout the day.

If new care needs exceed what the household can manage, this should be recognized before discharge rather than treated as a problem for the family to solve alone.

Communication should remain consistent when the recovery plan changes. Relatives involved in the patient's care may need to understand whether an unexpected development affects the likely duration of hospitalization, rehabilitation needs or the level of support required afterward.

Information sharing must respect the patient's privacy, preferences and applicable legal requirements.

The purpose of family involvement is to strengthen continuity and informed decision-making, not to transfer professional responsibilities to relatives without appropriate preparation or support.

Measuring Quality Requires Following the Whole Perioperative Pathway

Hospitals commonly monitor surgical site infections, mortality, complications, unplanned readmissions and length of stay. These indicators remain important, but they do not fully describe the quality of perioperative care for older people.

A patient may avoid a major surgical complication yet experience a substantial decline in daily functioning. Another may leave hospital earlier but require unexpected additional care because the recovery arrangements were inadequate.

Evaluation should therefore examine both the reliability of the pathway and outcomes that matter to patients.

One area is preoperative decision-making. A hospital may review whether patients meeting its defined criteria received relevant assessments, whether significant findings were communicated and whether these findings informed treatment decisions.

Another is the translation of assessment into action. Recording a positive screen is different from arranging a response. The service may examine whether identified needs were linked to an agreed action, an appropriately assigned professional responsibility, a referral or a documented clinical decision.

Handover is another important process. The hospital can review whether significant preoperative concerns reached the postoperative team and whether planned care arrangements were implemented or appropriately changed.

Postoperative measures may include relevant complications, unplanned escalation of care, delays in recognizing deterioration and aspects of functional recovery. Discharge readiness, referral completion and unexpected healthcare use after discharge may also provide useful information.

Patient-reported outcomes can add an important perspective. Older people may value relief of symptoms, recovery of mobility, independence in daily activities or confidence that the treatment decision reflected their priorities.

Such measures should be interpreted in relation to the procedure, preoperative functioning, expected recovery and patient complexity. Not every person will regain the same level of independence, and an unfavorable outcome does not automatically indicate poor care.

Elective and emergency patients should also be distinguished when analyzing results. Surgical urgency, frailty, comorbidities and procedure-related risks can substantially influence outcomes.

A hospital should avoid drawing conclusions from crude comparisons that do not account for these differences.

For an initial improvement project, a small number of clearly defined indicators may be more useful than an extensive reporting system that personnel cannot maintain.

The hospital might begin by examining whether eligible patients have an agreed care plan, whether significant vulnerabilities receive a documented response, whether key information is communicated during handover and whether discharge arrangements are completed appropriately.

These are proposed approaches to local quality improvement, not a nationally mandated Vietnamese geriatric surgery accreditation indicator set. ACS GSV standards and CMS reporting requirements may provide useful reference points but do not automatically apply to Vietnamese hospitals.

Measurement becomes valuable when the findings lead to review and improvement, rather than simply producing more data.

Implementing an Age-Friendly Perioperative Pathway in a Vietnamese Hospital

A hospital does not necessarily need to introduce a comprehensive geriatric surgery program across every surgical specialty at once.

A more practical starting point may be one surgical service, one patient population or one procedure with a sufficiently consistent care process to support evaluation and improvement.

For example, a hospital could begin with older patients undergoing elective colorectal surgery. This would allow the team to examine shared decision-making, preoperative assessment, anesthesia planning, postoperative recovery and discharge within a defined clinical pathway.

Another hospital might select orthopedic, abdominal or another surgical service because of its patient population, case volume, clinical priorities or available expertise.

The selected pathway should address a meaningful problem that the hospital can reasonably improve.

The first task is to understand how care currently works. The team should examine where patients enter the service, who makes the surgical decision, when preoperative assessment occurs, how information reaches the operating room and ward, and who coordinates recovery and discharge.

This review may reveal that assessments are already performed but are not consistently translated into care plans. Different departments may use separate documentation, referrals may be delayed or important information about baseline functioning may not reach the postoperative team.

These gaps offer a useful starting point for improvement.

Hospital leadership should designate a responsible clinical lead and establish appropriate participation from surgery, anesthesiology, nursing and other relevant services. Responsibilities for pathway design, training, monitoring and resolving implementation problems should be explicit.

The team can then agree on a manageable set of practices. These may include identifying patients requiring additional assessment, documenting treatment goals, converting significant findings into specific actions, communicating the plan during handover and reviewing recovery needs before discharge.

The hospital should determine which information must be recorded, where it will be available and who is responsible for acting on it.

An electronic system may be helpful, but an existing medical record process can also support an initial pilot if it allows relevant information to be documented and communicated reliably. Introducing new technology is not necessarily the first priority when the main problem concerns coordination or unclear responsibilities.

Training should focus on the decisions and tasks personnel will actually perform. Surgeons and anesthesiologists may need a shared understanding of how vulnerability findings influence perioperative planning. Nurses may need clear arrangements for recognizing changes in cognition or function, reporting concerns and documenting progress toward recovery goals.

A pilot should have a defined evaluation period and a small set of indicators that staff can collect consistently.

Process measures may initially be more feasible than attempting to attribute changes in mortality, complications or other major outcomes directly to the new pathway.

The team may begin by reviewing whether eligible patients received the intended assessment, whether significant findings led to an agreed response and whether relevant information reached the postoperative team.

Results should be discussed through existing clinical governance and quality improvement arrangements.

When expected actions are repeatedly missed, the hospital should examine why. The cause may involve workload, unavailable expertise, unclear responsibilities, documentation problems or a process that does not fit actual clinical practice.

The response should address the underlying operational problem rather than simply instruct personnel to comply more closely.

Expansion should follow demonstrated feasibility and useful learning. A pathway that works in one surgical specialty may need adaptation before being introduced elsewhere because the procedures, patient characteristics and recovery requirements differ.

Hospitals with limited geriatric expertise may develop a focused pathway supported by internal medicine, anesthesiology, nursing and rehabilitation services. Larger hospitals may be able to establish more formal multidisciplinary arrangements.

Neither approach should be judged solely by the number of specialists involved or the complexity of its documentation.

The important question is whether the organization can consistently identify relevant needs, make appropriate decisions, implement agreed actions and maintain continuity across the patient's surgical journey.

From a Successful Operation to a Successful Surgical Care Pathway

Surgery can offer substantial benefits to older people. It can relieve suffering, treat serious illness, preserve mobility and improve or extend life. Advanced age alone should not be a reason to withhold a potentially beneficial operation.

At the same time, deciding to operate requires more than determining whether a procedure is technically possible. For many older patients, the expected effects on independence, everyday functioning and the burden of recovery are central to whether treatment is worthwhile.

An age-friendly perioperative pathway connects these considerations to clinical practice.

Before surgery, it helps the patient and clinical team understand the likely benefits, risks and alternatives. During preparation, it identifies concerns that may influence decisions and develops realistic care arrangements. Around the operation, it supports communication and clear professional responsibilities. After surgery, it focuses on recognizing problems, supporting recovery and determining the next appropriate care setting.

For Vietnamese hospitals, the opportunity is not simply to adopt an international checklist or create another specialist assessment service. It is to make better use of information that is often already available but not consistently connected across departments.

The central question remains: How can a surgical service translate geriatric assessment into safer perioperative decisions, coordinated care and reliable recovery planning?

The answer lies in establishing a pathway in which assessment findings lead to meaningful decisions, responsibilities are clear, care plans accompany patients across departments and recovery is evaluated against realistic clinical and personal goals.

Age-friendly surgical care is not defined only by whether an older person survives an operation. It also depends on whether the treatment was appropriate, care was coordinated and the patient had a realistic opportunity to recover in a way that respects what matters most to them.

As Viet Nam's surgical services respond to an aging population, developing these capabilities offers a practical direction for strengthening healthcare quality, patient safety and continuity of care.

References

1. National Assembly of Viet Nam. Law on Medical Examination and Treatment No. 15/2023/QH15. Adopted 9 January 2023; effective 1 January 2024.

2. Government of Viet Nam. Decree No. 96/2023/NĐ-CP detailing certain provisions of the Law on Medical Examination and Treatment. 30 December 2023, as amended.

3. Ministry of Health of Viet Nam. Circular No. 19/2013/TT-BYT guiding the implementation of hospital healthcare quality management. 12 July 2013.

4. National Assembly of Viet Nam. Law on Older Persons No. 39/2009/QH12. 23 November 2009, as amended.

5. American College of Surgeons. Geriatric Surgery Verification Program: Optimal Resources for Geriatric Surgery, Program Standards and Levels of Participation. ACS.

6. Centers for Medicare & Medicaid Services. Hospital Inpatient Quality Reporting Program: Age Friendly Hospital Measure Specifications. July 2025.

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