Surgical care of the geriatric patient

Katz, Marilyn; Silverstein, Nicole; Coll, Patrick P.; Sullivan, Gail M.; Mortensen, Eric M.; Sachs, Adam; Gross, Jeffrey B.; Girard, Eric; Liang, Joy; Ristau, Benjamin T.; Stevenson, Christina; Smith, Phillip P.; Shames, Brian D.; Millea, Ryan; Ali, Irfan; Poulos, Constantine M.; Ramaraj, Akila B.; Otukoya, Azuka Onye; Nolan, James J.; Wahla, Zulara; Hardy, Cara C; Al-Naggar, Iman M.; Bliss, Lindsay A.; McFadden, David W.

doi:10.1067/j.cpsurg.2019.03.003

Cited by 13 publications

(3 citation statements)

References 175 publications

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“…Therefore, meticulous assessment and patient selection is of paramount importance when surgical treatment is considered 33 . Additional specialized tests, such as pulmonary function tests, cardiopulmonary exercise testing and echocardiography 33 , 34 , use of frailty scoring systems 35 and assessment of sarcopenia 36 , 37 should all be carefully considered in the preoperative assessment, accepting their limitations.…”

Section: Discussionmentioning

confidence: 99%

Oncological outcomes after pancreatoduodenectomy for pancreatic ductal adenocarcinoma in octogenarians: case-control study

et al. 2023

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Background By the end of this decade, 70 per cent of all diagnosed pancreatic ductal adenocarcinomas will be in the elderly. Surgical resection is the only curative option. In the elderly perioperative mortality is higher, while controversy still exists as to whether aggressive treatment offers any survival benefit. This study aimed to assess the oncological benefit of pancreatoduodenectomy in octogenarians with pancreatic ductal adenocarcinoma. Method Retrospective multicentre case-control study of octogenarians and younger controls who underwent pancreatoduodenectomy for pancreatic ductal adenocarcinoma between 2008 and 2017. The primary endpoint was overall survival and the secondary endpoint was disease-free survival. Results Overall, 220 patients were included. Although the Charlson co-morbidity index was higher in octogenerians, Eastern Cooperative Oncology Group performance status, ASA and pathological parameters were comparable. Adjuvant therapy was more frequently delivered in the younger group (n = 80, 73 per cent versus n = 58, 53 per cent, P = 0.006). There was no significant difference between octogenarians and controls in overall survival (20 versus 29 months, P = 0.095) or disease-free survival (19 versus 22 months, P = 0.742). On multivariable analysis, age was not an independent predictor of either oncological outcome measured. Conclusion Octogenarians with pancreatic ductal adenocarcinoma of the head and uncinate process may benefit from comparable oncological outcomes to younger patients with surgical treatment. Due to the age- and disease-related frailty and co-morbidities, careful preoperative assessment and patient selection is of paramount importance.

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Section: Discussionmentioning

confidence: 99%

Oncological outcomes after pancreatoduodenectomy for pancreatic ductal adenocarcinoma in octogenarians: case-control study

et al. 2023

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“…This in turn prevents adequate distension—a necessary requirement for an effective afferent data stream—posing a potential mechanism for loss of volume sensitivity with aging. The side effects of traditional pharmacologic treatment of LUTS complicate their use in the geriatric patient ( Risacher et al, 2016 ; Green et al, 2017 ); comorbidities often exist with LUTS, thus complicating surgical avenues as well ( Katz et al, 2019 ). Investigations of urotoxic and uroprotective factors have shown support for the geroscience hypothesis: the balance between these compounds pose a clear target for therapeutic intervention, with promising results in animal models: the PNPase inhibitor 8-AG acts to reduce urotoxic by-products while increasing uroprotective factors ( Birder et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

The Aged Lower Urinary Tract: Deficits in Neural Control Mechanisms

Hardy¹

2021

Front. Aging

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Bothersome urinary symptoms plague many older adults and disproportionally affect women. Underreporting of symptoms and general stigma/embarrassment associated with incontinence has negatively impacted the availability of treatments, as research cannot be championed if the severity of the problem is not apparent. Available therapeutics have limited efficacy and are often not recommended in aged patients. Lower urinary tract function has a long and rich history in animal studies; while much of the underlying anatomy has been described, including neural control mechanisms, the impact of aging has only just begun to be addressed. Recent work has provided strong evidence that neural control over micturition is significantly impacted by aging processes. This mini review discusses recent findings regarding how aging impacts the neural control mechanisms of micturition.

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“…Behavioral interventions can be exceptionally beneficial in limited circumstances: Limiting fluid intake in the evening hours, for instance, can help reduce instances of nocturia and timed voiding can reduce accidents in individuals with volume sensitivity or impaired cognition (Paraiso & Abate, 2009 ). Surgical interventions, such as sacral nerve stimulation devices, offer high rates of success in otherwise healthy adults, but risk–benefit must be considered in older adults as success is multifactorial (Katz et al, 2019 ). Decreased wound healing, tolerance for surgery/anesthesia, polypharmacy, and other comorbidities complicate how well an individual may recover and benefit from such a procedure.…”

Section: Considerations For Animal Modelsmentioning

confidence: 99%

Aging and urinary control: Alterations in the brain–bladder axis

Hardy,

Korstanje

2023

Aging Cell

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Age‐associated alterations in bladder control affect millions of older adults, with a heavy burden added to families both economically and in quality of life. Therapeutic options are limited with poor efficacy in older adults, lending to a growing need to address the gaps in our current understanding of urinary tract aging. This review summarizes the current knowledge of age‐associated alterations in the structure and function of the brain–bladder axis and identifies important gaps in the field that have yet to be addressed. Urinary aging is associated with decreased tissue responsiveness, decreased control over the voiding reflex, signaling dysfunction along the brain–bladder axis, and structural changes within the bladder wall. Studies are needed to improve our understanding of how age affects the brain–bladder axis and identify genetic targets that correlate with functional outcomes.

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Surgical care of the geriatric patient

Cited by 13 publications

References 175 publications

Oncological outcomes after pancreatoduodenectomy for pancreatic ductal adenocarcinoma in octogenarians: case-control study

Oncological outcomes after pancreatoduodenectomy for pancreatic ductal adenocarcinoma in octogenarians: case-control study

The Aged Lower Urinary Tract: Deficits in Neural Control Mechanisms

Aging and urinary control: Alterations in the brain–bladder axis

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