Pub Date : 2023-04-01DOI: 10.1097/AIA.0000000000000392
Ellene Yan, David He, Tarek K Rajji, Frances Chung
The older population, aged 65 years or older, is projected to nearly triple from 524 million in 2010 to 1.5 billion by 2050, representing 8.5% to 16.7% of the global population, respectively. 1 This increase is particularly pronounced in comparison to the trend of the younger population aged 20 years or below, which is estimated to remain relatively static from 2.5 billion in 2015 to 2.6 billion in 2050. With the increase in life expectancy, the number of individuals with cognitive impairment (CI) has increased by 117% in the last 25 years. 2 It will continue to increase with the aging forecast. The susceptibility of older individuals to develop CI partly derives from the complexity of the aging process. Aging involves in fl ammatory and physiological changes across multiple organ systems including the brain, ren-dering the older population more vulnerable and less resilient to future in fl ammatory insults. 3 Globally, 313 million surgeries are performed with 4 million postoperative deaths and
{"title":"Cognitive impairment and its adverse outcomes in older surgical patients: an under-recognized problem!","authors":"Ellene Yan, David He, Tarek K Rajji, Frances Chung","doi":"10.1097/AIA.0000000000000392","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000392","url":null,"abstract":"The older population, aged 65 years or older, is projected to nearly triple from 524 million in 2010 to 1.5 billion by 2050, representing 8.5% to 16.7% of the global population, respectively. 1 This increase is particularly pronounced in comparison to the trend of the younger population aged 20 years or below, which is estimated to remain relatively static from 2.5 billion in 2015 to 2.6 billion in 2050. With the increase in life expectancy, the number of individuals with cognitive impairment (CI) has increased by 117% in the last 25 years. 2 It will continue to increase with the aging forecast. The susceptibility of older individuals to develop CI partly derives from the complexity of the aging process. Aging involves in fl ammatory and physiological changes across multiple organ systems including the brain, ren-dering the older population more vulnerable and less resilient to future in fl ammatory insults. 3 Globally, 313 million surgeries are performed with 4 million postoperative deaths and","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 2","pages":"23-28"},"PeriodicalIF":0.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10077396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.1097/AIA.0000000000000391
Nina Butris, Evan Tang, David He, Dong-Xin Wang, Frances Chung
Sleep is an essential physiological function characterized by a temporary state of unawareness. Adequate sleep is essential for rest, recovery, survival, andenergy conservation. 1 Perioperatively, patients are at an increased risk of experiencing poor sleep quality, which has been linked to adverse postoperative outcomes. 2 – 6 As a result, quality of sleep is important to perioperative care.
{"title":"Sleep disruption in older surgical patients and its important implications.","authors":"Nina Butris, Evan Tang, David He, Dong-Xin Wang, Frances Chung","doi":"10.1097/AIA.0000000000000391","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000391","url":null,"abstract":"Sleep is an essential physiological function characterized by a temporary state of unawareness. Adequate sleep is essential for rest, recovery, survival, andenergy conservation. 1 Perioperatively, patients are at an increased risk of experiencing poor sleep quality, which has been linked to adverse postoperative outcomes. 2 – 6 As a result, quality of sleep is important to perioperative care.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 2","pages":"47-54"},"PeriodicalIF":0.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10064112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.1097/AIA.0000000000000397
David G A Williams, Timothy E Miller
% of the
{"title":"Nutrition screening and therapy in the older surgical patient: an area that is ignored.","authors":"David G A Williams, Timothy E Miller","doi":"10.1097/AIA.0000000000000397","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000397","url":null,"abstract":"% of the","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 2","pages":"29-33"},"PeriodicalIF":0.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10429510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.1097/AIA.0000000000000398
Evan M Henricks, Kurt J Pfeifer
Advances in surgical and anesthetic techniques coupled with increased life expectancy have led to an increasing proportion of older adults receiving surgical care. Commonly, these patients are medically complex, conferring increased risk for postsurgical complications. Postoperative pulmonary complications (PPCs), including respiratory failure, pneumonia, and exacerbation of chronic lung disease, are common in older surgical patients, occurring in ~6% of major abdominal procedures. Although older adults are at a significantly increased risk for cardiovascular disease, PPCs may account for a larger proportion of surgical complications than cardiac events and be associated with greater morbidity and mortality than cardiovascular complications. The older adult population is especially prone to these complications, as evidenced by the correlation between PPCs and advanced age, cognitive impairment, and functional dependence. Appropriately assessing and managing the risk of PPCs in older adults can help encourage age-friendly health system practices in the perioperative setting.
{"title":"Pulmonary assessment and optimization for older surgical patients.","authors":"Evan M Henricks, Kurt J Pfeifer","doi":"10.1097/AIA.0000000000000398","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000398","url":null,"abstract":"Advances in surgical and anesthetic techniques coupled with increased life expectancy have led to an increasing proportion of older adults receiving surgical care. Commonly, these patients are medically complex, conferring increased risk for postsurgical complications. Postoperative pulmonary complications (PPCs), including respiratory failure, pneumonia, and exacerbation of chronic lung disease, are common in older surgical patients, occurring in ~6% of major abdominal procedures. Although older adults are at a significantly increased risk for cardiovascular disease, PPCs may account for a larger proportion of surgical complications than cardiac events and be associated with greater morbidity and mortality than cardiovascular complications. The older adult population is especially prone to these complications, as evidenced by the correlation between PPCs and advanced age, cognitive impairment, and functional dependence. Appropriately assessing and managing the risk of PPCs in older adults can help encourage age-friendly health system practices in the perioperative setting.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 2","pages":"8-15"},"PeriodicalIF":0.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10449865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.1097/AIA.0000000000000396
Jennifer J Stewart, Judith S L Partridge, Jugdeep K Dhesi
In the developed world, the majority of surgery is now undertaken on older patients. This is not surprising given the association between aging and pathologies that require surgery, including degenerative disease (eg, osteoarthritis), neoplastic disease (eg, solid organ tumors), and vascular disease (eg, coronary or peripheral arterial disease). Older people have much to gain from surgery undertaken in terms of increasing longevity and/or symptom control. However, this older population presents to surgical services, not only with the index surgical pathology, but also with age-associated decline in physiological status, and often with other coexisting health issues including multimorbidity and geriatric syndromes such as frailty and/or cognitive impairment. There is now evidence across surgical subspecialties that these factors, poor physiological reserve, multimorbidity, frailty and cognitive impairment, are important, independent predictors of adverse postoperative outcomes. This is true across clinician-reported (morbidity, mortality), patientreported (experience, satisfaction), and process-related (late cancellations of surgery, length of hospital stay, readmissions) outcomes. Furthermore, these same factors are also associated with high financial costs to health and social care systems. With the observed changes in the age and pathophysiological profile of the surgical population, the need for geriatric medicine services to support surgical and anesthetic teams in delivering perioperative care for older people has been recognized. This need was first addressed as orthogeriatric services for patients with hip fractures were developed. Over the past 20 years geriatric medicine delivered perioperative services has expanded with innovative models of care now in existence for those presenting for planned and unplanned surgery across surgical subspecialties. These new perioperative services for older people are usually delivered using Comprehensive Geriatric Assessment (CGA) and optimization methodology. The first service to utilize and describe this CGA-based approach was established at Guy’s and St Thomas’ NHS Foundation Trust in the United Kingdom and has informed the development of other models of care nationally and internationally. In this article, we describe the Guy’s and St Thomas’ Perioperative medicine for Older People undergoing Surgery (POPS) service and discuss the workforce required to deliver it. The evidence supporting such an approach will be summarized and the translation of the service across hospitals in the United Kingdom and internationally will be described.
{"title":"Perioperative medicine for Older People undergoing Surgery (POPS): Comprehensive Geriatric Assessment (CGA) and optimization in the perioperative setting.","authors":"Jennifer J Stewart, Judith S L Partridge, Jugdeep K Dhesi","doi":"10.1097/AIA.0000000000000396","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000396","url":null,"abstract":"In the developed world, the majority of surgery is now undertaken on older patients. This is not surprising given the association between aging and pathologies that require surgery, including degenerative disease (eg, osteoarthritis), neoplastic disease (eg, solid organ tumors), and vascular disease (eg, coronary or peripheral arterial disease). Older people have much to gain from surgery undertaken in terms of increasing longevity and/or symptom control. However, this older population presents to surgical services, not only with the index surgical pathology, but also with age-associated decline in physiological status, and often with other coexisting health issues including multimorbidity and geriatric syndromes such as frailty and/or cognitive impairment. There is now evidence across surgical subspecialties that these factors, poor physiological reserve, multimorbidity, frailty and cognitive impairment, are important, independent predictors of adverse postoperative outcomes. This is true across clinician-reported (morbidity, mortality), patientreported (experience, satisfaction), and process-related (late cancellations of surgery, length of hospital stay, readmissions) outcomes. Furthermore, these same factors are also associated with high financial costs to health and social care systems. With the observed changes in the age and pathophysiological profile of the surgical population, the need for geriatric medicine services to support surgical and anesthetic teams in delivering perioperative care for older people has been recognized. This need was first addressed as orthogeriatric services for patients with hip fractures were developed. Over the past 20 years geriatric medicine delivered perioperative services has expanded with innovative models of care now in existence for those presenting for planned and unplanned surgery across surgical subspecialties. These new perioperative services for older people are usually delivered using Comprehensive Geriatric Assessment (CGA) and optimization methodology. The first service to utilize and describe this CGA-based approach was established at Guy’s and St Thomas’ NHS Foundation Trust in the United Kingdom and has informed the development of other models of care nationally and internationally. In this article, we describe the Guy’s and St Thomas’ Perioperative medicine for Older People undergoing Surgery (POPS) service and discuss the workforce required to deliver it. The evidence supporting such an approach will be summarized and the translation of the service across hospitals in the United Kingdom and internationally will be described.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 2","pages":"62-69"},"PeriodicalIF":0.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9120504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01Epub Date: 2023-02-23DOI: 10.1097/AIA.0000000000000394
Monika Sadlonova, Nicole B Katz, Jane S Jurayj, Laura Flores, Christopher M Celano, Christine A F von Arnim, Julie K Silver
{"title":"Surgical prehabilitation in older and frail individuals: a scoping review.","authors":"Monika Sadlonova, Nicole B Katz, Jane S Jurayj, Laura Flores, Christopher M Celano, Christine A F von Arnim, Julie K Silver","doi":"10.1097/AIA.0000000000000394","DOIUrl":"10.1097/AIA.0000000000000394","url":null,"abstract":"","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 2","pages":"34-46"},"PeriodicalIF":0.8,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10006316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10429509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.1097/AIA.0000000000000393
Leandra A Amado, Duminda N Wijeysundera
The aging global population has a profound impact on patient management in the perioperative setting. Older patients represent an ever-growing proportion of patients presenting for surgery, 1 and face an elevated risk for adverse outcomes. The elevated risk is explained by a high burden of comorbid disease associated with elevated age (eg, cardiovascular disease), age-associated geriatric syndromes (eg, frailty), and physiological changes directly related to aging. Cellular senescence explains many of these changes. Human cells only replicate a fi nite number of times; telomere shortening occurs during every replication cycle, thereby exposing DNA to damage. 2 Reduced regenerative capacity, along with other changes at a molecular and cellular level (eg, free radical pro-duction), result in pathophysiological changes seen in old age. In the cardiovascular system, aging results in loss of vascular compliance, endothelial dysfunction, changes in cardiac structure and function (myocardial remodeling, diastolic dysfunction, cardiac conduction system degeneration), and altered cardiac response to stress (eg, attenuated baroreceptor response). 3,4 These changes culminate in reduced cardiovascular function and reduced capacity to respond to acute physiological stressors. Preoperative cardiac assessment of older adults should address the sequalae of these age-related changes. In this review, we discuss several cardiac conditions especially relevant to older surgical patients (ie, hypertension, ischemic heart disease (IHD)]. We also address the role of multidimensional geriatric assessment as a component of high-quality preoperative evaluation.
{"title":"Cardiac assessment and management in older surgical patients.","authors":"Leandra A Amado, Duminda N Wijeysundera","doi":"10.1097/AIA.0000000000000393","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000393","url":null,"abstract":"The aging global population has a profound impact on patient management in the perioperative setting. Older patients represent an ever-growing proportion of patients presenting for surgery, 1 and face an elevated risk for adverse outcomes. The elevated risk is explained by a high burden of comorbid disease associated with elevated age (eg, cardiovascular disease), age-associated geriatric syndromes (eg, frailty), and physiological changes directly related to aging. Cellular senescence explains many of these changes. Human cells only replicate a fi nite number of times; telomere shortening occurs during every replication cycle, thereby exposing DNA to damage. 2 Reduced regenerative capacity, along with other changes at a molecular and cellular level (eg, free radical pro-duction), result in pathophysiological changes seen in old age. In the cardiovascular system, aging results in loss of vascular compliance, endothelial dysfunction, changes in cardiac structure and function (myocardial remodeling, diastolic dysfunction, cardiac conduction system degeneration), and altered cardiac response to stress (eg, attenuated baroreceptor response). 3,4 These changes culminate in reduced cardiovascular function and reduced capacity to respond to acute physiological stressors. Preoperative cardiac assessment of older adults should address the sequalae of these age-related changes. In this review, we discuss several cardiac conditions especially relevant to older surgical patients (ie, hypertension, ischemic heart disease (IHD)]. We also address the role of multidimensional geriatric assessment as a component of high-quality preoperative evaluation.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 2","pages":"1-7"},"PeriodicalIF":0.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9120501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01Epub Date: 2022-12-08DOI: 10.1097/AIA.0000000000000389
John Pearson, Cameron Jacobson, Nkemdirim Ugochukwu, Elliot Asare, Kelvin Kan, Nathan Pace, Jiuying Han, Neng Wan, Robert Schonberger, Michael Andreae
{"title":"Geospatial analysis of patients' social determinants of health for health systems science and disparity research.","authors":"John Pearson, Cameron Jacobson, Nkemdirim Ugochukwu, Elliot Asare, Kelvin Kan, Nathan Pace, Jiuying Han, Neng Wan, Robert Schonberger, Michael Andreae","doi":"10.1097/AIA.0000000000000389","DOIUrl":"10.1097/AIA.0000000000000389","url":null,"abstract":"","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 1","pages":"49-62"},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10107426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10071795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1097/AIA.0000000000000382
John W Patton, Brittany N Burton, Adam J Milam, Edward R Mariano, Rodney A Gabriel
{"title":"Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.","authors":"John W Patton, Brittany N Burton, Adam J Milam, Edward R Mariano, Rodney A Gabriel","doi":"10.1097/AIA.0000000000000382","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000382","url":null,"abstract":"","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 1","pages":"8-15"},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10075734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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