1.
[Preoperative assessment in elderly patients].
Humbert, M, Rubli, E, Major K, , Smith, C, Nguyen, S, Büla, C
Revue medicale suisse. 2014;(449):2101-6
Abstract
Age-related physiological changes and comorbidities affect older patients' tolerance to surgery. Pre-operative assessment in these patients requires, beside the usual physical evaluation, the systematic screening of common geriatric syndromes. Cognitive, gait and balance, nutritional, and functional impairments, all flag patients at higher risk for per- and postoperative complications. Preoperative assessment is an opportunity to detect these syndromes and propose preventative interventions (physical therapy, nutritional and cognitive support measures) likely to reduce the incidence of postoperative morbidity.
2.
Unmasking delirium.
Gillis, AJ, MacDonald, B
The Canadian nurse. 2006;(9):18-24
Abstract
The authors use a case study to illustrate the risks of delirium in older adult patients and discuss ways to prevent, identify and manage its occurrence. An estimated 60 to 80 per cent of hospitalized frail older adults experience at least one preventable episode of delirium, often leading to prolonged hospitalization, functional decline, increased morbidity and eventual nursing home placement or death. Delirium is a medical emergency, characterized by acute onset and a fluctuating course that is demonstrated by abrupt changes in mental status and function. It has three categories: hyperactive, hypoactive and mixed. Although delirium is amenable to expert nursing care, it is unrecognized or misdiagnosed in up to 70 per cent of older patients. Delirium results from the interplay of multiple forces associated with illness in the older adult, including drugs, substance abuse, metabolic disturbances, nutritional deficiencies, fluid disturbances, acute trauma or illness, infection and impaired physical or functional ability A proactive strategy for delirium prevention and treatment targets defined risk factors and the management of physiologic factors that precipitate delirium. It includes assessment, therapeutic environmental modification, standardized protocols for physiological interventions and staff education.
3.
The potential for elderly suicide. . . Is health care missing it?
Davis, P, Kenarney, K, Murdell, D, Zabak, K
Director (Cincinnati, Ohio). 2001;(4):122-5
Abstract
Assessment of elderly patients at risk for suicide, presents a unique challenge in healthcare. Assessment of residents entering long term care facilities does not end once they are admitted. Learning to identify the warning signs and situations that can precede "silent suicide" requires extraordinary sensitivity (Simon, 1989). A case study is utilized to review some of the most common risk factors for suicide in the elderly population. The impact on elderly people when they must leave their homes, is highlighted in the discussion of"relocation stress" (Harkulich, 1992) The reason why healthcare workers could misinterpret the signs and symptoms of potential elderly suicide is also included.