Reviewed by Dr Patrick Ruane
If your parent or elder relative is scheduled for major surgery, such as a hip or knee replacement, there are many proactive steps you and your family can take beforehand to increase the likelihood of a successful return home and recovery afterwards.
Don’t rely solely on healthcare teams and social services to keep you informed and to coordinate everything smoothly. They do their best but, unfortunately, services across the UK are often overstretched and things can slip through the cracks.
Note: This article serves as general informational guidance for surgeries in NHS hospitals, and assumes your parent has granted permission for your involvement in their care. It should not substitute professional advice. Consult a qualified healthcare professional for personalised recommendations.
Why is it so vital to prepare for major surgery?
Many issues can arise during or after a hospital stay when older people undergo major surgery. These can include:
- Complications like infections.
- Difficulty managing pain.
- Challenges with mobility and self-care.
Without proper preparation and support, these issues can lead to extended hospital stays, readmissions, or slower recovery times.
Months or weeks before surgery
Read the admissions letter (thoroughly!)
- Note when and where the surgery will take place and which department they need to go to on the day.
- Decide who will accompany them to the hospital on the day. If it’s you, book time off work if necessary. It’s important to have someone with them who can be a point of contact and advocate for them throughout their stay.
- Check for any tests your parent needs to have beforehand or if they need to bring any samples (urine or stool) with them.
- Look for restrictions on eating, drinking, or medications that need temporarily stopping before admission.
Remember: Not following the specific instructions in the letter can lead to the surgery being cancelled.
Tip: If there are restrictions, set an alarm in your or your parent’s phone to remind them. Re-read the letter in the days before surgery to double check.
Stay on top of health conditions
Certain medical conditions can affect recovery from surgery. Get a check-up with their GP to ensure these conditions are controlled as well as possible and any medications are adjusted ahead of surgery, if needed.
Key conditions to check:
- Diabetes
- High blood pressure
- Anaemia
Check vaccination status
Make sure your parent or elder relative’s vaccinations are up to date well before surgery. Key vaccinations to check include:
- Pneumococcal vaccine (if not received in the last 5 years)
- Flu vaccine (seasonal, particularly important in the winter months)
- Shingles vaccine (if they meet the eligibility criteria)
- RSV vaccine (if eligible and within the last 2 years)
Lifestyle changes
There are several lifestyle adjustments your parent or elder relative can make in the months or weeks leading up to surgery to reduce the risk of complications and help them recover faster.
Diet
- Ensure a healthy, balanced diet with plenty of protein-rich foods.
- Stay hydrated and avoid excessive alcohol consumption.
Exercise
- Increase activity levels and focus on exercises that improve balance and strength.
- Consult their doctor to determine which exercises are appropriate.
Weight
- Losing excess weight can ease pressure on the heart and lungs.
- Gaining weight may be necessary if they are frail or underweight.
- Speak to their doctor if concerned about their weight.
Smoking
- Stop or reduce smoking to improve wound healing and reduce the risk of complications.
Attend pre-admissions assessment
Pre-admission assessments usually take place around a few days to a few weeks before the surgery takes place.
If your parent is asked to come in for a pre-admissions assessment, this is an important opportunity to:
Exchange information – Share details about your parent or relative’s medical problems, medications, allergies, and any issues related to anaesthetic.
Ask questions about how their surgery and recovery – Here are a few questions to consider:
- Assuming the surgery goes to plan, is their health expected to eventually return to the same level as it is now? (this is called baseline health status)
- How long should it take them to recover from surgery?
- What are the expected recovery milestones?
- What risks are involved, and how are they managed?
- What additional medications will they need to take following surgery?
- What support will they need at home to recover? Might we need to consider temporary placement in a care home?
- Do any medications need to be temporarily stopped before surgery, and when can they be restarted?
Tip: Bring a notepad and pen or use your phone to write down or record responses.
Note: If they are not asked to come in for a pre-admissions assessment, find an opportunity before the surgery to ask their consultant and medical team these questions so you have a clear understanding of what to expect post-surgery.
Consider and organise after-care
It’s very likely they are not going to be able to do a lot of the ‘activities of daily living’ they would normally do while they recover.
They may only need support with basic things, but organising care last minute when they come out is something you definitely want to avoid if you can.
Consider:
- Who will clean the house during this time?
- Who will help them bathe and dress?
- Who will do the grocery shopping and prepare their meals?
You might want to start researching a carer or local care options now – unless you or a family member or friend can provide the care they need.
Note: Your parent or elder relative may qualify for up to six weeks of NHS reablement care after their surgery, depending on their needs. However, reablement care isn’t guaranteed and arranging it can take time, so you may need to organise temporary support to address their immediate needs in the interim.
Prepare their home
Ensure your parent’s living space is safe and accessible for them to live in when they return home.
This may involve:
- Installing handrails
- Securing loose rugs
- Rearranging furniture (e.g., having a bed on the ground floor of the house)
Even small changes can make a big difference in facilitating a smooth transition home.
Note: Home modifications are sometimes organised for free through social services as part of a discharge care package but this can take time.
Days before surgery
Report any illness or wounds
If your parent cuts, scrapes or damages their skin around the affected area prior to surgery, contact their surgeon to let them know.
Surgeons need healthy, undamaged skin to perform operations and the surgery may need to be rescheduled for a later date.
Pack a well-equipped hospital bag
Make a list of all the things they might need and start packing a few days before their admission. Make sure the bag has a luggage tag with their name and NHS number and contact details.
Use this checklist to ensure nothing is missed:
Clothing and comfort
- Comfortable clothes, including a dressing gown
- Non-slip slippers
- Warm blanket (Particularly important if your parent feels the cold more. Hospitals can be cold and blankets provided aren’t always sufficient.)
- Ear plugs and eye mask (wards are bright and often very noisy)
Personal essentials
- Toiletries
- Glasses, hearing aids (with spare batteries), and dentures (label their cases with their name and NHS number to avoid loss)
- Current prescribed medications (enough for the expected length of stay)
- Small amount of cash
Entertainment and communication
- Mobile phone and charger
- iPad and charger
- Books, magazines, or puzzles
- Headphones (for quiet video watching or taking calls)
Useful extras
- Pad and pen (to note down important information)
- List of key emergency contact numbers
- Medical documents or letters related to surgery (Make copies to keep at home as well)
- Photos of loved ones (hospitals can be lonely!)
Eat a good-sized last meal
Surgery timing can be unpredictable, so it’s a good idea to have a hearty final meal before they begin fasting for surgery, often the night before (check the admissions letter for exact timing).
This prevents them from feeling uncomfortably hungry if their surgery is in the afternoon or delayed.
Ensure good hygiene
Cleanliness helps reduce the risk of infection during and after the procedure.
- Encourage your parent or relative to take a shower or bath the night before or the morning of the surgery.
- Pay special attention to washing the surgical site and surrounding areas.
- Remove any jewellery, makeup, or nail polish as these can interfere with the surgery and monitoring equipment.
Day of surgery
Leave valuables at home
Make sure they don’t bring anything valuable with them. All jewellery, watches or anything of value should be removed and left at home.
Have someone accompany them
It’s important that you or another close friend or relative accompanies your parent to the hospital on the day of their surgery so you or they can be a point of contact and advocate for them throughout their stay.
Ask questions
To ensure a smooth hospital experience, consider asking the medical team the following:
- Surgery duration: How long is the surgery expected to take, and who will inform relatives afterward?
- DNAR status: What is your parent or relative’s Do Not Attempt Resuscitation (DNAR) status?
- Blood clot prevention: What steps are being taken to prevent blood clots?
- Post-surgery ward: What ward will they be on after surgery?
- Ward contact info: What is the phone number of the ward?
- Care team contact: Who is the main person in charge of their care for questions?
- Visiting information: When can you visit after surgery, and what are the visiting hours and limits?
- Ward rounds: What time are the ward rounds?
- Mealtimes: When are mealtimes?
- Discharge coordination: Who leads the discharge team, and can you get a copy of the hospital’s discharge policy?
- NHS Reablement Care: Will your parent likely receive this care, for how long, and who coordinates it?
Share key information
- Power of Attorney: If you hold Power of Attorney for Health and Welfare, bring documentation to confirm it so the medical team knows they can communicate with you.
- Health details: Inform the team of any cognitive issues, allergies, dietary requirements, or other pre-existing medical conditions.
- Living situation: Explain your parent’s living arrangements and discuss if a temporary care or rehabilitation facility would be safer for their recovery.
- Dentures: If your parent wears dentures, notify the staff and discuss how to keep them safe, as dentures frequently go missing in hospitals.
In summary
Taking proactive steps ahead of any planned, major surgery will go a long way to ensuring your parent has a much better, less stressful stay and subsequent discharge from hospital, and you can have a greater sense of control and more peace of mind.
Remember that this is general information for educational purposes only. Advice will vary depending on your parent’s health condition, what type of surgery they are having, which hospital they are having the surgery at and various other factors.
Always speak directly with a healthcare professional for personalised advice tailored to your parent’s specific situation.
Common questions
- How long does it take for elderly to recover from major surgery?
Recovery after major surgery can vary for older adults, depending on things like the type of surgery, their health before the procedure, any complications, and how well they can follow care instructions afterward.
In general, older people may take longer to heal because of factors like less muscle strength, slower healing, and other health issues. Recovery could take a few weeks, a few months, or longer, especially for more complicated surgeries. It’s important to work closely with the healthcare team and follow their advice to help with the recovery process.
- What age is considered high risk for surgery?
There isn’t a set age that automatically makes someone high risk for surgery, since a person’s overall health and medical conditions are important factors. That said, people over 65 are often seen as higher risk because they’re more likely to have age-related health issues or multiple medical conditions. However, age by itself doesn’t determine the risk – things like general health, fitness, and the type of surgery also play a big role in assessing risk.
- Is there a high risk for infection in hospital?
Hospitals can carry a higher risk of infection because of germs, exposure to other sick patients, and medical procedures that can introduce bacteria.
Older adults are more at risk because their immune systems are often weaker and they may have other health issues. While the risk of infection after surgery depends on the type of procedure, there is always some level of risk involved.
