525 EVERYONE NEEDS TO POOP: REDUCING CONSTIPATION IN THE ELDERLY INPATIENT POPULATION

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
J C R G Rollo-Walker
Keyword(s):  
Elderly Patients ◽  
Nursing Staff ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
Medical Review ◽  
Dependent Effect ◽  
Elderly Inpatient ◽  
Inpatient Population ◽  
Multi Disciplinary Team

Abstract Introduction Due to a variety of factors when elderly patients are admitted to hospital they can become constipated. This can impact the entire admission increasing morbidity and mortality for what is a treatable problem. The aim therefore was to assess how prevalent constipation was across the inpatient population; analyse if there were any common themes and implement interventions that might help solve these. Method Data was collected over 15 days across the department (up to 87 patients) using nursing handover sheets to review the date bowels had last been opened. Patients were classified as constipated if they had not opened their bowels for more than 3 days. On two days common themes in the constipated patients were reviewed and analysed. On average 27% of patients were constipated. The majority of these had been deemed ‘Medically Ready for Discharge’. They all had either no or only a reduced range of aperients prescribed. Stakeholders including patients, nursing staff, prescribers and Consultants were surveyed. First cycle intervention was to highlight those constipated at morning Multi-disciplinary Team (MDT) meetings to prompt medical review. Second cycle intervention: an e-prescribing bundle was designed to allow for simple prescription and for nurses to give aperients on an as required basis. A laxative prescribing guide sheet was also written to aid prescribers. Results Aim is to reduce constipation to less than 20% thereby reducing morbidity and mortality in inpatients. Highlighting patients at MDT had little effect partly as it was person dependent. Effect of prescribing bundle yet to be determined but received positively by stakeholders. Prescribing guide received positively by Consultants and junior prescribers. Conclusions Person dependent intervention was ineffective at reducing constipation highlighted by staff sickness due to Covid-19. A prescribing bundle is more system based. If used at admission hopefully will be effective and sustainable.

Anaesthesia in the elderly

2017 ◽  
Author(s):  
Bernadette Veering ◽  
Chris Dodds
Keyword(s):  
Elderly Patients ◽  
Postoperative Morbidity ◽  
Medical Condition ◽  
Clinical Care ◽  
The Elderly ◽  
Individual Variability ◽  
Morbidity And Mortality ◽  
Clear Understanding ◽  
Organ Systems ◽  
Specific Organ

The elderly population continues to grow. As surgical intervention in disease processes becomes more aggressive, the anaesthetist is faced with an increasing number of elderly patients. Elderly patients should be approached with a clear understanding of ageing, how it occurs, how it affects specific organ systems, and how it may influence clinical care, when a patient is subjected to an operation. The ageing process is a multifactorial process, resulting in a decreased capacity for adaptation and producing a gradual decrease in functional reserve of many organ systems. This has significant effects on the physiological responses to surgical and pharmacological trespass faced during anaesthesia. Increasing age is associated with changes in the response to a wide variety of drugs. Changes in dose–response relationships may be as a result of changes in pharmacokinetics, pharmacodynamics, or a combination of both. One should realize that increasing age is associated with a large inter-individual variability in dose requirements. As such, it is important to carefully titrate the dose against the desired clinical effect in an older patient. Preoperative physical and mental state are the most important determinants of per- and postoperative morbidity and mortality. The number of co-morbidities increases with advanced age and as such, optimization of the medical condition is essential to reduce the morbidity and mortality.

Morbidity and Mortality of C2 Fractures in the Elderly

Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1055-1059 ◽  
Author(s):  
Yi-Ren Chen ◽  
Maxwell Boakye ◽  
Robert T. Arrigo ◽  
Paul S. A. Kalanithi ◽  
Ivan Cheng ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Stay ◽  
Treatment Modality ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Complication Rates ◽  
Term Survival ◽  
Cord Injury

Abstract BACKGROUND: Closed C2 fractures commonly occur after falls or other trauma in the elderly and are associated with significant morbidity and mortality. Controversy exists as to best treatment practices for these patients. OBJECTIVE: To compare outcomes for elderly patients with closed C2 fractures by treatment modality. METHODS: We retrospectively reviewed 28 surgically and 28 nonsurgically treated cases of closed C2 fractures without spinal cord injury in patients aged 65 years of age or older treated at Stanford Hospital between January 2000 and July 2010. Comorbidities, fracture characteristics, and treatment details were recorded; primary outcomes were 30-day mortality and complication rates; secondary outcomes were length of hospital stay and long-term survival. RESULTS: Surgically treated patients tended to have more severe fractures with larger displacement. Charlson comorbidity scores were similar in both groups. Thirty-day mortality was 3.6% in the surgical group and 7.1% in the nonsurgical group, and the 30-day complication rates were 17.9% and 25.0%, respectively; these differences were not statistically significant. Surgical patients had significantly longer lengths of hospital stay than nonsurgical patients (11.8 days vs 4.4 days). Long-term median survival was not significantly different between groups. CONCLUSION: The 30-day mortality and complication rates in surgically and nonsurgically treated patients were comparable. Elderly patients faced relatively high morbidity and mortality regardless of treatment modality; thus, age alone does not appear to be a contraindication to surgical fixation of C2 fractures.

scholarly journals Appendicular perforation and its contributing factors

2017 ◽  
Vol 4 (6) ◽  
pp. 2007
Author(s):  
Anandaravi B. N. ◽  
Ramaswami B.
Keyword(s):  
Risk Factors ◽  
Acute Appendicitis ◽  
Elderly Patients ◽  
Perforated Appendicitis ◽  
Clinical History ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
Delayed Presentation ◽  
Contributing Factors ◽  
Steroid Dependent

Background: The objective was to study of different risk factors contributing in appendicular perforation and effective management of patients by knowing risk factors.Methods: This study was conducted in the department of general surgery K. R. Hospital Mysore medical college and research institute, Mysore, Karnataka, India from January 2015 to June 2016. Patients of age above 18 years and both sexes operated for acute appendicitis were included in present study. The clinical history, clinical features, investigations, intraoperative findings, were noted and surgical procedure done and all perforated appendicitis cases were operated lower midline incision, through wash given with normal saline drain in situ. Post operatively antibiotics were given and all patients follow up done for one month.Results: Present study duration is one and half year we operated total 100 patients for acute appendicitis. In this study 55 patients were male (55%) and 45 patients were females (45%). According to our study acute appendicitis is more common in males. Appendicular perforation has noticed in 23 female patients. The incidence of perforated appendicitis is low in males 12 out of 35 as compared to females 23 out of 35. The incidence of appendicular perforation is higher in the extreme of ages. In the elderly patients it is 58.33%. Thus, according to present study findings age above (>40 years) is strongly associated with the perforated appendicitis (p<0.001 chi squared test). Delayed presentation shows 77.41% appendicular perforation and faecolith associated with 64.51%.Conclusions: The morbidity and mortality rates are higher in elderly patients, diabetics, steroid dependent and immunocompromised patients. We should be aggressive in the treatment of acute appendicitis associated with high risk factors. So once acute appendicitis is diagnosed, the expedient surgery and appropriate use of perioperative antibiotics can help in reducing the morbidity and mortality.

scholarly journals Hip Fractures in the Elderly During the COVID-19 Pandemic: A Latin-American Perspective With a Minimum 90-Day Follow-Up

2021 ◽  
Vol 12 ◽  
pp. 215145932110245
Author(s):  
Tomas Zamora ◽  
Felipe Sandoval ◽  
Hugo Demandes ◽  
Javier Serrano ◽  
Javiera Gonzalez ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Latin American ◽  
Clinical Information ◽  
The Elderly ◽  
Older Age ◽  
Morbidity And Mortality ◽  
Level Of Evidence ◽  
Fragility Hip Fracture

Introduction: Hip fracture patients have been severely affected by the COVID-19 pandemic; however, the sub acute effects of a concomitant SARS-CoV-2 infection and the outcomes in highly exposed developing countries are still unknown. Our objective is to describe the morbidity and mortality of elderly patients admitted for a hip fracture during the COVID-19 pandemic in Chile, with a minimum 90-day follow-up. Also, to elucidate predictors for mortality and to compare mortality results with the pre-pandemic era. Material and Methods: Multicentric retrospective review of patients admitted for a fragility hip fracture in 3 hospitals during the COVID-19 pandemic, and during the same time in 2019. All clinical information and images were recorded, and patients were followed for a minimum of 90-days. Morbidity and mortality were the primary outcomes. Uni/multivariable models were performed to elucidate predictors for mortality utilizing the Weibull’s regression. Results: Three hundred ninety-one cases were included. From the 2020 cohort (162 patients), 24 (15%) had a concomitant SARS-CoV-2 infection. Fourteen patients (58%) tested positive after admission. The COVID-19(+) group had a higher risk of in-hospital, 30-day, and 90-day mortality (p < 0.001). They also had a prolonged hospital stay and presented with more complications and readmissions (p < 0.05). Only COVID-19(+) status and older age were independent predictors for mortality with a HR = 6.5 (p = < 0.001) and 1.09 (p = 0.001), respectively. The 2020 cohort had twice the risk of mortality with a HR = 2.04 (p = 0.002) compared to the 2019 cohort. However, comparing only the COVID-19 (-) patients, there was no difference in mortality risk, with a HR = 1.30 (p = 0.343). Discussion: The COVID-19 pandemic has significantly affected healthcare systems and elderly patients. Conclusions: Hip fracture patients with a concomitant SARS-CoV-2 virus infection were associated with increased morbidity and mortality throughout the first 3 months. COVID-19 status and older age were significant predictors for mortality. Efforts should be directed into nosocomial infection reduction and prompt surgical management. Level of evidence: Level III

scholarly journals Perceptions of the nursing staff regarding the safety of elderly patients in the cardiac computed tomography with contrast

2014 ◽  
Vol 23 (2) ◽  
pp. 338-346
Author(s):  
Laura Vargas Acauan ◽  
Maria Cristina Soares Rodrigues
Keyword(s):  
Computed Tomography ◽  
Elderly Patients ◽  
Nursing Staff ◽  
Cardiac Computed Tomography ◽  
Federal District ◽  
The Elderly ◽  
Descriptive Study ◽  
Private Hospitals ◽  
Human Interactions ◽  
Iodinated Contrast

Descriptive study, with qualitative approach, in order to understand the perception of the nursing staff regarding the safety of elderly patients in the administration of iodinated contrast media, conducted at the diagnostic imaging centers of two private hospitals, located in Brasília, Federal District, Brazil. Data were collected by technical interview of eleven participants, between July and August 2012. The analysis and processing of the data were made by means of the method of content analysis, bringing out the safety category of the elderly in the realization of cardiac computed tomography - coronarian angiography. The nursing staff understood that the safety of the elderly in the exam is associated with the ability to assess risks for adverse events related to the administration of the radiopharmaceutical, in which processes, technologies and human interactions intertwine, implying in safe practices.

Surgical Considerations in Older Adults With Cancer

2014 ◽  
Vol 32 (24) ◽  
pp. 2647-2653 ◽  
Author(s):  
Beatriz Korc-Grodzicki ◽  
Robert J. Downey ◽  
Armin Shahrokni ◽  
T. Peter Kingham ◽  
Snehal G. Patel ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Functional Decline ◽  
The Elderly ◽  
Treatment Decisions ◽  
Morbidity And Mortality ◽  
Limiting Factor ◽  
Patients With Cancer ◽  
Cognitive Limitations ◽  
Appropriate Treatment ◽  
Safe Performance

Purpose The aging of the population is a real concern for surgical oncologists, who are increasingly being asked to treat patients who would not have been considered for surgery in the past. In many cases, decisions are made with relatively little evidence, most of which was derived from trials in which older age was a limiting factor for recruitment. Methods This review focuses on risk assessment and perioperative management. It describes the relationship between age and outcomes for colon, lung, hepatobiliary, and head and neck cancer, which are predominantly diseases of the elderly and are a major cause of morbidity and mortality. Results Effective surgery requires safe performance as well as reasonable postoperative life expectancy and maintenance of quality of life. Treatment decisions for potentially vulnerable elderly patients should take into account data obtained from the evaluation of geriatric syndromes, such as frailty, functional and cognitive limitations, malnutrition, comorbidities, and polypharmacy, as well as social support. Postoperative care should include prevention and treatment of complications seen more frequently in the elderly, including postoperative delirium, functional decline, and the need for institutionalization. Conclusion Surgery remains the best modality for treatment of solid tumors, and chronologic age alone should not be a determinant for treatment decisions. With adequate perioperative risk stratification, functional assessment, and oncologic prognostication, elderly patients with cancer can do as well in terms of morbidity and mortality as their younger counterparts. If surgery is determined to be the appropriate treatment modality, patients should not be denied this option because of their age.

scholarly journals Comparing Emergent and Elective Colectomy Outcomes in Elderly Patients: A NSQIP Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Mostapha El Edelbi ◽  
Ibrahim Abdallah ◽  
Rola F. Jaafar ◽  
Hani Tamim ◽  
Samer Deeba ◽  
...  
Keyword(s):  
Elderly Patients ◽  
The Elderly ◽  
Open Colectomy ◽  
Morbidity And Mortality ◽  
Chronic Obstructive ◽  
Chronic Obstructive Pulmonary Disorder ◽  
Improvement Program ◽  
Outcome Differences ◽  
Elective Colectomy ◽  
Emergent Surgery

Introduction. With the increasing prevalence of colorectal cancer (CRC) worldwide, especially in the elderly, and the variability between physiological and chronological age and its impact on functional status, acute symptoms leading to emergent surgery due to colorectal malignancy may lead to increased morbidity and mortality. The aim of this study is to identify the outcome differences of elective vs. emergent open colectomy in patients above 80 years. Methods. The National Surgical Quality Improvement Program (NSQIP) database was reviewed from 2010 to 2014 for open colectomy based on CPT codes. Comparison between groups was done based on the clinical context at presentation as elective or emergent surgery. Data were analyzed using SAS. Results. Elective colectomies were performed in 8289 (70.8%) vs. emergent colectomies in 3409 (29.1%). Emergent colectomy patients had higher American Society of Anesthesiologists (ASA) preoperative classification III-IV, 1429 (42.0%) and 224 (6.6%), vs. 1238 (14.9%) and 21 (0.2%) in elective colectomy patients p < 0.0001 . Emergent colectomy patients had more comorbidities such as chronic obstructive pulmonary disorder (493 (14.5%) vs. 796 (9.6%)), congestive heart failure (206 (6.0%) vs. 310 (3.8%)), dialysis (106 (3.1%) vs. 56 (0.7%)), and acute renal failure (166 (4.9%) vs. 46 (0.6%)) p < 0.0001 , respectively. Postoperative morbidity and mortality were significantly higher in emergent colectomy (1651 (48.4%) and 872 (25.6%)) vs. elective colectomy (1859 (22.4%) and 567 (6.8%)) p < 0.0001 , respectively. Conclusion. Emergent open colectomy in elderly patients carries a higher risk of morbidity and mortality when compared to elective open colectomy with risk factors being higher ASA classification and more comorbidities.

scholarly journals Review: Delirium in the Elderly: A Comprehensive Review

2011 ◽  
Vol 26 (2) ◽  
pp. 97-109 ◽  
Author(s):  
Vikrant Mittal ◽  
Sunanda Muralee ◽  
Deena Williamson ◽  
Nicole McEnerney ◽  
Jennifer Thomas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Early Detection ◽  
Elderly Patients ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
Comprehensive Review ◽  
Medication Effect ◽  
And Behaviors

Delirium is a common neuropsychiatric syndrome in the elderly characterized by concurrent impairments in cognition and behaviors. The etiologies for delirium are often multifactorial and are due to underlying medical illnesses and/or due to medication effect. The diagnosis of delirium is often missed in elderly patients and this condition may be mislabeled as depression or dementia. Untreated, delirium can have devastating consequences in the elderly with high rates of morbidity and mortality. Available evidence indicates that early detection, reduction of risk factors, and better management of this condition can decrease its morbidity rates. In this review, we discuss the etiology, neurobiology, diagnosis, prevention, and treatments for this potentially lethal condition in the elderly.

scholarly journals Clinico-pathological features of colon cancer patients undergoing emergency surgery: a comparison between elderly and non-elderly patients

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 726-734 ◽  
Author(s):  
Gianluca Costa ◽  
Barbara Frezza ◽  
Pietro Fransvea ◽  
Giulia Massa ◽  
Mario Ferri ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Emergency Surgery ◽  
The Elderly ◽  
Mortality Rates ◽  
Elderly Group ◽  
Morbidity And Mortality ◽  
Morbidity Rate ◽  
Emergency Setting ◽  
Tumor Site ◽  
Significant Difference

AbstractBackgroundColorectal cancer (CRC) is one of the most common cancers in patients older than 65 years. Emergency presentation represents about 30% of cases, with increased morbidity and mortality rates. The aim of this study is to compare the perioperative outcome between elderly and non-elderly patients undergoing emergency surgery.MethodWe retrospectively analysed CRC patients that underwent emergency surgery at the Departments of Surgery of the Sapienza University Sant’Andrea Hospital in Rome, and at San Donato Hospital in Arezzo, between June 2012 and June 2017. Patients were divided into two groups: non-elderly (< 65 years) and elderly (≥ 65 years). Variables analysed were sex, onset symptoms, associated disease, ASA score, tumor site and TNM stage, surgical procedures and approach, and morbidity and mortality.ResultsOf a total of 123 patients, 29 patients were non-elderly and 94 patients were elderly. No significant differences were observed in sex, onset symptoms and tumor site between the two groups. Comorbidities were significantly higher in elderly patients (73.4% vs 41.4%, p<0.001). No significant differences were observed between the two groups in surgical approach and the rate of one-stage procedures. Elderly patients were more frequently treated by Hartmann’s procedure compared to non-elderly patients (20.2% vs 6.9%). Left colorectal resection with protective ileostomy was most frequent in the non-elderly group (27.6% vs 11.7%). No significant differences were found in the pT and pN categories of the TNM system between the two groups. However, a higher number of T3 in non-elderly patients was observed. A consistent number of non-oncologically adequate resections were observed in the elderly (21.3% vs 3.5%; p<0.03). The morbidity rate was significantly higher in the elderly group (31.9 % vs 3.4%, p<0.001). No significant difference was found in the mortality rate between the two groups, being 13.8% in the elderly and 6.9% in the non-elderly.ConclusionsEmergency colorectal surgery for cancer still presents significant morbidity and mortality rates, especially in elderly patients. More aggressive tumors and advanced stages were more frequent in the non-elderly group and as a matter it should be taken into account when treating such patients in the emergency setting in order to perform a radical procedure as much as possible.

A survey of psychotropic drug use in elderly psychiatric inpatients

1997 ◽  
Vol 14 (3) ◽  
pp. 108-111 ◽  
Author(s):  
Ruth Loane ◽  
Sheila McGauran ◽  
Con Buckley ◽  
Fenton Howell ◽  
Zachary Johnson ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Psychotropic Drug ◽  
Psychiatric Inpatient ◽  
Alternative Methods ◽  
Hospital Data ◽  
Psychiatric Disturbance ◽  
Elderly Inpatient ◽  
Inpatient Population ◽  
One Year ◽  
Management Issues

AbstractObjective: The objective of the present study was to examine the use of medication in an elderly psychiatric inpatient population.Method: This was a retrospective survey of medication prescribed to the total elderly inpatient population of a single psychiatric hospital. Data collected included basic sociodemographic information, length of stay, number of admissions, frequency of psychiatric disturbance, diagnosis and medication prescribed.Results: A total of 340 cases were studied, 229 (67%) were female, 324 (95%) had been inpatients for more than one year, 111 (33%) suffered from dementia, while the remainder were in the functional category. In 57% more than one psychotropic drug was used. Over half (56%) of those with dementia were on neuroleptic medication.Conclusion: Psychotropic polypharmacy was found in this population of elderly patients. Management issues emphasised include the risk of polypharmacy in this age group, the need for staff education, an active pharmacy committee and alternative methods of managing behavioural disturbance in elderly patients in particular those with dementia.

Sign in / Sign up

Export Citation Format

Share Document