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 Cognitive decline, functional dependency and sociodemographic characteristics in elderly patients with bone fractures

2015 ◽  
Vol 5 (2) ◽  
pp. 221-232
Author(s):  
Ana R. Ortega ◽  
Mª José Calero
Keyword(s):  
Elderly Patients ◽  
Cognitive Decline ◽  
Bone Fractures ◽  
Functional Decline ◽  
The Elderly ◽  
Structured Interview ◽  
Demographic Variables ◽  
Cognitive Status ◽  
Functional Dependency ◽  
Functional Gain

The objective of this paper was to study the evolution of cognitive status and of functional dependency in patients over 65 and how these relate to different demographic variables. The sample consisted of 259 elderly people admitted to the Hospital Neurotraumatológico in Jaen (Spain) with a diagnosis of bone fracture. Sociodemographic data was obtained through a semi-structured interview. Furthermore, the following tests were also administered: Barthel Index, Lawton and Brody’s Scale, Phototest, and Informant Questionnaire on Cognitive Decline in the Elderly. According to the results of this study, elderly patients show increased dependency during hospitalization and a mild recovery at discharge, but without regaining their dependency values prior to hospitalization. There is a differential incidence of functional decline as a function of gender, where women have significantly lower functional dependency at home than men and they do not decline as much as men do from their status prior to hospitalization. Also, we have encountered significant inverse relations between the different levels of dependency and cognitive status, and the age of the elderly patient. Moreover, married patients experienced greater functional gain than did the widowed patients, regardless of gender.

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.

Toll like receptors as a risk factor for early death in elderly cancer patients.

2017 ◽  
Vol 35 (7_suppl) ◽  
pp. 133-133
Author(s):  
Jurema Telles O Lima ◽  
Maria Julia Gonçalves Mello ◽  
Luiz Claudio Santos Thuler ◽  
Letícia Telles Sales ◽  
Marina Santaliz de Godoy Moreno ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Peripheral Blood ◽  
Skin Color ◽  
Protective Factor ◽  
Early Death ◽  
The Elderly ◽  
Nutritional Risk ◽  
Toll Like Receptors ◽  
Patients With Cancer ◽  
Incident Cancer

133 Background: the elderly cancer group is a heterogeneous and growing one. In the elderly, the genes of toll-like receptors (TLR) have been described as related to the immunosenescence process and carcinogenesis. The relationship of this gene family with carcinogenesis and immunoregulatory responses seems a promising field. Methods: Between 2015 and 2016, a prospective cohort study in 445 elderly patients with incident cancer ( ≥ 60 years) at the time of admission, assessed and collected sociodemographic and clinical variables and collected analysis of peripheral blood in translational exploratory study. Determination of TLR2 and TLR9 was performed by flow cytometry with monoclonal antibodies anti-TLR2 and TLR9 in the peripheral blood at the beginning of anti-cancer therapy in older patients with cancer. Results: 445 elderly patients were included with incident cancer, age of 71.13 years (SD 7.41) means. Most were male (50.9%) and self-reported black or brown skin color (71.4%). The topography of prostate cancer was more frequent (29.4%), followed by the digestive system (24.3%). They were mostly patients with advanced stage (III and IV) at nutritional risk (52.6%) and reported using up to 5 medications (77.2%). Patients were followed for an average of 128 days (SD 54.37). During this period, there were 62 deaths (13.9 %) with a mean overall survival of 165 days (95% CI 161.25 to 170.02). There are significant differences in the percentage values of TLR9 (p = 0.0009) and TLR2 (p = 0.04) in monocytes between the groups of patients who died in less than 6 months of treatment and those who survived. Conclusions: Overexpression of TLR9 and TLR2 may be a protective factor for the occurrence of early death in elderly patients with cancer.

scholarly journals Cancer Surgery in the Elderly

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Gopal C. Kowdley ◽  
Nishant Merchant ◽  
James P. Richardson ◽  
Justin Somerville ◽  
Myriam Gorospe ◽  
...  
Keyword(s):  
Decision Making ◽  
Elderly Patients ◽  
The Elderly ◽  
Cancer Surgery ◽  
Decision Making Process ◽  
Benefit Ratio ◽  
Patients With Cancer ◽  
The World ◽  
Surgery In The Elderly ◽  
Surgical Treatments

The proportions both of elderly patients in the world and of elderly patients with cancer are both increasing. In the evaluation of these patients, physiologic age, and not chronologic age, should be carefully considered in the decision-making process prior to both cancer screening and cancer treatment in an effort to avoid ageism. Many tools exist to help the practitioner determine the physiologic age of the patient, which allows for more appropriate and more individualized risk stratification, both in the pre- and postoperative periods as patients are evaluated for surgical treatments and monitored for surgical complications, respectively. During and after operations in the oncogeriatric populations, physiologic changes occuring that accompany aging include impaired stress response, increased senescence, and decreased immunity, all three of which impact the risk/benefit ratio associated with cancer surgery in the elderly.

Supportive Care Considerations for Older Adults With Cancer

2014 ◽  
Vol 32 (24) ◽  
pp. 2627-2634 ◽  
Author(s):  
Arash Naeim ◽  
Matti Aapro ◽  
Rashmi Subbarao ◽  
Lodovico Balducci
Keyword(s):  
Elderly Patients ◽  
Supportive Care ◽  
Chronic Conditions ◽  
Treatment Options ◽  
The Elderly ◽  
Strongly Correlated ◽  
Lifestyle Management ◽  
Patients With Cancer ◽  
Age Appropriate

The treatment of cancer presents specific concerns that are unique to the growing demographic of elderly patients. Because the incidence of cancer is strongly correlated with aging, the expansion of supportive care and other age-appropriate therapies will be of great importance as the population of elderly patients with cancer increases in the coming years. Elderly patients are especially likely to experience febrile neutropenia, complications from chemotherapy-induced nausea, anemia, osteoporosis (especially in patients diagnosed with breast or prostate cancer), depression, insomnia, and fatigue. These issues are often complicated by other chronic conditions related to age, such as diabetes and cardiac disease. For many patients, symptoms may be addressed both through lifestyle management and pharmaceutical approaches. Therefore, the key to improving quality of life for the elderly patient with cancer is an awareness of their specific needs and a familiarity with emergent treatment options.

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.

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.

Impact of Age and Comorbidity in Myelodysplastic Syndromes

2008 ◽  
Vol 6 (9) ◽  
pp. 927-934 ◽  
Author(s):  
Reinhard Stauder ◽  
Thomas Nösslinger ◽  
Michael Pfeilstöcker ◽  
Wolfgang R. Sperr ◽  
Friedrich Wimazal ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Elderly Patients ◽  
Myelodysplastic Syndromes ◽  
Intensive Therapy ◽  
Functional Decline ◽  
Surrogate Marker ◽  
Scoring Systems ◽  
The Elderly ◽  
Western World ◽  
Comorbidity Scores

Myelodysplastic syndromes (MDS) represent a heterogeneous group of myeloid neoplasms that are preferentially diagnosed in the elderly. With the increase in older patients with MDS in the Western world and the availability of more therapeutic options, new strategies and algorithms for optimal management and treatment of these patients must be developed. Although age is recognized as an important adverse variable affecting survival, most scoring systems have not included age in score risk calculations. Comorbidity is of particular importance and a frequent covariable in elderly patients with MDS. However, although comorbidity scores have been established and used for risk assessment in younger high-risk patients scheduled to undergo intensive therapy, these scores are only just being applied to elderly patients, with relevant results. Advanced age should not exclude a patient with MDS from appropriate treatment, and age alone should not be considered a surrogate marker for functional decline or comorbidities. This article discusses the need to improve scoring systems, individualized risk-assessment, and treatment algorithms for elderly patients with MDS by including age and comorbidities.

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