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.

scholarly journals The role of the internal medicine specialist in the management of infective complications in general surgical wards

2013 ◽  
pp. 12-19
Author(s):  
Patrizia Zoboli ◽  
Giuseppe Chesi ◽  
Fabrizio Boni ◽  
Federica Maselli ◽  
Lisa Zambianchi
Keyword(s):  
Internal Medicine ◽  
Elderly Patients ◽  
Risk Evaluation ◽  
Medical Condition ◽  
The Elderly ◽  
Operative Management ◽  
Surgical Team ◽  
Medical Consultant ◽  
Post Surgery

BACKGROUND Internal medicine specialists are often asked to evaluate a patient before surgery. Perioperative risk evaluation for elderly patients is important, because complications increase with age. The increasing age of the general population increases the probabilities of surgery in the older patients. The manifestation of a surgical problem, is more likely to be severe and complicated in the elderly patients. In fact, emergency surgery treatment occurs more frequently in the elderly (e.g., it is much more common to see intestinal obstruction complicating colorectal cancer in the elderly compared with a younger population). Old age is an independent factor for long hospital stay after surgery. The role of the preoperative medical consultant is to identify and evaluate a patient’s current medical status and provide a clinical risk profile, in order to decide whether further tests are indicated prior to surgery, and to optimise the patient’s medical condition in the attempt of reducing the risk of complications. The medical consultant must know which medical condition could eventually influence the surgery, achieve a good contact and communication between the medical and surgical team, in order to obtain the best management planning. AIM OF THE STUDY This paper focuses on the rational use of antibiotic prophylaxis and on the treatment of the complications of post-surgery infections (e.g., pulmonary complication, peritonitis, intra-abdominal infection). Specific aspects of pre-operative risk evaluation and peri and post-operative management are discussed. CONCLUSIONS The internal medicin specialist in collaboration with the surgical team is necessary in the peri and post-surgery management.

scholarly journals Multicenter phase III randomized trial comparing laparoscopy and laparotomy for colon cancer surgery in patients older than 75 years: the CELL study, a Fédération de Recherche en Chirurgie (FRENCH) trial

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Gilles Manceau ◽  
Antoine Brouquet ◽  
Pascal Chaibi ◽  
Guillaume Passot ◽  
Olivier Bouché ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Elderly Patients ◽  
Randomized Trial ◽  
Postoperative Morbidity ◽  
The Elderly ◽  
Cancer Surgery ◽  
Phase Iii ◽  
Randomized Controlled ◽  
Colon Cancer Surgery

Abstract Background Several multicenter randomized controlled trials comparing laparoscopy and conventional open surgery for colon cancer have demonstrated that laparoscopic approach achieved the same oncological results while improving significantly early postoperative outcomes. These trials included few elderly patients, with a median age not exceeding 71 years. However, colon cancer is a disease of the elderly. More than 65% of patients operated on for colon cancer belong to this age group, and this proportion may become more pronounced in the coming years. In current practice, laparoscopy is underused in this population. Methods The CELL (Colectomy for cancer in the Elderly by Laparoscopy or Laparotomy) trial is a multicenter, open-label randomized, 2-arm phase III superiority trial. Patients aged 75 years or older with uncomplicated colonic adenocarcinoma or endoscopically unresectable colonic polyp will be randomized to either colectomy by laparoscopy or laparotomy. The primary endpoint of the study is overall postoperative morbidity, defined as any complication classification occurring up to 30 days after surgery. The secondary endpoints are: 30-day and 90-day postoperative mortality, 30-day readmission rate, quality of surgical resection, health-related quality of life and evolution of geriatric assessment. A 35 to 20% overall postoperative morbidity rate reduction is expected for patients operated on by laparoscopy compared with those who underwent surgery by laparotomy. With a two-sided α risk of 5% and a power of 80% (β = 0.20), 276 patients will be required in total. Discussion To date, no dedicated randomized controlled trial has been conducted to evaluate morbidity after colon cancer surgery by laparoscopy or laparotomy in the elderly and the benefits of laparoscopy is still debated in this context. Thus, a prospective multicenter randomized trial evaluating postoperative outcomes specifically in elderly patients operated on for colon cancer by laparoscopy or laparotomy with curative intent is warranted. If significant, such a study might change the current surgical practices and allow a significant improvement in the surgical management of this population, which will be the vast majority of patients treated for colon cancer in the coming years. Trial registration ClinicalTrials.gov NCT03033719 (January 27, 2017).

Postoperative care and analgesia

2017 ◽  
Author(s):  
Chris Dodds ◽  
Chandra M. Kumar ◽  
Frédérique Servin
Keyword(s):  
Elderly Patients ◽  
Hearing Aids ◽  
Postoperative Care ◽  
The Elderly ◽  
Individual Variability ◽  
Residual Effects ◽  
Impaired Hearing ◽  
Patient Controlled Analgesia ◽  
Anaesthetic Agents ◽  
Delayed Recovery

There are many reasons for delayed recovery, but, usually, it is due to residual effects of anaesthetic agents/premedication. There are guidelines for recognizing and managing these cases. Emergence delirium may be dangerous, and it should be recognized and treated as an emergency. Elderly patients may have impaired hearing and vision. Spectacles and hearing aids should be given back to them as soon as possible in the recovery area to limit disorientation. Pain and its intensity may be difficult to recognize and quantify in the elderly. Increased inter-individual variability in the elderly means that titration to effect rather than a fixed dosage is essential, and when the mental status of the patient allows it, patient-controlled analgesia (PCA) is quite appropriate.

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.

Social Representations of Nurses on Medical Safety Culture in Clinical Care for Elderly People

2021 ◽  
pp. 319-328
Author(s):  
Maria do Céu Mendes Pinto Marques ◽  
Francisca Tereza Galiza ◽  
Maria Célia Freitas ◽  
Maria Vilani Cavalcante Guedes
Keyword(s):  
Elderly Patients ◽  
Elderly People ◽  
Nursing Care ◽  
Drug Safety ◽  
Social Representations ◽  
Clinical Care ◽  
The Elderly ◽  
Exploratory Research ◽  
Care For The Elderly ◽  
Clinical Nursing

Evaluating the culture of drug safety, of certain services, and specific subjects, especially for the elderly population, makes it possible to identify gaps in clinical nursing care. The study aimed to analyze the social representations of nurses regarding the culture of drug safety in clinical care for the elderly people. This is a descriptive and exploratory research of qualitative nature, having the theoretical support of social representations. The chapter samples 38 nurses via interview and a non-participant observation. Analysis is done using Alceste software. This resulted in seven stable classes, and Class 3 had the largest representation, 23% of the corpus. Class 3 maintained hierarchical and semantic proximity to Class 2, which deals with technologies to ensure the safety of elderly patients in the use of medicines. For nurses, technologies help in the safety of elderly patients, but do not guarantee the extinction of adverse events. The chapter considered the need for patient safety to become an organizational culture favoring the quality of clinical nursing care in the handling of medicines.

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.

A Successful Strategy for Recruiting Elderly Patients with Mild Hyperparathyroidism into a Randomized Controlled Trial

2010 ◽  
Vol 2 (1) ◽  
pp. 29-32
Author(s):  
Nancy D Perrier ◽  
Joshua MV Mammen ◽  
Safia Rafeeq ◽  
Holly Holmes ◽  
Nancy E Thompson ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Elderly Patients ◽  
Chronic Conditions ◽  
Older Persons ◽  
Medical Condition ◽  
Controlled Trial ◽  
Treatment Strategies ◽  
The Elderly ◽  
Treatment Trials ◽  
Surgical Trial

ABSTRACT Objective Effective strategies that improve the inclusion of older persons in clinical trials are needed to better characterize and treat chronic conditions that affect elderly patients. Especially challenging is the recruitment of the elderly into treatment trials for chronic conditions with vague symptoms, as is the case for primary hyperparathyroidism. The incidence of primary hyperparathyroidism increases with age, and the disease may present with symptoms that are difficult to objectively measure but contribute to decline of function and quality of life. Understanding the optimal treatment of primary hyperparathyroidism necessitates inclusion of greater numbers of older persons in treatment trials. As a part of our study of asymptomatic hyperparathyroidism, we also devised a strategy to recruit and retain older persons in a randomized surgical trial for primary hyperparathyroidism. Design Individuals greater than 60 years of age who did not meet established criteria for surgical intervention for primary hyperparathyroidism were offered the opportunity to participate in a clinical study evaluating the benefits of immediate minimally invasive parathyroidectomy (MIP) vs medical observation. Intervention Strategies to encourage participation and compliance included compensation for incidental expenses of lodging, meals, and travel for clinic visits related to the study as well as regular interaction with an experienced study coordinator. Measurements Study participation included formal neurocognitive evaluations, functional magnetic resonance brain imaging, functional performance batteries, and sleep studies over a 6-month period. Results Thirty-five individuals ranging in age from 61 to 79 years were screened for participation. Nine individuals were ineligible, and 14 of eligible individuals consented to participate in the study. Among the 12 eligible individuals who declined to participate, the most common reason identified was distance to study center. Conclusion We report an effective strategy to recruit a substantial proportion of eligible elderly individuals as subjects in a study of treatment strategies for a medical condition with few overt symptoms.

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

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