Geriatric syndromes in peri-operative elderly cancer patients

Cicerchia, Marcella; Ceci, Moira; Locatelli, Carola; Gianni, Walter; Repetto, Lazzaro

doi:10.1016/j.suronc.2009.11.005

Cited by 21 publications

(8 citation statements)

References 63 publications

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“…Among the aging population, the total number of cases of colorectal cancer is increasing as well. Studies have demonstrated that age is a risk factor that affects surgical outcome, and surgery is infrequently offered to older cancer patients because of the increased risk of surgical morbidity and mortality 4 . Thus, the decision to perform surgery on older patients often presents as an ethical dilemma 5 .…”

Section: Introductionmentioning

confidence: 99%

Impact of Comorbidities on the Outcomes of Older Patients Receiving Rectal Cancer Surgery

Chang¹,

Shih²,

Lin³

2012

International Journal of Gerontology

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s u m m a r yBackground: The decision to perform surgery on older patients often presents as an ethical dilemma. The purpose of this study is to investigate the impact of comorbidities on the clinical outcomes of older rectal cancer surgery patients, with the goal of enabling healthcare professionals to evaluate the risk of surgery for the treatment of cancer in older patients with comorbid chronic disease. Methods: This study included 320 patients >60 years of age who were treated from 2004e2009 at a medical center in northern Taiwan. Logistic regression and Cox proportional hazards regression were used to determine if various chronic diseases (e.g., hypertension, diabetes, cardiovascular disease, cerebrovascular disease) increase the risk of in-hospital complications and 1-year mortality. Results: In the multivariate analysis, the risk of in-hospital complications for diabetic patients was 3.43 times that of nondiabetic patients (95% confidence interval [CI]: 1.13e10.37). For patients with cerebrovascular disease, the risk was 4.99 times that of those without cerebrovascular disease (95% CI: 1.30e19.07). In addition, patients 80 years of age demonstrated significantly higher 1-year mortality rates (HR ¼ 3.49, 95% CI:1.18e10.30). However, a history of hypertension, diabetes, cardiovascular disease, or cerebrovascular disease was not a significant predictor of 1-year mortality. Conclusion: Older patients with comorbidities are at a higher risk of in-hospital complications following rectal cancer surgery, whereas the presence of comorbidities did not show a significant adverse effect on 1-year mortality in the present study. We suggest using population-based data to establish effective therapeutic strategies for treating each comorbidity.

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Section: Introductionmentioning

confidence: 99%

Impact of Comorbidities on the Outcomes of Older Patients Receiving Rectal Cancer Surgery

Chang¹,

Shih²,

Lin³

2012

International Journal of Gerontology

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“…angepasst werden [13]. Etwa 25% der alten Patienten erleiden kurze oder längere Perioden eines Delirs und damit häufiger als jüngere Patienten [3]. …”

Section: Sedierung Und Delirunclassified

Pharmakotherapie alter Patienten

Thürmann

Schmiedl

2011

Med Klin

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Drug therapy in seniors needs to be adapted to the capacity of the aged organism. The dosages of a high number of drugs from several classes (e.g., antibiotics, low molecular weight heparins) have to be modified according to age or reduced renal function, which is a common feature in old age. Moreover, elderly patients due to their physiological alterations exhibit an increased response to drugs having an influence on renal function: diuretics, nonsteroidal anti-inflammatory drugs, inhibitors of the renin-angiotensin-aldosterone system, and contrast media. The choice of drugs should consider their age-specific tolerability, i.e., fall-risk increasing drugs and those with strong anticholinergic side effects should be avoided. Analgesics, sedatives, and narcotics have to be selected according to the age of the patient and dosages should be adapted. Multimorbidity is often treated with polypharmacy, whereby it is not unusual that this is the cause for acute hospital admission. The necessity of all drugs prescribed has to be scrutinized and the drug burden should be reduced as clinically required.

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“…Educating medical staff in the recognition of specific geriatric syndromes, such as delirium, and communication with hearing impaired elderly or patients with cognitive dysfunction is only the beginning of optimising peri-operative care. 50 Furthermore, medical staff dealing with elderly patients need to be educated about managing co-morbidity and polypharmacy, and the importance of functional assessments for treatment planning. It is up to geriatricians and surgeons combined to change the omnipresent image that geriatric medicine is dull and stuffy.…”

Section: Room For Improvementmentioning

confidence: 99%