Surgical Morbidity in the Elderly Bariatric Patient: Does Age Matter?

Background : Surgical treatment of obesity in the elderly, particularly over 65, remains controversial; it is explained by the increased surgical risk or the lack of data demonstrating its long-term benefit. Few studies have evaluated the clinical effects of bariatric surgery in this population. Aim : To evaluate the results of surgical treatment of obesity in patients over 60 years, followed for an average period of five years. Method : This was a retrospective study evaluating 46 patients, 60 years or older, who underwent surgical treatment of obesity, by conventional gastric bypass technique (laparotomy). The average age was 64 years (60-71), mean BMI of 49.6 kg/m2 (38-66), mean follow-up of 5.9 years; 91% of patients were hypertensive, 56% diabetics and 39% had dyslipidemia. Results : The incidence of complications (major and minor) in patients under 65 years was 26% and over 65 years 37% (p=0.002). There were no deaths in the group with less than 65 years and there were two deaths (12.5%) over 65 years. The average loss of overweight over 65 years or less was 72% vs 68% (p=0.56). There was total control of the diabetes mellitus in 77% and partial in 23%, with no difference between groups. There was improvement in arterial hypertension in 56% of patients, also no difference between groups. The average LDL levels did not differ between the pre and postoperative (106 mg/dl to 102 mg/dl), an increase of HDL (56 mg/dl to 68 mg/dL) and reduced triglyceride levels (136 mg/dl to 109 mg/dl). There was no statistical difference in the variation of the cholesterol fractions and triglycerides between the groups. Two patients in the group with less than 65 years died in late follow-up, of brain tumor and pneumonia, three and five years after bariatric surgery, respectively. Conclusions : Surgical morbidity and mortality were higher in patients over 65 years, and this group had the same benefits observed in patients lower 65 years for weight loss and comorbidities control.

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Can preoperative assessment of cancer in the elderly (PACE) predict 30-days postoperative outcomes?

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.8537 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 8537-8537 ◽

Cited By ~ 1

Author(s):

R. A. Audisio ◽

H. S. Ramesh ◽

R. Gennari ◽

G. Corsini ◽

M. Maffezzini ◽

...

Keyword(s):

Hospital Stay ◽

Regression Models ◽

Elective Surgery ◽

Univariate Analysis ◽

Preoperative Assessment ◽

The Elderly ◽

Postoperative Outcomes ◽

Stepwise Logistic Regression ◽

Short Term ◽

Surgical Morbidity

8537 Background: Surgery is the treatment of choice for solid cancers. Frequent functional impairment/comorbidities in the elderly enhances the risk of treatment related complications. Inability to forecast short term outcomes after cancer surgery in elderly affects clinical practice, denying optimal treatment. No validated instrument is available to help make informed decision; a compilation of validated questionnaires (PACE) is established to preoperatively inform on the health condition of elderly cancer pts. This international multicentre study investigates how components of PACE preoperatively assessed are associated with postoperative outcomes. Methods: A prospective series of consenting elderly cancer pts (≥70 yrs) receiving elective surgery (moderate-major+) were recruited from 8 hospitals (UK, Netherlands, Italy, Japan, Belgium) (07/2003–12/2005) and assessed using PACE (Comorbidities, IADL, ADL, GDS, BFI, PS, MMS, ASA). 30day morbidity, hospital stay and mortality were recorded. Results: 448 pts [breast (48%), GI (30%), GU (16%), miscellaneous (6%)] were recruited and followed postoperatively. Observed morbidity was 36% (161 pts), mortality 4% (16 pts) and median hospital stay was 5 days (range 2 -10). All components of PACE but ASA were associated with morbidity (p<0.05) and hospital stay (p<0.05) on univariate analysis. Operative deaths were too few to look for associations. Forward stepwise logistic regression models (multivariate analysis) identified 3 components of PACE as best describing the occurrence of post-surgical morbidity: BFI (OR (upper quartile)= 2.4; 95% CI=1.2–4.9); PS (OR=1.9; 95% CI=1.1–3.4); IADL (OR=1.7; 95% CI=1.0–3.0). The same components were also selected into the model as best describing hospital stay beyond average: BFI (OR (upper quartile)=18.1; 95% CI=7.2–45.3), PS (OR=2.2; 95%=1.2–4.4) and IADL (OR=2.7; 95% CI=1.4–5.1). Of those pts exposed to all 3 factors entered into the regression models 61% experienced complications and >80% had a longer hospital stay. Conclusions: BFI, PS and IADL appear to be the most relevant prognosticators of short term surgical outcomes. A holistic appraisal of elderly pts undergoing surgery is warmly recommended when consenting the patient and during the decision making process. No significant financial relationships to disclose.

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Are the frail destined to fail?: Frailty index as a predictor of surgical morbidity and mortality in the elderly

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2011.06.147 ◽

2011 ◽

Vol 213 (3) ◽

pp. S65

Author(s):

Joseph S. Farhat ◽

Anthony J. Falvo ◽

H. Mathilda Horst ◽

Andrew Swartz ◽

Vic Velanovich ◽

...

Keyword(s):

Frailty Index ◽

The Elderly ◽

Morbidity And Mortality ◽

Surgical Morbidity

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Cell surface changes during aging of human bladder epithelium examined by lectin probes and SEM

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100162429 ◽

1990 ◽

Vol 48 (3) ◽

pp. 966-967

Author(s):

J. Jacob ◽

M.F.M. Ismail

Keyword(s):

The Elderly ◽

Ultrastructural Changes ◽

Pokeweed Mitogen ◽

Asymmetric Structure ◽

Luminal Surface ◽

Bladder Epithelium ◽

Aldehyde Groups ◽

Cell Surface Changes ◽

Phosphate Buffered Saline ◽

Surface Changes

Ultrastructural changes have been shown to occur in the urinary bladder epithelium (urothelium) during the life span of humans. With increasing age, the luminal surface becomes more flexible and develops simple microvilli-like processes. Furthermore, the specialised asymmetric structure of the luminal plasma membrane is relatively more prominent in the young than in the elderly. The nature of the changes at the luminal surface is now explored by lectin-mediated adsorption visualised by scanning electron microscopy (SEM).Samples of young adult (21-31 y old) and elderly (58-82 y old) urothelia were fixed in buffered 2% glutaraldehyde for 10 m and washed with phosphate buffered saline (PBS) containing Ca++ and Mg++ at room temperature. They were incubated overnight at 4°C in 0.1 M ammonium chloride in PBS to block any remaining aldehyde groups. The samples were then allowed to stand in PBS at 37°C for 2 h before incubation at 37°C for 30 m with lectins. The lectins used were concanavalin A (Con A), wheat germ agglutinin (WGA), phytohaemagglutinin (PHA) and pokeweed mitogen (PWM) at a concentration of 500 mg/ml in PBS at pH 7.A.

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The effect of dental geriatric curricula on attitudes toward the elderly

Journal of Dental Education ◽

10.1002/j.0022-0337.1988.52.9.tb02232.x ◽

1988 ◽

Vol 52 (9) ◽

pp. 516-518 ◽

Cited By ~ 2

Author(s):

J Mann ◽

TJ Bomberg ◽

JM Holtzman ◽

DB Berkey

Keyword(s):

The Elderly

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Speech-Language Pathologists' Attitudes Toward Aging and the Elderly

Contemporary Issues in Communication Science and Disorders ◽

10.1044/cicsd_30_f_146 ◽

2003 ◽

Vol 30 (Fall) ◽

pp. 146-155 ◽

Cited By ~ 5

Author(s):

Jeff Searl ◽

Rodney M. Gabel

Keyword(s):

The Elderly ◽

Speech Language Pathologists ◽

Attitudes Toward Aging

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Pharmacology Issues Related to Dementia Syndrome of Depression in Elderly Residents of Long-Term Care Settings

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld25.2.61 ◽

2015 ◽

Vol 25 (2) ◽

pp. 61-69

Author(s):

Angel L. Ball ◽

Adina S. Gray

Keyword(s):

Depressive Symptoms ◽

The Elderly ◽

Environmental Communication ◽

Pharmacological Intervention ◽

Team Approach ◽

Discussion Paper ◽

Term Care ◽

Anticholinergic Medications ◽

Inappropriate Treatment ◽

Dementia Syndrome

Pharmacological intervention for depressive symptoms in institutionalized elderly is higher than the population average. Among the patients on such medications are those with a puzzling mix of symptoms, diagnosed as “dementia syndrome of depression,” formerly termed “pseudodementia”. Cognitive-communicative changes, potentially due to medications, complicate the diagnosis even further. This discussion paper reviews the history of the terminology of “pseudodementia,” and examines the pharmacology given as treatment for depressive symptoms in the elderly population that can affect cognition and communication. Clinicians can reduce the risk of misdiagnosis or inappropriate treatment by having an awareness of potential side effects, including decreased attention, memory, and reasoning capacities, particularly due to some anticholinergic medications. A team approach to care should include a cohesive effort directed at caution against over-medication, informed management of polypharmacology, enhancement of environmental/communication supports and quality of life, and recognizing the typical nature of some depressive signs in elderly institutionalized individuals.

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