Perioperative Care of the Elderly Surgical Patient

Abstract

Elderly surgical patients undergo approximately 20% or more of all surgical procedures in acute care hospitals across the country. Elderly people also are more at risk for surgical intervention because of age-related system changes and comorbid conditions. In recent years, greater knowledge about aging and advanced surgical, anesthetic, and monitoring technology has made it possible for many elderly people to undergo surgery without significant mortality. This article is intended to increase the ability of perioperative nurses to anticipate, plan, and provide care for their elderly surgical patients.

Care of the older perioperative patient

“…Eyesight diminishes and may require the use of spectacles, and reduced dentition may result in the wearing of dentures (Bailes 2000). Eyesight diminishes and may require the use of spectacles, and reduced dentition may result in the wearing of dentures (Bailes 2000).…”

“…Should this action not be possible, limbs must be positioned in as natural position as is feasible and appropriate supports and padding used to maintain them. The reasons for this are a patient's reduced metabolic activity thus less heat production, with fewer skin sensors to detect the cold (Bailes 2000). Inadvertent hypothermia is estimated as occurring to between 50 -90% of perioperative patients (Meeker and Rothrock 1999).…”

“…For older female patients the presence of osteoporosis increases the risk of fractures occurring during positioning and additional care should be taken when utilising positions such as lithotomy where legs are being actively lifted and positioned, (Hogstel andTaylor-Martof 1994, Bailes 2000) Throughout surgery, staff should maintain an awareness of their own position and The time span from leaving the ward until completion of positioning on the operating table provides the opportunity for patients to lose body heat. Additionally a less efficient shivering response will reduce any efforts to overcome an identified temperature loss (Bailes 2000). With studies demonstrating an association with increased postoperative bleeding, morbid cardiac events and poor postoperative wound healing (Meeker and Rothrock 1999).…”

“…Shivering results in increased oxygen consumption, with reduced cardiac and pulmonary abilities resulting in possible hypoxia (Bailes 2000). Shivering results in increased oxygen consumption, with reduced cardiac and pulmonary abilities resulting in possible hypoxia (Bailes 2000).…”

“…Biological ageing commences from the age of thirty and is a progressive and gradual decline affecting all body systems, with all individuals affected at different rates (Bailes 2000). The majority of physiological changes Amanda Parker MA BSC [Hons] RNRNT Clinical Specialist/lecturer Queen Victoria NHS Trust East GrinsteadV Kingston University and St George's Hospital Medical School occur in those aged over 75, with the rates of morbidity and mortality much higher in the 'oldest old' (Hogstel et al 1994), with individuals affected differently individualised care becomes essential.…”