Preoperative assessment and preparation of elderly patients undergoing major surgery

2017 ◽  
Author(s):  
Chris Dodds ◽  
Chandra M. Kumar ◽  
Frédérique Servin
Keyword(s):  
Elderly Patients ◽  
Elective Surgery ◽  
Preoperative Assessment ◽  
The Elderly ◽  
Major Surgery ◽  
Patient Factors ◽  
Functional Reserve ◽  
Behavioural Adaptation ◽  
Disease States ◽  
Better Than

The benefits to the elderly of current surgical advances are as good as or better than to younger patients. Preassessment serves to individualize operative decisions to optimize the patient’s condition and improve the outcome. These processes require experienced surgical and anaesthetic input. General patient factors are detailed, including communication skills, behavioural adaptation, functional reserve, cognitive function, and frailty. Systematic comorbidities, such as cardiovascular, neurological, respiratory, renal and nutritional status are discussed. The risk/benefit of the proposed procedure, which is often assessed using risk-stratification systems, is reviewed. Time to full recovery and the duration of convalescence are identified as lacking appropriate data at present. Finally, the emerging data on active, multidisciplinary ‘prehabilitation’ before surgery to improve and optimize the general fitness, chronic disease states, and medication of elderly patients in the weeks before elective surgery are examined.

Anaesthesia for the Elderly Patient (Oxford Anaesthsia Library)

2017 ◽  
Author(s):  
Chris Dodds ◽  
Chandra M. Kumar ◽  
Frédérique Servin
Keyword(s):  
Elderly Patient ◽  
Elderly Patients ◽  
Independent Living ◽  
Ethical Issues ◽  
Preoperative Assessment ◽  
The Elderly ◽  
Day Surgery ◽  
Gynaecological Surgery ◽  
Current State

This book provides a timely and authoritative synopsis of the current state of anaesthesia and the elderly patient at a time when the challenge of caring for the growing numbers of elderly patients is probably the greatest faced by healthcare across the globe. The book reviews important developments in the understanding of clinical practice serving the elderly. It describes the need for anaesthesia to deliver ‘best care’ to the elderly, with the aim to maintain their independent living. It then details the key features of ageing and the effect these have on physiology and pharmacology. Specific aspects of practice, including preoperative assessment; day surgery; emergency surgery; anaesthesia for orthopaedic, urological, and gynaecological surgery, as well as major abdominal surgery; neurosurgery; and critical care. Emphasis is placed on managing postoperative care and cognitive dysfunction (POCD), with additional discussion of ethical issues and the law pertaining to the elderly patient. A new chapter reviews the challenges of treating elderly patients in non-theatre environments.

Relationship Between the Administration of Selected Medications and Falls in Hospitalized Elderly Patients

1995 ◽  
Vol 29 (4) ◽  
pp. 354-358 ◽  
Author(s):  
Barry J Gales ◽  
Susan M Menard
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
Half Life ◽  
The Elderly ◽  
Disease States ◽  
Hospitalized Elderly ◽  
Benzodiazepine Use ◽  
Hospitalized Elderly Patients ◽  
The Relationship ◽  
Digoxin Therapy

Objective: To examine the relationship between administration of selected medications and falls experienced by hospitalized elderly patients. Benzodiazepines and other medications previously associated with falls in elderly patients residing in the community and nursing homes were the primary focus. Design: Retrospective case control. Setting: Private, not-for-profit, 575-bed acute care hospital. Participants: A total of 100 patients who had fallen and 100 control patients, aged at least 70 years, admitted during the same 17-month time period. Main Outcome Measures: We examined the relationship between falls and patient demographics, underlying disease states, number of concurrent disease states, and length of hospitalization. Possible associations between the administration of narcotics, benzodiazepines, antidepressants, antipsychotics, other sedating agents, antihypertensives, diuretics, nitrates, and digoxin 48 hours prior to the fall or reference day were explored. The relationships between benzodiazepine half-life, dosage, administration frequency, cumulative dose, and falls were also examined. Results: Demographically the groups were similar except that patients who had fallen were hospitalized significantly longer (mean 18.8 vs 12.2 d; p < 0.00001) than control patients. Benzodiazepines were received by more (40% vs 20%, odds ratio = 2.67) patients who had fallen than control patients. The use of long (>24 h) half-life benzodiazepines was similar in patients who had fallen (48%) and control patients (45%). Long half-life benzodiazepines were commonly administered (65%) to patients who had fallen in doses greater than that recommended for the elderly. Benzodiazepine use, expressed as milligrams of diazepam equivalents received during the 48-hour study, was higher in patients who had fallen than in control patients (15.00 ± 17.80 vs 9.73 ± 6.58 mg), but this was not statistically significant (p = 0.1030). Congestive heart failure (37% vs 24%), digoxin therapy (35% vs 22%), or administration of 3 or more psychoactive agents (17% vs 4%) were all more common in patients who had fallen than in control patients. Conclusions: Falls experienced by the elderly patients in our acute care institution were associated with the presence of congestive heart failure along with digoxin therapy, benzodiazepine use, or the use of at least 3 psychoactive agents.

scholarly journals Frailty as a growing challenge for anesthesiologists – results of a Dutch national survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
A. Bouwhuis ◽  
C. E. van den Brom ◽  
S. A. Loer ◽  
C. S. E. Bulte
Keyword(s):  
Elderly Patients ◽  
Frail Elderly ◽  
Perioperative Care ◽  
Elderly Population ◽  
Multidisciplinary Approach ◽  
Anesthetic Management ◽  
The Elderly ◽  
Adverse Outcomes ◽  
Functional Reserve ◽  
Patient File

Abstract Background Frailty is a multidimensional condition characterized by loss of functional reserve, which results in increased vulnerability to adverse outcomes following surgery. Anesthesiologists can reduce adverse outcomes when risk factors are recognized early and dedicated care pathways are operational. As the frail elderly population is growing, we investigated the perspective on the aging population, familiarity with the frailty syndrome and current organization of perioperative care for elderly patients among Dutch anesthesiologists. Methods A fifteen-item survey was distributed among anesthesiologists and residents during the annual meeting of the Dutch Society of Anesthesiology. The first section included questions on self-reported competence on identification of frailty, acquaintance with local protocols and attitude towards the increasing amounts of elderly patients presenting for surgery. The second part included questions on demographic features of the participant such as job position, experience and type of hospital. Answers are presented as percentages, using the total number of replies for the question per group as a denominator. Results A sample of 132 surveys was obtained. The increasing number of elderly patients was primarily perceived as challenging by 76% of respondents. Ninety-nine percent agreed that frailty should influence anesthetic management, while 85% of respondents claimed to feel competent to recognize frailty. Thirty-four percent of respondents reported the use of a dedicated pathway in the preoperative approach of frail elderly patients. However, only 30% of respondents reported to know where to find the frailty screening in the patient file and appointed that frailty is not consistently documented. Interestingly, only 43% of respondents reported adequate collaboration with geriatricians. This could include for example a standardized preoperative multidisciplinary approach or dedicated pathway for the elderly patient. Conclusions This survey demonstrated that the increasing number of frail elderly patients is perceived as important and relevant for anesthetic management. Opportunities lie in improving the organization and effectuation of perioperative care by more consistent involvement of anesthesiologists.

scholarly journals Efficacy and tolerability of fixed association of oxycodone and naloxone in elderly patients with ribs fracture: An 18-month retrospective study

2019 ◽  
Vol 15 (2) ◽  
Author(s):  
Alessandro Riccardi ◽  
Beatrice Spinola ◽  
Pierangela Minuto ◽  
Marco Licenziato ◽  
Valeria Ghiglione ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Elderly Patients ◽  
The Elderly ◽  
Pain Scale ◽  
Rib Fractures ◽  
Multiple Rib Fractures ◽  
Short And Long Term ◽  
Inflammatory Drugs ◽  
Better Than

Blunt chest trauma with isolated or multiple rib fractures constitutes a common presentation in Emergency Department (ED), particularly in elderly people. Rib fractures in the elderly create short- and long-term disabilities with a dramatic impact. Pain management in the elderly could be problematic due to non-steroidal anti-inflammatory drugs (NSAIDs) contraindication or interaction with other drugs. We performed this retrospective study collecting and retrieving all patients aged 65 or older, with a diagnosis of rib(s) fracture(s) during an 18-month period. We analyzed the different treatments chosen, and divided them into subgroups: oxycodone- naloxone, and other treatments (also divided in: codeineacetaminophen; NSAID or Acetaminophen; Tramadol or Tapentadol). A total of 475 elderly patients (aged 65 and older) with single or multiple rib fractures were evaluated in our ED in 18 months: of these 410 patients were considered eligible, with a mean age of 79.28 years (standard deviation 7.83). 185 were male and 225 were female. Our study confirms the efficacy and tolerability of fixed association of oxycodone and naloxone. This association determined the highest and fastest reduction on Numeric Pain Scale reported by patients and is significantly better than other drugs in oral administration.

scholarly journals Intraoperative transfusion practices and perioperative outcome in the European elderly: A secondary analysis of the observational ETPOS study

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262110
Author(s):  
Linda Grüßer ◽  
András Keszei ◽  
Mark Coburn ◽  
Rolf Rossaint ◽  
Sebastian Ziemann ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Elderly Population ◽  
Elective Surgery ◽  
Secondary Analysis ◽  
The Elderly ◽  
Transfusion Practice ◽  
Demographic Development ◽  
Red Blood Cell Transfusions ◽  
The Mean ◽  
Dramatic Growth

The demographic development suggests a dramatic growth in the number of elderly patients undergoing surgery in Europe. Most red blood cell transfusions (RBCT) are administered to older people, but little is known about perioperative transfusion practices in this population. In this secondary analysis of the prospective observational multicentre European Transfusion Practice and Outcome Study (ETPOS), we specifically evaluated intraoperative transfusion practices and the related outcomes of 3149 patients aged 65 years and older. Enrolled patients underwent elective surgery in 123 European hospitals, received at least one RBCT intraoperatively and were followed up for 30 days maximum. The mean haemoglobin value at the beginning of surgery was 108 (21) g/l, 84 (15) g/l before transfusion and 101 (16) g/l at the end of surgery. A median of 2 [1–2] units of RBCT were administered. Mostly, more than one transfusion trigger was present, with physiological triggers being preeminent. We revealed a descriptive association between each intraoperatively administered RBCT and mortality and discharge respectively, within the first 10 postoperative days but not thereafter. In our unadjusted model the hazard ratio (HR) for mortality was 1.11 (95% CI: 1.08–1.15) and the HR for discharge was 0.78 (95% CI: 0.74–0.83). After adjustment for several variables, such as age, preoperative haemoglobin and blood loss, the HR for mortality was 1.10 (95% CI: 1.05–1.15) and HR for discharge was 0.82 (95% CI: 0.78–0.87). Pre-operative anaemia in European elderly surgical patients is undertreated. Various triggers seem to support the decision for RBCT. A closer monitoring of elderly patients receiving intraoperative RBCT for the first 10 postoperative days might be justifiable. Further research on the causal relationship between RBCT and outcomes and on optimal transfusion strategies in the elderly population is warranted. A thorough analysis of different time periods within the first 30 postoperative days is recommended.

scholarly journals Characterization of Inflammatory Bowel Disease in Elderly Patients: A Review of Epidemiology, Current Practices and Outcomes of Current Management Strategies

2015 ◽  
Vol 29 (6) ◽  
pp. 327-333 ◽  
Author(s):  
Peter Stepaniuk ◽  
Charles N Bernstein ◽  
Laura E Targownik ◽  
Harminder Singh
Keyword(s):  
Inflammatory Bowel Disease ◽  
Elderly Patients ◽  
Bowel Disease ◽  
Elective Surgery ◽  
The Elderly ◽  
Colonic Disease ◽  
Aminosalicylic Acid ◽  
Inflammatory Bowel ◽  
New Diagnosis ◽  
To Receive

The authors review and summarize the current literature regarding the epidemiology, clinical presentation and management of inflammatory bowel disease (IBD) in elderly patients.Among elderly patients, the incidence of ulcerative colitis (UC) is higher than that of Crohn disease (CD). Elderly patients with a new diagnosis of UC are more likely to be male and have left-sided colitis. Elderly patients with a new diagnosis of CD are more likely to be female and have colonic disease. Conversely, increasing age at diagnosis has been associated with a lower likelihood of having any of a family history of IBD, perianal disease in CD and extraintestinal manifestations. Although response to drug therapies appears to be similar in elderly patients and younger individuals, the elderly are more likely to receive 5-aminosalicylic acid agents, and less likely to receive immunomodulators and biologics. Corticosteroid use in the elderly is comparable with use in younger individuals. The rates of surgical intervention appear to be lower for elderly CD patients but not elderly UC patients. Elderly individuals with UC are more likely to need urgent colectomy, which is associated with an increased mortality rate. Elective surgery is associated with similar outcomes among the elderly and young patients with IBD. Therefore, the use of immunomodulators and biologics, and earlier consideration of elective surgery for medically refractory disease in elderly patients with IBD, should be emphasized and further evaluated to prevent complications of chronic corticosteroid(s) use and to prevent emergency surgery.

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

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8537-8537 ◽  
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.

106 Precipitating factors in the elderly patients admitted with the diagnosis of heart failure. Are easy to find?

2006 ◽  
Vol 5 (1) ◽  
pp. 25-26
Author(s):  
R VIDALPEREZ ◽  
E ABUASSI ◽  
M PARAMODEVEGA ◽  
P VELOSO ◽  
A VARELAROMAN ◽  
...  
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
The Elderly ◽  
Precipitating Factors

Evaluation of R-CHOP and R-CVP in the treatment of elderly patient with non-Hodgkin lymphoma

MedPharmRes ◽  
2019 ◽  
Vol 3 (3) ◽  
pp. 1-6
Author(s):  
Truc Phan ◽  
Tram Huynh ◽  
Tuan Q. Tran ◽  
Dung Co ◽  
Khoi M. Tran
Keyword(s):  
Elderly Patients ◽  
Hodgkin Lymphoma ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
The Elderly ◽  
Free Survival ◽  
Non Hodgkin Lymphoma ◽  
Common Sign ◽  
Related Mortality

Introduction: Little information is available on the outcomes of R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine and prednisone) and R-CVP (rituximab with cyclophosphamide, vincristine and prednisone) in treatment of the elderly patients with non-Hodgkin lymphoma (NHL), especially in Vietnam. Material and methods: All patients were newly diagnosed with CD20-positive non-Hodgkin lymphoma (NHL) at Blood Transfusion and Hematology Hospital, Ho Chi Minh city (BTH) between 01/2013 and 01/2018 who were age 60 years or older at diagnosis. A retrospective analysis of these patients was perfomed. Results: Twenty-one Vietnamese patients (6 males and 15 females) were identified and the median age was 68.9 (range 60-80). Most of patients have comorbidities and intermediate-risk. The most common sign was lymphadenopathy (over 95%). The proportion of diffuse large B cell lymphoma (DLBCL) was highest (71%). The percentage of patients reaching complete response (CR) after six cycle of chemotherapy was 76.2%. The median follow-up was 26 months, event-free survival (EFS) was 60% and overall survival (OS) was 75%. Adverse effects of rituximab were unremarkable, treatment-related mortality accounted for less than 10%. There was no difference in drug toxicity between two regimens. Conclusions: R-CHOP, R-CVP yielded a good result and acceptable toxicity in treatment of elderly patients with non-Hodgkin lymphoma. In patients with known cardiac history, omission of anthracyclines is reasonable and R-CVP provides a competitive complete response rate.

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