scholarly journals Modifications in anesthesia for geriatric patients

2016 ◽  
Vol 84 (2) ◽  
pp. 10-11
Author(s):  
Brandon Chau ◽  
Alexander Levit
Keyword(s):  
Daily Living ◽  
Patient Monitoring ◽  
Postoperative Delirium ◽  
Geriatric Patients ◽  
Postoperative Morbidity ◽  
Perioperative Period ◽  
The Elderly ◽  
Organ Function ◽  
Age Related ◽  
Geriatric Anesthesia

The volume of geriatric surgery is expected to increase dramatically by 2020, requiring a more widespread appreciation of the unique risks and challenges of anesthesia in the elderly. Changes in pharmacokinetics along with age-related changes in organ function have important implications for patient monitoring and dosing of anesthetic, analgesic, and sedative medications. Preoperative screening for risk of postoperative morbidity is improved with an assessment of activities of daily living, and regional anesthesia may be considered to reduce the risk of postoperative delirium, although this remains controversial. Specific homeostatic parameters should be closely monitored in the perioperative period. The approach to anesthesia in geriatric patients should not be merely extrapolated from younger patients, and further evidence specific to geriatric anesthesia will improve surgical outcomes.

Neuromuscular adaptations to healthy aging

2018 ◽  
Vol 43 (11) ◽  
pp. 1158-1165 ◽  
Author(s):  
Chris J. McNeil ◽  
Charles L. Rice
Keyword(s):  
Daily Living ◽  
Healthy Aging ◽  
The Elderly ◽  
Neuromuscular System ◽  
Healthy Humans ◽  
Age Related ◽  
Physiological Adaptations ◽  
Neuromuscular Adaptations ◽  
The Central Nervous System ◽  
Stimulation Of

Even in the absence of disease or disability, aging is associated with marked physiological adaptations within the neuromuscular system. An ability to perform activities of daily living and maintain independence with advanced age is reliant on the health of the neuromuscular system. Hence, it is critical to elucidate the age-related adaptations that occur within the central nervous system and the associated muscles to design interventions to maintain or improve neuromuscular function in the elderly. This brief review focuses on the neural alterations observed at both spinal and supraspinal levels in healthy humans in their seventh decade and beyond. The topics addressed are motor unit loss and remodelling, neural drive, and responses to transcranial magnetic stimulation of the motor cortex.

Pharmacologic Considerations in the Elderly Surgical Patient

2016 ◽  
Author(s):  
Linda Sohn ◽  
Joe C. Hong ◽  
Michael W. Yeh ◽  
Tara A. Russell ◽  
Marcia M. Russell
Keyword(s):  
Older Adults ◽  
Surgical Procedures ◽  
Postoperative Delirium ◽  
Medication Management ◽  
The Elderly ◽  
The United States ◽  
Surgical Patient ◽  
Age Related ◽  
The Impact ◽  
Preoperative Medication

The most rapidly growing segment of the elderly population corresponds to persons age 85 and over. As of 2006, elderly patients accounted for 35.3% of the inpatient and 32.1% of the outpatient surgical procedures occurring in the United States. Because age-related changes occur in each organ system in all elderly individuals, this population merits special consideration when undergoing surgical procedures. Furthermore, there is a high probability that older adults will have multiple chronic medical problems, which may present a complex medication management challenge. This review covers the pharmacologic impact of physiologic changes associated with aging, preoperative assessment, preoperative medication management, delirium and the impact of perioperative medications in the elderly, anesthesia and related medications, and specific drug classes and their use in the elderly surgical patient. Figures show an overview of the management of the elderly surgical patient, and preoperative medication management. Tables list medications that should be avoided in older patients with reduced renal function, drugs that exhibit additive adverse effects, medications with high anticholinergic activity, medications that inhibit and induce the CYP450 system, herbal supplements, 2015 Beers Criteria summary of potentially inappropriate medication use in older adults, drugs associated with postoperative delirium, risk factors for postoperative delirium, and clinical pharmacology of commonly used anesthetic agents.   This review contains 2 highly rendered figures, 9 tables, and 61 references

Pharmacologic Considerations in the Elderly Surgical Patient

2017 ◽  
Author(s):  
Linda Sohn ◽  
Joe C. Hong ◽  
Michael W. Yeh ◽  
Tara A. Russell ◽  
Marcia M. Russell
Keyword(s):  
Older Adults ◽  
Surgical Procedures ◽  
Postoperative Delirium ◽  
Medication Management ◽  
The Elderly ◽  
The United States ◽  
Surgical Patient ◽  
Age Related ◽  
The Impact ◽  
Preoperative Medication

The most rapidly growing segment of the elderly population corresponds to persons age 85 and over. As of 2006, elderly patients accounted for 35.3% of the inpatient and 32.1% of the outpatient surgical procedures occurring in the United States. Because age-related changes occur in each organ system in all elderly individuals, this population merits special consideration when undergoing surgical procedures. Furthermore, there is a high probability that older adults will have multiple chronic medical problems, which may present a complex medication management challenge. This review covers the pharmacologic impact of physiologic changes associated with aging, preoperative assessment, preoperative medication management, delirium and the impact of perioperative medications in the elderly, anesthesia and related medications, and specific drug classes and their use in the elderly surgical patient. Figures show an overview of the management of the elderly surgical patient, and preoperative medication management. Tables list medications that should be avoided in older patients with reduced renal function, drugs that exhibit additive adverse effects, medications with high anticholinergic activity, medications that inhibit and induce the CYP450 system, herbal supplements, 2015 Beers Criteria summary of potentially inappropriate medication use in older adults, drugs associated with postoperative delirium, risk factors for postoperative delirium, and clinical pharmacology of commonly used anesthetic agents.   This review contains 2 highly rendered figures, 9 tables, and 61 references

scholarly journals Preoperative Cognitive Impairment and Postoperative Delirium Predict Decline in Activities of Daily Living after Cardiac Surgery—A Prospective, Observational Cohort Study

Geriatrics ◽  
2020 ◽  
Vol 5 (4) ◽  
pp. 69
Author(s):  
Ulf Guenther ◽  
Falk Hoffmann ◽  
Oliver Dewald ◽  
Ramy Malek ◽  
Kathrin Brimmers ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Daily Living ◽  
Postoperative Delirium ◽  
Functional Decline ◽  
Preoperative Assessment ◽  
Perioperative Period ◽  
Subsequent Treatment ◽  
Assessment Tools

Cardiac surgery and subsequent treatment in the intensive care unit (ICU) has been shown to be associated with functional decline, especially in elderly patients. Due to the different assessment tools and assessment periods, it remains yet unclear what parameters determine unfavorable outcomes. This study sought to identify risk factors during the entire perioperative period and focused on the decline in activity of daily living (ADL) half a year after cardiac surgery. Follow-ups of 125 patients were available. It was found that in the majority of patients (60%), the mean ADL declined by 4.9 points (95% CI, −6.4 to −3.5; p < 0.000). In the “No decline” -group, the ADL rose by 3.3 points (2.0 to 4.6; p < 0.001). A multiple regression analysis revealed that preoperative cognitive impairment (MMSE ≤ 26; Exp(B) 2.862 (95%CI, 1.192–6.872); p = 0.019) and duration of postoperative delirium ≥ 2 days (Exp(B) 3.534 (1.094–11.411); p = 0.035) was independently associated with ADL decline half a year after the operation and ICU. Of note, preoperative ADL per se was neither associated with baseline cognitive function nor a risk factor for functional decline. We conclude that the preoperative assessment of cognitive function, rather than functional assessments, should be part of risk stratification when planning complex cardiosurgical procedures.

scholarly journals Postoperative Delirium Is Associated with Long-term Decline in Activities of Daily Living

2019 ◽  
Vol 131 (3) ◽  
pp. 492-500 ◽  
Author(s):  
Zhongyong Shi ◽  
Xinchun Mei ◽  
Cheng Li ◽  
Yupeng Chen ◽  
Hailin Zheng ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Postoperative Delirium ◽  
Postoperative Mortality ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Lost To Follow Up

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Postoperative delirium is one of the most common complications in the elderly surgical population. However, its long-term outcomes remain largely to be determined. Therefore a prospective cohort study was conducted to determine the association between postoperative delirium and long-term decline in activities of daily living and postoperative mortality. The hypothesis in the present study was that postoperative delirium was associated with a greater decline in activities of daily living and higher mortality within 24 to 36 months after anesthesia and surgery. Methods The participants (at least 65 yr old) having the surgeries of (1) proximal femoral nail, (2) hip replacement, or (3) open reduction and internal fixation under general anesthesia were enrolled. The Confusion Assessment Method algorithm was administered to diagnose delirium before and on the first, second, and fourth days after the surgery. Activities of daily living were evaluated by using the Chinese version of the activities of daily living scale (range, 14 to 56 points), and preoperative cognitive function was assessed by using the Chinese Mini-Mental State Examination (range, 0 to 30 points). The follow-up assessments, including activities of daily living and mortality, were conducted between 24 and 36 months after anesthesia and surgery. Results Of 130 participants (80 ± 6 yr, 24% male), 34 (26%) developed postoperative delirium during the hospitalization. There were 32% of the participants who were lost to follow-up, resulting in 88 participants who were finally included in the data analysis. The participants with postoperative delirium had a greater decline in activities of daily living (16 ± 15 vs. 9 ± 15, P = 0.037) and higher 36-month mortality (8 of 28, 29% vs. 7 of 75, 9%; P = 0.009) as compared with the participants without postoperative delirium. Conclusions Postoperative delirium was associated with long-term detrimental outcomes, including greater decline in activities of daily living and a higher rate of postoperative mortality.

scholarly journals Perioperative management of geriatric patients for orthopedic surgeries

2020 ◽  
Vol 6 (2) ◽  
pp. 427
Author(s):  
Bhavya Krishna ◽  
Nidhi Pathak
Keyword(s):  
Life Expectancy ◽  
Orthopedic Surgery ◽  
Lower Limb ◽  
Geriatric Patients ◽  
Perioperative Management ◽  
Perioperative Period ◽  
Review Article ◽  
Neuraxial Blockade ◽  
Geriatric Anesthesia ◽  
The Mean

<p class="abstract">With increasing life expectancy, the mean age of patient orthopedicians and anesthesiologists have to deal with is increasing. In this review article, we discuss the case management of three centurions aged 110, 105 and 102 years respectively who underwent lower limb orthopedic surgery under nerve block, general anesthesia and neuraxial blockade, and elaborate on the various issues faced perioperatively by the treating team. The challenges and differences faced in perioperative period in geriatric anesthesia were discussed and literature reviewed for the benefit of the operating surgeons.</p>

scholarly journals Outcomes and interventions in the elderly with and without cognitive impairment: a longitudinal study

2020 ◽  
Vol 14 (4) ◽  
pp. 394-402
Author(s):  
Anne Caroline Soares da Silva ◽  
Juliana Hotta Ansai ◽  
Natália Oiring de Castro Cezar ◽  
Francisco Assis Carvalho Vale ◽  
Julimara Gomes dos Santos ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Older People ◽  
Clinical Outcomes ◽  
Daily Living ◽  
Home Visit ◽  
Geriatric Patients ◽  
The Elderly ◽  
Community Dwelling ◽  
Community Dwelling Older People

ABSTRACT. Background: Clinical follow-up studies are necessary for a better understanding of the evolution of cognitive impairment as well as the development of better assessment and intervention tools. Objective: To investigate whether older people with preserved cognition (PC), mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) show differences in clinical outcomes and interventions after a 32-month period. Methods: One hundred twenty-four community-dwelling older people were included and classified in one of three groups (PC, MCI and mild AD). Information on clinical outcomes (deaths, new diagnoses, falls, need for assistance or changes in routine and hospitalizations) and interventions (increased use of medication, physiotherapeutic intervention, practice of physical exercise, etc.) in the 32-month period were collected by telephone or during a home visit on a single day. Results: Ninety-five participants (35 with PC, 33 with MCI and 27 with AD) were reevaluated after 32 months. The need for assistance/changes in routine was significantly higher in the AD group, especially with regard to basic activities of daily living. Unlike the other groups, the PC group did not show “other diagnoses” (urinary incontinence, prolapse, change in vision or autoimmune disease). No significant differences were found regarding other variables. Conclusions: Older people with and without cognitive impairment exhibited differences in some clinical outcomes after 32 months, such as need for assistance or changes in their routine and new diagnoses of specific diseases. Therefore, the multidimensionality of geriatric patients should be considered when planning assessments and interventions.

Influences of Aging and Footedness on Stepping Over Obstacles

2009 ◽  
Author(s):  
Shih Shan Chen ◽  
Hsuan Sung Chang ◽  
Chia Ling Chen ◽  
Hsieh Ching Chen ◽  
Jen Suh Chern ◽  
...  
Keyword(s):  
Older Adults ◽  
Obstacle Avoidance ◽  
Daily Living ◽  
Control Strategies ◽  
The Elderly ◽  
External Factors ◽  
Age Related ◽  
Avoidance Strategies ◽  
Internal And External Factors

Stepping over obstacles is an essential ability to walk safely in daily living. There are internal and external factors interacting to keep us stay in balance during negotiating obstacles. As we get older, the walking patterns and avoidance strategies may change due to the age-related degradation of our body. Since many studies show that tripping over obstacles is one of the most frequent causes of falls in the elderly [1], it is important for us to understand the control strategies of older adults during obstacle avoidance. The observation could let to an increased awareness of obstacle avoidance tasks and help diminishing falls risks in older adults [2].

scholarly journals Effect of Chronic Administration of Resveratrol on Cognitive Performance during Aging Process in Rats

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
A. R. Navarro-Cruz ◽  
R. Ramírez y Ayala ◽  
C. Ochoa-Velasco ◽  
E. Brambila ◽  
R. Avila-Sosa ◽  
...  
Keyword(s):  
Cognitive Performance ◽  
Cognitive Abilities ◽  
Elderly Population ◽  
Geriatric Patients ◽  
Therapeutic Potential ◽  
Chronic Administration ◽  
The Elderly ◽  
Age Related ◽  
Health Demands ◽  
Sirt1 Gene

The increase in the elderly population has generated concern to meet health demands. The research efforts to elucidate the mechanisms of damage associated with aging have also been significantly increased, especially in order to avoid the reduction of the cognitive abilities in geriatric patients, resulting from the damage generated mainly at the level of the hippocampus during old age. At present, many studies describe resveratrol as an antiaging component. There are reports that it can activate the Sirt1 gene related to antiaging, emulating the effects obtained by caloric restriction in rodents. The aim of the study was to evaluate the effect of chronic administration of resveratrol (10 mg/kg) on cognitive performance in behavioral tests after 8 months of treatment and on the preservation of cerebral integrity in the cytoarchitecture of regions CA1 and CA2. Results showed that the cytoarchitecture of the CA1 and CA2 regions in the hippocampus retained their integrity over time in rats treated with resveratrol, and the behavioral test performed revealed that chronic resveratrol administration for 8 months showed improvements in cognitive performance. The results indicate that resveratrol may exhibit therapeutic potential for age-related conditions.

scholarly journals ANAESTHESIA FOR HIP FRACTURE SURGERY IN GERIATRIC PATIENTS (CLINICAL GUIDELINES)

2017 ◽  
Vol 11 (2) ◽  
pp. 133-142
Author(s):  
Victor A. Koriachkin ◽  
D. V Zabolotski ◽  
V. V Kuzmin ◽  
O. G Anisimov ◽  
A. A Ezhevsky ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Pain Relief ◽  
Hip Fractures ◽  
Postoperative Period ◽  
Geriatric Patients ◽  
Clinical Guideline ◽  
Perioperative Period ◽  
The Elderly ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Clinical guideline contained a summary on the management of hip fractures in the elderly. Presents the key positions, the implementation of which is required in the perioperative period. Special attention is given pain relief, prevention of delirium and management of patients in the postoperative period.

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