Preoperative Evaluation of the Elderly Surgical Patient

2017 ◽  
Author(s):  
Tracy S. Wang ◽  
Jennifer Roberts
Keyword(s):  
Functional Status ◽  
Surgical Outcomes ◽  
Patient Population ◽  
Preoperative Evaluation ◽  
The Elderly ◽  
Diagnostic Approach ◽  
Surgical Patient ◽  
Specific Patient ◽  
Specific Patient Population ◽  
Specific Disease

The following is a detailed approach to the preoperative evaluation of the elderly surgical patient. A focus is placed on physiologic changes in the elderly that predispose them to complications and a systems-based approach to appropriate perioperative evaluation. Specifically, recommendations on the workup of cardiovascular, pulmonary, and renal systems are discussed. We also introduce the concept of frailty as a measure of an elderly patient's overall physiologic reserve. Finally, a diagnostic approach to common elderly-specific disease processes such as decreased functional status, malnutrition, and delirium is outlined. Throughout, an emphasis is placed on how to carefully assess this specific patient population and optimize preoperative functional status to improve surgical outcomes in the elderly. This review has 1 figure, 4 tables, and 62 references.

scholarly journals You Are Only as Frail as Your Arteries: Prehabilitation of Elderly Surgical Patients

2019 ◽  
Vol 9 (4) ◽  
pp. 380-386
Author(s):  
Matthew J. Durand ◽  
Angela K. Beckert ◽  
Carrie Y. Peterson ◽  
Kirk A. Ludwig ◽  
Timothy J. Ridolfi ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Functional Capacity ◽  
Surgical Outcomes ◽  
Vascular Function ◽  
Elderly Population ◽  
The Elderly ◽  
Surgical Patients ◽  
Surgical Patient ◽  
Effective Strategy ◽  
Preoperative Period

Abstract Purpose of Review To discuss the concept of prehabilitation for the elderly frail surgical patient as well as strategies to improve preoperative functional capacity and vascular function to decrease postoperative complications. Recent Findings Frailty is associated with poor surgical outcomes yet there is no consensus on how frailty should be measured or mitigated in the preoperative period. Prehabilitation, or improving functional capacity prior to surgery typically through exercise, has been shown to be an effective strategy to decrease preoperative frailty and improves surgical outcomes. Use of remote ischemic preconditioning (RIPC) may serve as an alternative to exercise in this fragile patient population. Summary Prehabilitation programs using strategies targeted at improving vascular function may decrease frailty in the preoperative period and improve surgical outcomes in the elderly population.

Using a Group Workshop to Encourage Collaborative Learning in an Undergraduate Counseling Course

1993 ◽  
Vol 20 (2) ◽  
pp. 108-110 ◽  
Author(s):  
Gary S. Goldstein
Keyword(s):  
Collaborative Learning ◽  
Therapeutic Intervention ◽  
Patient Population ◽  
Collaborative Work ◽  
Specific Patient ◽  
Specific Patient Population ◽  
Advanced Study ◽  
Upper Level

This article summarizes a collaborative learning project for an upper level undergraduate counseling course. Groups of students designed and presented a workshop on a therapeutic intervention for a specific patient population. Each student also wrote a paper on an individually selected topic. Examples of students' workshops, reactions to and evaluations of the assignment, and grading procedures are described. The assignment provides a model for the kind of collaborative work students may encounter in advanced study.

Regulatory Issues on Behavioral and Psychological Symptoms of Dementia in the United States

2000 ◽  
Vol 12 (S1) ◽  
pp. 331-336 ◽  
Author(s):  
Thomas Laughren
Keyword(s):  
United States ◽  
Patient Population ◽  
Psychological Symptoms ◽  
The United States ◽  
Specific Patient ◽  
Regulatory Issues ◽  
Broad Category ◽  
Drug Labeling ◽  
Specific Patient Population ◽  
Behavioral And Psychological Symptoms

The entity, behavioral and psychological symptoms of dementia (BPSD), is a useful concept in that it focuses attention on an aspect of dementia that has long been ignored in both research and treatment. Although it is useful as a broad category that includes a number of more specific clinical entities, BPSD is too broad a target to serve as an indication for a particular drug. Labeling with such a claim would be potentially misleading because it would not be clear what specific patient population would likely benefit from treatment.

An analysis of epidural related pressure sores in a specific patient population

Acute Pain ◽  
2003 ◽  
Vol 5 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Fiona Duncan ◽  
Carol Haigh ◽  
Stephen Bailey
Keyword(s):  
Patient Population ◽  
Pressure Sores ◽  
Specific Patient ◽  
Specific Patient Population

Preoperative Evaluation of the Elderly Surgical Patient

2017 ◽  
Author(s):  
Tracy S. Wang ◽  
Jennifer Roberts ◽  
Nicholas G Berger
Keyword(s):  
Risk Assessment ◽  
Elderly Population ◽  
Preoperative Evaluation ◽  
Hospital Costs ◽  
The Elderly ◽  
The United States ◽  
Surgical Patient ◽  
Key Words Aging ◽  
Major Morbidity ◽  
Short Term Mortality

The elderly population uses a significant portion of health care resources in the United States and poses an increasing challenge to perioperative care. Many reports point to both increasing age and frailty as important risk factors for short-term mortality; cardiovascular, pulmonary, and renal complications; and increased length of stay and hospital costs following operation. To provide the best care for the aging US population, it is important for the clinician to be familiar with the appropriate presurgical workup specific to the comorbidities prevalent to the elderly population. This review discusses the postoperative complications facing elderly surgical patients and the physiologic complications of aging, with a particular emphasis on the concept of frailty as a predictor of major morbidity and mortality. With age and comorbidities in mind, this review discusses the relevant preoperative cardiovascular, respiratory, and renal workup and includes important guidelines for appropriate risk assessment and reduction in the elderly surgical patient. This review contains 1 figure, 5 tables, and 86 references. Key words: aging, anesthesia, elderly, frailty, outcomes, preoperative workup, risk assessment

Problems of generalization of findings. Regulatory attitudes

1994 ◽  
Vol 9 (3) ◽  
pp. 143-144 ◽  
Author(s):  
U Kern
Keyword(s):  
Clinical Trials ◽  
Major Depression ◽  
Clinical Studies ◽  
Patient Population ◽  
Study Data ◽  
Specific Patient ◽  
Need For Treatment ◽  
Specific Patient Population ◽  
Valid Data ◽  
Animal Exposure

To approve a drug means to release it for use in a specific patient population which should be characterized as clearly as possible in the labelled indications in the Summary of Product Characteristics (eg patients with major depression according to DSM III-R).Ideally, the patient samples in various clinical trials should be representative of this specific patient population, and the crucial question is whether the study data allow an extrapolation to the wider patient population which we intend to treat.Basically, what is valid for preclinical data and animal exposure, should also be valid for humans: more or less all regulatory authorities agree that they should accept valid data and information from all regions and all clinical studies available in order to minimize unnecessary human exposures and needless duplication. This is especially important in therapeutic fields where there is an urgent need for treatment due to the lack of suitable alternatives.

Preoperative Evaluation of the Elderly Surgical Patient

2017 ◽  
Author(s):  
Tracy S. Wang ◽  
Jennifer Roberts ◽  
Nicholas G Berger
Keyword(s):  
Risk Assessment ◽  
Elderly Population ◽  
Preoperative Evaluation ◽  
Hospital Costs ◽  
The Elderly ◽  
The United States ◽  
Surgical Patient ◽  
Key Words Aging ◽  
Major Morbidity ◽  
Short Term Mortality

The elderly population uses a significant portion of health care resources in the United States and poses an increasing challenge to perioperative care. Many reports point to both increasing age and frailty as important risk factors for short-term mortality; cardiovascular, pulmonary, and renal complications; and increased length of stay and hospital costs following operation. To provide the best care for the aging US population, it is important for the clinician to be familiar with the appropriate presurgical workup specific to the comorbidities prevalent to the elderly population. This review discusses the postoperative complications facing elderly surgical patients and the physiologic complications of aging, with a particular emphasis on the concept of frailty as a predictor of major morbidity and mortality. With age and comorbidities in mind, this review discusses the relevant preoperative cardiovascular, respiratory, and renal workup and includes important guidelines for appropriate risk assessment and reduction in the elderly surgical patient. This review contains 1 figure, 5 tables, and 86 references. Key words: aging, anesthesia, elderly, frailty, outcomes, preoperative workup, risk assessment

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