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

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.

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Treatment with CPAP in Elderly Patients with Obstructive Sleep Apnoea

Journal of Clinical Medicine ◽

10.3390/jcm9020546 ◽

2020 ◽

Vol 9 (2) ◽

pp. 546 ◽

Cited By ~ 1

Author(s):

Tomas Posadas ◽

Grace Oscullo ◽

Enrique Zaldívar ◽

Alberto Garcia-Ortega ◽

José Daniel Gómez-Olivas ◽

...

Keyword(s):

Clinical Trials ◽

Elderly Patients ◽

Obstructive Sleep Apnoea ◽

The Elderly ◽

Sleep Apnoea ◽

Age Group ◽

Obstructive Sleep ◽

Receive Treatment ◽

Therapeutic Tools

The population pyramid is changing as a result of the ever-increasing life expectancy, which makes it crucial to acquire an in-depth understanding of the diseases that most often affect the elderly. Obstructive sleep apnoea (OSA) affects 15%–20% of the population aged over 65 years. Despite this prevalence, there have been very few specific studies on the management of OSA in this age group, even though over 60% of the patients aged over 65-70 years who attend sleep units with suspicion of OSA receive treatment with continuous positive airway pressure (CPAP), on the basis of an extrapolation of the positive results achieved by CPAP in clinical trials involving middle-aged males. However, the latter’s form of presentation, evolution and, probably, prognosis comparing with OSA are not the same as those of elderly patients. Recent clinical trials performed on an exclusive series of elderly patients have shed light on the possible role of CPAP treatment in elderly patients with OSA, but there are still many questions that need to be answered. The physiological increase in the number of sleep-related disorders with the passing of years, and the lack of validated diagnostic and therapeutic tools for this age group are probably the greatest obstacles to define, diagnose and treat OSA in the elderly.

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Associate Members: A Life Worth Living

British Journal of Occupational Therapy ◽

10.1177/030802268604901108 ◽

1986 ◽

Vol 49 (11) ◽

pp. 362-364 ◽

Cited By ~ 1

Author(s):

Jean Parker

Keyword(s):

Elderly Patients ◽

Long Term Care ◽

The Elderly ◽

Worth Living ◽

Term Care ◽

Life Worth Living ◽

Meaningful Existence ◽

Time And Energy

Long-term care patients need a meaningful existence. It is our responsibility to ensure that time and energy are channelled into purposeful solutions for the disease of ‘time with nothing to do’. The author has taken up this challenge. Working as an activities organizer with the elderly for 11 years, she was determined never to take the role of a baby-sitter. The recreation unit has grown from its first eight guests to a purpose-built unit with approximately 1,500 attendances per month. A busy happy atmosphere now prevails where once there was a sea of dead faces. The choice to retain a sense of dignity and purpose should be available to all elderly patients who require long-term care.

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Anaesthesia in the elderly

10.1093/med/9780199642045.003.0086 ◽

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.

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The Role of Spinal Orthoses in Osteoporotic Vertebral Fractures of the Elderly Population (Age 60 Years or Older): Systematic Review

Global Spine Journal ◽

10.1177/2192568220948036 ◽

2020 ◽

pp. 219256822094803

Author(s):

Barry Ting Sheen Kweh ◽

Hui Qing Lee ◽

Terence Tan ◽

Joost Rutges ◽

Travis Marion ◽

...

Keyword(s):

Systematic Review ◽

Elderly Patients ◽

Vertebral Fractures ◽

Postural Stability ◽

Elderly Population ◽

The Elderly ◽

Functional Improvement ◽

Osteoporotic Vertebral Fractures ◽

Spinal Orthoses

Study Design: Systematic review. Objective: Spinal orthoses have been generally used in the management of osteoporotic vertebral fractures in the elderly population with purported positive biomechanical and functional effects. To our knowledge, this is the first systematic review of the literature examining the role of spinal orthoses in osteoporotic elderly patients who sustain low energy trauma vertebral fractures. Methods: A systematic literature review adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Methodical searches utilizing MEDLINE, EMBASE, Google Scholar, and Cochrane Databases was performed. Results: Of the 2019 articles initially retrieved, 7 published articles (4 randomized controlled trials and 3 prospective cohort studies) satisfied the inclusion criteria. Five studies reported improvement in quantitative measurements of spinal column stability when either a rigid or semirigid orthosis was used, while 1 study was equivocal. The studies also showed the translation of biomechanical benefit into significant functional improvement as manifested by improved postural stability and reduced body sway. Subjective improvement in pain scores and quality of life was also noted with bracing. Conclusion: The use of spinal orthoses in neurologically intact elderly patients aged 60 years and older with osteoporotic compression vertebral fractures results in improved biomechanical vertebral stability, reduced kyphotic deformity, enhanced postural stability, greater muscular strength and superior functional outcomes.

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Balancing the Efficacy and Tolerability of First-line Treatment in Elderly Myeloma Patients

European Oncology & Haematology ◽

10.17925/eoh.2010.04.0.85 ◽

2010 ◽

Vol 00 (04) ◽

pp. 85

Author(s):

Valeria Magarotto ◽

Antonio Palumbo ◽

◽

Keyword(s):

Elderly Patients ◽

Elderly Population ◽

The Elderly ◽

New Drugs ◽

High Dose ◽

Standard Drug ◽

High Dose Dexamethasone ◽

Life Threatening ◽

Choice Of Therapy

Multiple myeloma (MM) is the second most frequent malignancy of the blood. It is more common among the elderly population, with <28% of patients 65–74 years of age and 37% >75 years of age. Before the introduction of novel agents, melphalan and prednisone (MP) was the best treatment for patients not eligible for autologous stem cell transplantation (ASCT). Steroids provide other options but with a higher toxicity, especially in elderly patients. Currently, the association of thalidomide with MP (MPT) represents the gold standard of treatment for patients ineligible for ASCT. Bortezomib and lenalidomide associated with MP provided effective and safe alternatives. High-dose dexamethasone combined with the new drugs is effective, but very toxic for elderly patients. Trials that combine low-dose dexamethasone with thalidomide, lenalidomide and bortezomib plus other agents such as doxorubicin and cyclophosphamide are ongoing. The role of transplantation is controversial in myeloma patients >65 years of age because elderly patients are fragile and the choice of therapy must take into account the likelihood of co-morbidities. Reducing the dose of the standard drug – eventually prolonging the duration of the treatment and administering prophylaxis – allows effective treatment of MM, without important or life-threatening toxicities.

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

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1017 ◽

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.

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The Role of Psychotherapy and Humor for Death Anxiety, Death Wishes, and Aging

OMEGA - Journal of Death and Dying ◽

10.2190/d0nx-7v03-w1h0-4614 ◽

2007 ◽

Vol 54 (1) ◽

pp. 41-51 ◽

Cited By ~ 15

Author(s):

Joseph Richman

Keyword(s):

Elderly Patients ◽

Death Anxiety ◽

The Elderly ◽

Social Attitudes ◽

Problems In Living ◽

Death Wishes ◽

Anxiety Depression

This article is part of a series of humor on social attitudes (Richmen, 1977), humor by the elderly (Richman, 1989), assessment (Richman, 1996a), and psychotherapy (Richman, 1996b). The present study is based on the topics of humor related to death anxiety and wishes, and aging that emerged during psychotherapy with elderly patients. The healing qualities of laughter and humor have been observed since Biblical times to the present, however the applications of humor to professional psychotherapy is still in its infancy. The examples in this study spell out how humor in therapy can bring people together, and help them affirm life and laugh at anxiety, depression, and their problems in living.

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F010 Role of advanced age and hypertension in the elderly patients ≥ 85 years old with hypertrophic cardiomyopathy

Atherosclerosis ◽

10.1016/s0021-9150(97)84587-x ◽

1998 ◽

Vol 136 ◽

pp. S49

Author(s):

Nen-Chung Chang ◽

Zhi-Yang Lai ◽

Paul Chan ◽

Tze-Che Wang

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Elderly Patients ◽

The Elderly ◽

Advanced Age

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Effectiveness of Family Function in Quality of Life in Elderly Patients: An Evidence Based Case Report

Muhammadiyah Journal of Geriatric ◽

10.24853/mujg.1.2.52-57 ◽

2021 ◽

Vol 1 (2) ◽

pp. 52

Author(s):

Muhammad Sobri Maulana

Keyword(s):

Quality Of Life ◽

Elderly Patients ◽

Chronically Ill ◽

The Elderly ◽

Evidence Based ◽

Literature Searching ◽

Family Function ◽

Based Medicine

Background: Geriatric care is an important part in healthcare and are sometimes neglected. Family caregivers figures assume a key role in postponing and potentially forestalling standardization of chronically ill elderly patients. The role of family function in depression has been demonstrated from earlier studies, however, the part of family function in quality of life the elderly has not concentrated widely. Objective: To evaluate the connection between family function and quality of life. Methods: Literature searching was conducted through PubMed, Science Direct and Embase. Critical appraisal using appraisal sheet for prognosis from Oxford Center for Evidence Based Medicine in 2011. Results: One article was found with good validity showed that direct relationship between family function and quality of life is not associated. However, if depression is present it plays as a strong mediator between family function and quality of life. Conclusion: Family function mediated with depression plays an important role in quality of life in elderly patients.

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