The very elderly surgical population in a critically ill scenario: clinical characteristics and outcomes

Silva, Diana de Jesus Neves; Casimiro, Luís Guilherme; Oliveira, Mónica Isabel Sequeira de; Ferreira, Luciana Brás da Cunha; Abelha, Fernando

doi:10.1016/j.bjane.2020.02.002

Cited by 5 publications

(3 citation statements)

References 28 publications

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“…Our data suggest that 1 day without nutrition increases the risk of death by approximately 15% in the first week of evolution. The population of critically ill older adults has increased, 15,16 which implies the importance of applying strategies that can reduce or avoid a prescription for fasting in this population. This study is significant because older adults are often excluded from this kind of research, resulting in a knowledge gap regarding the effect of nutrition therapy on their outcomes.…”

Section: Discussionmentioning

confidence: 99%

Nutrition as a risk for mortality and functionality in critically ill older adults

Loss

Teichmann

Paula

et al. 2022

J Parenter Enteral Nutr

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Background There is no specific recommendation for nutrition therapy for critically ill older adults. However, targeting energy and protein balance and avoiding fasting could improve outcomes in this population with high‐risk nutrition outcomes. This study aimed to evaluate the associations between nutrition and mortality/functionality in critically ill older patients. Methods A single‐center retrospective observational study of critically ill patients aged 65 years or older was conducted. We extracted data from the dietitian evaluations on energy, protein, and the type of diet (fasting, oral, enteral, or parenteral) prescribed in the first week of intensive care unit admission. Primary outcomes were intrahospital mortality and independence and functional capacity evaluated after hospital discharge. Results Of the 2043 patients screened, 533 were included in the study. Most patients were men (52.1%), with a median age of 73 (68–78) years. Overall, the intrahospital mortality rate was 53.8%. Simplified Acute Physiology Score 3 (SAPS 3), serum albumin and C‐reactive protein levels, and surgical patients were independently associated with fasting in a multivariate analysis. The multivariate regression analyses showed that SAPS 3, serum albumin level, and fasting were independently associated with mortality. Each fasting day increases the risk of mortality by 16.7%. Also, independence and functional capacity were not related to nutrition prescription. Conclusion Older adults (65 years or older) constitute a fragile population in whom nutrition breaks were associated with increased hospital mortality. Furthermore, a prospective clinical trial is necessary to establish the best strategy to feed this population.

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Section: Discussionmentioning

confidence: 99%

Nutrition as a risk for mortality and functionality in critically ill older adults

Loss

Teichmann

Paula

et al. 2022

J Parenter Enteral Nutr

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“…Esse fato deve-se ao próprio processo do envelhecimento que está associado a maior prevalência de comorbidades, os pacientes mais idosos tendem a apresentar mais eventos mórbidos. Idade avançada representa uma condição de vulnerabilidade, assim como doenças crônicas, fragilidade e a natureza invasiva do procedimento cirúrgico são outros importantes preditores de mortalidade (Silva, Casimiro, Oliveira, Ferreira, & Abelha, 2020).…”

Section: Idadeunclassified

Identificação dos diagnósticos de enfermagem em recuperação pós-anestésica segundo a Teoria das necessidades humanas básicas

Borges

Bernardo

Soares

et al. 2021

RSD

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Na sala de recuperação pós-anestésica são realizados cuidados intensivos em pacientes no pós-operatório imediato de procedimento anestésico-cirúrgico, permanecendo sob observação até o momento em que estejam conscientes, com reflexos protetores existentes e com os sinais vitais estáveis. De tal modo, o presente estudo visa identificar os diagnósticos de enfermagem mais frequentes em sala de recuperação pós-anestésica segundo a Teoria das necessidades humanas básicas. Trata-se de uma pesquisa de natureza quantitativa, do tipo descritivo com delineamento transversal, feita com um instrumento validado para a coleta dos dados, aplicado em pacientes maiores de 18 anos que passaram por atendimento cirúrgico, sendo admitidos na sala de recuperação pós-anestésica de uma unidade hospitalar de grande porte, referência em assistência de alta complexidade no Sistema Único de Saúde da região nordeste do Brasil. A amostra do estudo compôs-se de 48 pacientes, com trinta e duas mulheres (66,7%) e dezesseis homens (33,3%). Foram identificados 22 diagnósticos de Enfermagem, destes 17 corresponderam às necessidades humanas básicas psicobiológicas, 4 às necessidades humanas básicas psicossociais e 1 psicoespiritual. Diagnósticos encontrados em 100% da amostra: Risco de Infecção, Risco de Queda, Risco de Desequilíbrio da Temperatura Corporal, Risco de Aspiração, Integridade da Pele Prejudicada e Mobilidade no Leito Prejudicada. Em suma, os diagnósticos identificados são achados comuns em pacientes de pós-operatório imediato, sendo possível antecipar as ações e evitar que ocorram essas complicações e o agravamento da condição de saúde do paciente.

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“…[ 27 28 ] A correlation between different age brackets and FS with the surgical outcome in the very elderly (aged more than 85 years) has been shown in a wide patients’ group. [ 29 ]…”

Section: Introductionmentioning

confidence: 99%

Geriatric anesthesia: Demographics, epidemiology, state of the art at international level, educational needs, and future perspectives

Bettelli

2023

Saudi J Anaesth

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Population aging has induced in the last year a corresponding aging inside the surgical population, currently accounting for 45%.50% of the total surgical population in the majority of the advanced countries. This has induced a number of new challenges in the daily anesthesia practice, ranging from the need of implementing specific education in the field of geriatric medicine, organizational adjustments aimed to adapt our preoperative evaluation methodology to the needs older patients present, and a careful redesign of the whole perioperative course for these patients. Today’s anesthesiologists are called to became familiar with the aging processes and their impact on the patho.physiological perioperative course, with the concept of functional impairment and frailty and with the dimensions of polypathology, polymedication, and reduced functional reserves. The introduction of new trends such as the team-based approach and interdisciplinary culture are essential to overcome these emerging criticalities.

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The very elderly surgical population in a critically ill scenario: clinical characteristics and outcomes

Cited by 5 publications

References 28 publications

Nutrition as a risk for mortality and functionality in critically ill older adults

Nutrition as a risk for mortality and functionality in critically ill older adults

Identificação dos diagnósticos de enfermagem em recuperação pós-anestésica segundo a Teoria das necessidades humanas básicas

Geriatric anesthesia: Demographics, epidemiology, state of the art at international level, educational needs, and future perspectives

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