Functional independence after major abdominal surgery in the elderly

Lawrence, Valerie A.; Hazuda, Helen P.; Cornell, John E.; Pederson, Thomas; Bradshaw, Patrick T.; Mulrow, Cynthia D.; Page, Carey P.

doi:10.1016/j.jamcollsurg.2004.05.280

Cited by 442 publications

(341 citation statements)

References 44 publications

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“…Location can be mapped graphically with reasonable test-retest reliability in the elderly [29]. Multidimensional assessment is ideal, because it includes assessment of mood and function, both of which can affect postoperative rehabilitation [30,31], and can be performed using scales such as the McGill Pain Questionnaire [32], brief pain inventory [33] or geriatric pain measure [34], although further research is needed to support the validity of using these in some older patient groups [35].…”

Section: The Assessment Of Pain In the Older Populationmentioning

confidence: 99%

The assessment and management of peri‐operative pain in older adults

Schofield

2013

Anaesthesia

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SummaryA number of recent reports have highlighted the inadequate provision of pain relief for older inpatients. Despite the availability of numerous validated pain measures, pain remains poorly assessed in some cases and, particularly, in the cognitively impaired. Without proper assessment, patients may receive inadequate or inappropriate analgesia, both of which can worsen outcome. Most drugs and techniques that are used for analgesia in younger patients are also suitable for older patients, although dosages may have to be adjusted to avoid the side‐effects that are consequent upon age‐related changes in drug pharmacokinetics and pharmacodynamics, co‐morbidity, frailty, cognitive impairment and polypharmacy. This paper reviews current guidelines and methods of assessing pain in the older adult, and describes the use of, and problems with, mild, moderate, strong, adjuvant and local anaesthetic drugs in the older population for analgesia, advocating multimodal intervention to reduce dose‐related side‐effects, particularly of opioids.

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Section: The Assessment Of Pain In the Older Populationmentioning

confidence: 99%

The assessment and management of peri‐operative pain in older adults

Schofield

2013

Anaesthesia

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“…6 Long-term outcomes are not well studied in the elderly population, but evidence regarding functional outcomes suggests a 3-6 month minimum return to baseline functional status following major abdominal surgery. 9 This has been verified in patients undergoing resection for pancreatic cancer. 10 The substantial cognitive changes associated with general anesthesia 11,12 are certainly compounded by prolonged hospitalizations or intensive care unit (ICU) stays.…”

Section: Surgical Outcomesmentioning

confidence: 79%

Pancreatic Cancer in the Very Elderly Patient: Challenges and Solutions

Bellevue¹,

Johnson²,

Feczko³

et al. 2016

Surg Res Open J

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Pancreatic cancer is responsible for a significant disease burden on the aging US population. The only chance at curing this highly morbid disease is surgical resection, however choosing appropriate surgical candidates in the elderly population remains challenging. We review the literature for appropriate treatment modalities to the elderly patient. Although significant literature exists in choosing appropriate surgical candidates as well as managing those not deemed fit for surgery, the medical community is not unified when approaching these patients. Further collaboration between the surgical, medical, and palliative communities will likely spawn better outcomes for less overall health care cost in the future.

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“…10 Our case illustrates how a frail patient, with considerable risk factors for postoperative complications, underwent a short but intense, period of physical, nutritional and cognitive preparation. Because of this preparation, he was able to overcome the stress of surgery, and returned home after 1 week where he continued to improve his functional capacity and remained independent.…”

Section: Discussionmentioning

confidence: 96%

Optimizing a frail elderly patient for radical cystectomy with a prehabilitation program

Carli

Awasthi

Gillis

et al. 2014

CUAJ

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Cite as: Can Urol Assoc J 2014;8(11-12):e884-7. http://dx.doi.org/10.5489/cuaj.2025 Published online November 24, 2014. AbstractThe purpose of this case report is to discuss the positive impact of a multimodal prehabilitation program on postoperative recovery of a frail patient undergoing radical cystectomy. An 85-year-old man with significant history for poorly controlled type II diabetes, anemia, chronic renal failure, and glaucoma was found to have muscle invasive urothelial carcinoma of the bladder with hydronephrosis. He was scheduled for elective radical cystoprostatectomy and ileal conduit diversion. He was enrolled in a multimodal prehabilitation program in view of his frailty (Fried score = 5), 15% body weight loss, weak grip strength, severe depression and moderate anxiety, poor nutritional status (patient-generated subjective global assessment [PG-SGA] = B), low functional walking capacity (6-minute walking test [6MWT] = 210 metres, predicted 621 metres). The 4-week program included moderate aerobic and resistant exercises, nutritional counselling with whey protein supplementation (20 g/day), and relaxation exercises. Surgery and the postoperative period were uneventful, although he required treatment of his hyperglycemia and hypomagnesemia. He left the hospital on postoperative day 7 and returned home where he continued the multimodal program for 8 weeks. Measurements of 6MWT, Health-Related Quality of Life (SF-36), physical activity, Hospital Anxiety and Depression Scale (HADS), were conducted at baseline, before surgery and at 4 and 8 weeks after surgery. These tests revealed a progressive remarkable improvement before surgery that continued after surgery.

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Functional independence after major abdominal surgery in the elderly

Cited by 442 publications

References 44 publications

The assessment and management of peri‐operative pain in older adults

The assessment and management of peri‐operative pain in older adults

Pancreatic Cancer in the Very Elderly Patient: Challenges and Solutions

Optimizing a frail elderly patient for radical cystectomy with a prehabilitation program

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