More Than the Operation: Rethinking Surgery for Older Patients

When families face surgery for an ageing parent, the questions are usually about the operation itself. Will it work? How long is recovery? When can Mum or Dad come home? According to perioperative physician and geriatrician Dr Sheila Rahman, those aren’t always the questions that matter most.

“A lot of the time it's actually not about the operation itself," she says. "It's about the person in front of you. What will recovery look like? What matters most to them? And sometimes it's about making sure surgery is the right decision in the first place."

That perspective sits at the heart of her work as a perioperative physician and consultant geriatrician, and it reflects the multidisciplinary philosophy of Joint Vision Orthopaedic Group.

Looking after the whole person

Many people have never heard of a geriatrician until an ageing parent or grandparent needs one … and contrary to popular belief, the role isn’t about treating “old age.” Geriatricians care for older adults with complex medical needs, helping them maintain independence, function and quality of life. That can mean assessing memory concerns, preventing falls, reviewing medications, coordinating rehabilitation or preparing someone for major surgery. The common thread is a focus on the person, not a single condition.

“We don’t have a cookie-cutter approach,” Dr Rahman says. “Every patient is different, and every decision has to be centred on what that person wants and what gives them the best quality of life.”

Physician and Geriatrician Dr Sheila Rahman talking with Joint Vision cofounder and Orthopaedic Surgeon Dr Meghan Dares recently.

Why surgery is different for older adults

Older Australians are living longer than ever, with many active and independent well into their 80s and 90s. But ageing also brings complexity: chronic conditions, multiple medications, frailty, memory problems and social circumstances can all shape how someone recovers from surgery. That’s where perioperative medicine comes in, an emerging field focused on optimising patients before, during and after an operation to reduce complications and help them recover safely.

For Dr Rahman, it has become a professional passion. “I realised this was where I could make the biggest difference,” she says. “You see the impact almost immediately — helping patients navigate decisions, preparing them for surgery, supporting them afterwards, and working with the whole team to improve outcomes.”

More than a surgeon, more than a physician

One of the reasons Dr Rahman was drawn to Joint Vision was its commitment to multidisciplinary care, where orthopaedic surgeons, physicians, physiotherapists and rehabilitation professionals work together rather than in isolation.

“You can’t practise perioperative medicine without multidisciplinary care,” she says. “Healthcare is still very siloed, even though we’re told not to be — and that’s what makes this place unusual.”

For patients, it means decisions are shaped by several perspectives. Rather than simply asking whether a knee or hip can be replaced, the conversation widens: Would non-surgical options serve the patient better, or surgery offer only limited benefit? Will they cope with surgery? How can they be medically optimised beforehand? What support will they need afterwards? Will the operation genuinely improve their independence and quality of life, or could these become worse? These are often the questions that determine success.

Becoming an advocate

One word comes up repeatedly when Dr Rahman describes her work: advocacy. Older patients are often managing multiple conditions, complex family situations and difficult decisions. Some live with cognitive impairment; others face hearing or vision loss, language barriers or limited family support. Someone needs to step back and see the bigger picture.

“You really have to be that patient’s advocate. First and foremost, age should not be a barrier to considering treatment, or even having the conversation,” she says. “Sometimes surgery is beneficial, sometimes it isn’t. Every patient deserves an informed choice.”

Challenging the myths about ageing

The biggest misconception she encounters is that growing older automatically means becoming frail. It doesn’t. “I always tell people that dementia is not normal ageing,” she says. “Frailty doesn’t mean someone is old, and being old doesn’t mean someone is frail.”

She has cared for a patient over 100 who was living independently at home, taking no regular medications and walking with a stick, while others decades younger have been left significantly frail by chronic illness. “Age on its own tells you very little,” she says. “You really have to get to know the patient before making decisions that could change their life.”

The future of caring for older Australians

As Australia’s population ages, caring well for older patients will mean treating the whole person, not a single condition. The operation is only one chapter in their story — helping them recover well, stay independent and keep living the life they value is what matters most.

About Dr Sheila Rahman

Dr Sheila Rahman is a perioperative physician and consultant geriatrician providing specialist care for older adults, with subspecialty expertise in orthogeriatrics, perioperative medicine and rehabilitation, alongside the management of complex, acute and general medical conditions. She holds a Master of Perioperative Medicine, and her ANZCA Chapter of Perioperative Medicine qualification underpins perioperative service design, teaching and training. She has established a clinic for older patients being considered for surgery, and her redesign of orthogeriatric services has earned both local and national recognition. She is an examiner for the ANZCA Chapter of Perioperative Medicine program, a senior clinical lecturer at the University of Wollongong Graduate School of Medicine, and an examiner for the Royal Australasian College of Physicians.

Dr Rahman leads Compass Geriatrics, a specialist service, which works with Joint Vision Orthopaedic Group. Through collaborative, multidisciplinary care, she medically optimises older adults for surgery, reduces their perioperative risk, and helps them recover safely and maintain their independence.

For consultations and appointments, please contact 1800 955 802 or visit Compass Geriatrics.