Effect of Aging on Cardiac Function Plus Monitoring and Support

Martin, Robert; Farrah, Jason P.; Chang, Michael

doi:10.1016/j.suc.2014.09.010

Cited by 17 publications

(7 citation statements)

References 31 publications

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“…arteries that lead to decreased compliance, stiffness, and eventual hypertension. 5 In addition, geriatric patients at baseline may have systolic and diastolic dysfunction 6 and a blunted response to adrenergic stimulation that may limit vasoconstriction 5,7 and the ability to mount a tachycardic response, 6,8 which is frequently magnified by the chronic use of betablocking agents in this population. These physiologic changes of aging are highlighted in our series as geriatric trauma patients more often presented with hypertension (30 vs 7%), cardiac disease (10 vs 1%), and cerebrovascular disease (4 vs 0.6%).…”

Section: Discussionmentioning

confidence: 99%

A Comprehensive Investigation of Comorbidities, Mechanisms, Injury Patterns, and Outcomes in Geriatric Blunt Trauma Patients

Brown

Rix

Klein

et al. 2016

The American Surgeon™

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The geriatric population is growing and trauma providers are often tasked with caring for injuries in the elderly. There is limited information regarding injury patterns in geriatric trauma patients stratified by mechanism of injury. This study intends to investigate the comorbidities, mechanisms, injury patterns, and outcomes in geriatric blunt trauma patients. A retrospective study of the 2012 National Trauma Databank was performed. Adult blunt trauma patients were identified; geriatric (>/=65) patients were compared with younger (<65) patients regarding admission demographics and vital signs, mechanism and severity of injury, and comorbidities. The primary outcome was injuries sustained and secondary outcomes included mortality, length of stay in the intensive care unit and hospital, and ventilator days. There were 589,830 blunt trauma patients who met the inclusion criteria, including 183,209 (31%) geriatric and 406,621 (69%) nongeriatric patients. Falls were more common in geriatric patients (79 vs 29%, P < 0.0001). Geriatric patients less often had an Injury Severity Score >/=16 (18 vs 20%, P < 0.0001) but more often a head Abbreviated Injury Scale >/=3 (24 vs 18%, P < 0.0001) and lower extremity Abbreviated Injury Scale >/=3 (24% vs 8%, P < 0.0001). After logistic regression older age was an independent risk factor for mortality for the overall population and across all mechanisms. Falls are the most common mechanism for geriatric trauma patients. Geriatric patients overall present with a lower Injury Severity Score, but more often sustain severe injuries to the head and lower extremities. Injury patterns vary significantly between older and younger patients when stratified by mechanism. Mortality is significantly higher for geriatric trauma patients and older age is independently associated with mortality across all mechanisms.

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Section: Discussionmentioning

confidence: 99%

A Comprehensive Investigation of Comorbidities, Mechanisms, Injury Patterns, and Outcomes in Geriatric Blunt Trauma Patients

Brown

Rix

Klein

et al. 2016

The American Surgeon™

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“…As learned from patients with traumatic injury, the systolic BP threshold suggesting shock may begin at 110 mmHg in the elderly, rather than the usual 90 mmHg. As the elderly have reduced cardiovascular reserve, occult heart failure should not be forgotten; some drugs may affect heart rate, and it may be necessary to correct reduced contractility or afterload by means of vasopressors. This is best done by invasive monitoring and echocardiography in critical care, and should be prioritized early during resuscitation and preparation for surgery.…”

Section: Clinical Assessment and Preoperative Optimizationmentioning

confidence: 99%

Emergency general surgery in the geriatric patient

Desserud

Veen

Søreide

2016

Journal of British Surgery

147

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Background: Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care.Methods: This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. Results:The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care.Conclusion: Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited.

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“…Importantly, the consequences of these alterations do not appear at rest (Martin et al 2015). In contrast, during physical work the impairments in contractility in older adults lead to a diminished increase in ejection fraction by up to 20% and a consequent reduction in cardiac output compared with younger individuals (Hawkins and Wiswell 2003;Martin et al 2015).…”

Section: Systolic and Diastolic Functionmentioning

confidence: 99%

“…However, the age-related increase in resting sympathetic tone (i.e., reduced capacity to increase during stress) combined with the reduced sensitivity to changes in sympathetic stimulation limits the ability of the aging heart to increase heart rate during exertion (Hawkins and Wiswell 2003;Bellew et al 2005;Fleg et al 2005), which ultimately reduces the capacity to increase blood supply to the working muscles. Consequently, older adults rely more heavily on increasing stroke volume for increases in cardiac output relative to their younger counterparts (Martin et al 2015). Alternatively, changes in aging blood vessels can manifest as a marked reduction in elasticity (Greenwald 2007) and thereby increased stiffness, which leads to an increase in cardiac afterload.…”

Section: Cardiac and Vascular Responsivenessmentioning

confidence: 99%

Age, human performance, and physical employment standards

Kenny

Groeller

McGinn

et al. 2016

Appl. Physiol. Nutr. Metab.

100

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Abstract:The proportion of older workers has increased substantially in recent years, with over 25% of the Canadian labour force aged ≥55 years. Along with chronological age comes age-related declines in functional capacity associated with impairments to the cardiorespiratory and muscular systems. As a result, older workers are reported to exhibit reductions in work output and in the ability to perform and/or sustain the required effort when performing work tasks. However, research has presented some conflicting views on the consequences of aging in the workforce, as physically demanding occupations can be associated with improved or maintained physical function. Furthermore, the current methods for evaluating physical function in older workers often lack specificity and relevance to the actual work tasks, leading to an underestimation of physical capacity in the older worker. Nevertheless, industry often lacks the appropriate information and/or tools to accommodate the aging workforce, particularly in the context of physical employment standards. Ultimately, if appropriate workplace strategies and work performance standards are adopted to optimize the strengths and protect against the vulnerability of the aging workers, they can perform as effectively as their younger counterparts. Our aim in this review is to evaluate the impact of different individual (including physiological decline, chronic disease, lifestyle, and physical activity) and occupational (including shift work, sleep deprivation, and cold/heat exposure) factors on the physical decline of older workers, and therefore the risk of work-related injuries or illness.Key words: aging, worker, work ability, functional capacity, health, fitness, exercise.Résumé : La proportion de travailleurs âgés s'est accrue substantiellement au cours des dernières années; plus de 25 % de la main d'oeuvre au Canada est âgée de ≥55 ans. Avec l'avancement en âge vient le déclin de la capacité fonctionnelle associé à des troubles des systèmes cardiorespiratoire et musculaire. Ainsi, selon des études, il y a une diminution dans la production de travail des individus plus âgés et dans leur capacité à effectuer et maintenir un rythme de travail. Toutefois, la documentation scientifique rapporte des points de vue divergents à propos des conséquences du vieillissement de la main-d'oeuvre, car les tâches physiquement exigeantes peuvent être associées à une amélioration ou à un maintien des fonctions physiques. De plus, les méthodes actuelles d'évaluation des fonctions physiques des travailleurs plus âgés ne sont pas pertinentes ou ne sont pas suffisamment ajustées aux tâches courantes, ce qui entraîne une sous-estimation de la capacité physique des travailleurs plus âgés. Quoi qu'il en soit, cette industrie ne dispose pas souvent des informations ou des outils pertinents pour s'ajuster à la main-d'oeuvre vieillissante notamment dans le contexte des normes de travail physique. En fin de compte, si on adopte de bonnes stratégies et des normes de travail ajustées aux forces et à la...

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Effect of Aging on Cardiac Function Plus Monitoring and Support

Cited by 17 publications

References 31 publications

A Comprehensive Investigation of Comorbidities, Mechanisms, Injury Patterns, and Outcomes in Geriatric Blunt Trauma Patients

A Comprehensive Investigation of Comorbidities, Mechanisms, Injury Patterns, and Outcomes in Geriatric Blunt Trauma Patients

Emergency general surgery in the geriatric patient

Age, human performance, and physical employment standards

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