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

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

scholarly journals Implications of Education and Prehabilitation on the Geriatric Surgical Patient

2017 ◽  
Author(s):  
Theadore Hufford ◽  
Jonathan Rubin ◽  
Ghaith Al-Qudah ◽  
Michael Prendergast
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Elderly Population ◽  
Community Hospital ◽  
Surrogate Marker ◽  
The Elderly ◽  
The United States ◽  
Low Risk ◽  
Surgical Patient ◽  
Discharge Disposition

INTRODUCTION Recently there has been a significant increase in age in the United States. It is necessary to better understand the physiological and surgical needs of these patients in order to optimize outcomes. The vast majority of procedures performed in adult patients are low-risk operations, such as laparoscopic cholecystectomy. Our aim is to investigate the outcomes, including length of stay, morbidity, mortality, re-admission and discharge disposition of the elderly population (>80) undergoing low-risk operations in our tertiary community hospital. METHODS A retrospective chart review was done at a tertiary community hospital. The time frame utilized was 2011-2015. Patients were excluded only on the basis of their age (< 80) at the time of operation. RESULTS There were a total of 30 patients who underwent laparoscopic cholecystectomy from 2011 to 2015. 21 patients (70%) were female and 9 (30%) were male. No patients were converted to an open procedure. The average age was 86.4 years and average ASA classification prior to surgery was 2.88. Higher ASA class, specifically those that were class III/IV were more likely to have an increased length of stay that was statistically significant. Overall age greater than 80 was an independent risk factor for transfer to a higher level of care upon discharge (SNF, LTAC, etc.), a surrogate marker for physical decompensation following surgery. CONCLUSIONS Routine surgery, such as the laparoscopic cholecystectomy, effects the elderly population in a more substantial way, and early recognition coupled with increased education for physicians regarding geriatric patients can help to reduce length of stay, morbidity, and overall physical and mental deconditioning.

scholarly journals Considerations for a Respiratory Syncytial Virus Vaccine Targeting an Elderly Population

Vaccines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 624
Author(s):  
Laura M. Stephens ◽  
Steven M. Varga
Keyword(s):  
Respiratory Syncytial Virus ◽  
Disease Burden ◽  
Elderly Population ◽  
Vaccine Development ◽  
The Elderly ◽  
The United States ◽  
Susceptible Population ◽  
Age Related ◽  
Syncytial Virus ◽  
Tract Infections

Respiratory syncytial virus (RSV) is most commonly associated with acute lower respiratory tract infections in infants and children. However, RSV also causes a high disease burden in the elderly that is often under recognized. Adults >65 years of age account for an estimated 80,000 RSV-associated hospitalizations and 14,000 deaths in the United States annually. RSV infection in aged individuals can result in more severe disease symptoms including pneumonia and bronchiolitis. Given the large disease burden caused by RSV in the aged, this population remains an important target for vaccine development. Aging results in lowered immune responsiveness characterized by impairments in both innate and adaptive immunity. This immune senescence poses a challenge when developing a vaccine targeting elderly individuals. An RSV vaccine tailored towards an elderly population will need to maximize the immune response elicited in order to overcome age-related defects in the immune system. In this article, we review the hurdles that must be overcome to successfully develop an RSV vaccine for use in the elderly, and discuss the vaccine candidates currently being tested in this highly susceptible population.

scholarly journals Livestock production and antibiotic resistant pneumonia in the elderly population of the United States

2015 ◽  
Vol 81 (1) ◽  
pp. 111
Author(s):  
K. Howell ◽  
G.A. Beresin ◽  
G. Jeffries ◽  
A. Liss ◽  
E. Naumova
Keyword(s):  
United States ◽  
Elderly Population ◽  
The Elderly ◽  
The United States ◽  
Livestock Production ◽  
Antibiotic Resistant

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 Noninvasive Testing for Diagnosis of Stable Coronary Artery Disease in the Elderly

2020 ◽  
Vol 21 (17) ◽  
pp. 6263
Author(s):  
Sergey G. Kozlov ◽  
Olga V. Chernova ◽  
Elena V. Gerasimova ◽  
Ekaterina A. Ivanova ◽  
Alexander N. Orekhov
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Elderly Population ◽  
The Elderly ◽  
The United States ◽  
Diagnostic Methods ◽  
Exercise Stress ◽  
Attractive Alternative ◽  
Artery Disease

Efficient diagnostic approaches to detect coronary artery disease (CAD) in elderly patients are necessary to ensure optimal and timely treatment. The population of suspected CAD patients older than 70 years is especially vulnerable and constantly growing. Finding the optimal diagnostic approach is challenging due to certain features of this population, such as high prevalence of comorbidities, existing contraindications to exercise tests or cognitive decline, which hinders correct assessment of the patient’s situation. Moreover, some symptoms of CAD can have variable significance in the elderly compared to younger adult groups. In this review, we present current recommendations of the United States (US) and European cardiologists’ associations and discuss their applicability for diagnostics in the elderly population. Exercise electrocardiogram (ECG) and exercise stress echocardiography (SE) tests are not feasible for a substantial proportion of elderly patients. Coronary computed tomography angiography (CTA) appears to be an attractive alternative for such patients, but is not universally applicable; for instance, it is problematic in patients with significant calcification of the vessels. Moreover, more studies are needed to compare the results delivered by CTA to those of other diagnostic methods. Future efforts should be focused on comparative studies to better understand the limits and advantages of different diagnostic methods and their combinations. It is possible that some of the currently used diagnostic criteria could be improved to better accommodate the needs of the elderly population.

New Directions in Health Insurance Design: Implications for Public Policy and Practice

2003 ◽  
Vol 31 (S4) ◽  
pp. 60-62
Author(s):  
Karen Pollitz ◽  
Donna Imhoff ◽  
Charles Scott ◽  
Sara Rosenbaum
Keyword(s):  
Public Health ◽  
Health Insurance ◽  
Private Health Insurance ◽  
Elderly Population ◽  
United States Public Health ◽  
Healthcare Spending ◽  
The Elderly ◽  
The United States ◽  
Policy And Practice ◽  
Insurance System

This is a volatile time for health insurance policy. Medicare and Medicaid are in turmoil, as is the private health insurance market. Public and private health insurance costs constitute eighty percent of healthcare spending in the United States. Public health professionals depend on the insurance system to behave in ways that are responsive to public health in prevention and crisis management.Seventy-five percent of the American population, excluding the elderly, has coverage through the private health insurance system. Ninety percent of this group receives their insurance through employer-sponsored programs, and the remaining ten percent buy their own coverage. Approximately ten percent of the non-elderly population has insurance through a government program, and fifteen percent of the non-elderly population, almost forty-one million Americans, is uninsured.

Intergenerational Transfers and Public Expenditure on the Elderly in Modern Britain

1988 ◽  
Vol 8 (2) ◽  
pp. 129-146 ◽  
Author(s):  
Paul Johnson ◽  
Jane Falkingham
Keyword(s):  
Social Services ◽  
Elderly Population ◽  
Public Expenditure ◽  
Age Groups ◽  
The Elderly ◽  
The United States ◽  
Generational Conflict ◽  
The Us ◽  
Families With Children ◽  
Poor Children

ABSTRACTIn the United States, much attention has recently been directed to the issue of whether the welfare system has become over-generous to the retired population, at the expense of families with children. The proportion of the US elderly population living in poverty has fallen significantly in the last fifteen years while the number of poor children has increased rapidly, and it has been suggested that this lack of investment in the next generation of workers may have disastrous longterm consequences for the U.S. economy. This paper considers whether similar trends are evident in Britain. It reviews data on the poverty and income of the elderly population, and finds little unequivocal evidence of relative economic gain over the last two decades, although it is clear that many children have suffered from the recent rise in unemployment-induced poverty. It also looks at direct public expenditure on the elderly through both the pension and the health and personal social services systems, and finds no evidence of a transfer of public resources away from children and towards the elderly population. The paper concludes that the British welfare state has been remarkably neutral in its allocation of resources between generations, and that, in the British context, any discussion of inter-generational conflict for welfare resources establishes a false dichotomy, because economic inequality within broad age groups is much greater than inequality between age groups.

Sign in / Sign up

Export Citation Format

Share Document