The ageing patient – sans everything?

Keays, Rick

doi:10.1111/anae.12488

Cited by 5 publications

(4 citation statements)

References 23 publications

(23 reference statements)

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“…As the population ages, its need for healthcare intervention escalates . We are more likely to meet this need if older anaesthetists continue to contribute.…”

Section: What Should We Do?mentioning

confidence: 99%

The ageing anaesthetist

Redfern

Gallagher

2013

Anaesthesia

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“…As the population ages, its need for healthcare intervention escalates . We are more likely to meet this need if older anaesthetists continue to contribute.…”

Section: What Should We Do?mentioning

confidence: 99%

The ageing anaesthetist

Redfern

Gallagher

2013

Anaesthesia

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“…The projected population aged over 65 will be 26% of the total by 2060, with associated health spending projected to increase from just under 7% of gross domestic product in 2016-17, to around 9% by 2061-62 [23]. Such demographic change will result in higher rates of age-related co-morbidity and will predictably place a greater burden on ICU capacity [24]. This is likely to be associated with increased patient complexity and LOS.…”

Section: Discussionmentioning

confidence: 99%

Mathematical modelling of patient flows to predict critical care capacity required following the merger of two district general hospitals into one

et al. 2014

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SummaryThere is both medical and political drive to centralise secondary services in larger hospitals throughout the National Health Service. High‐volume services in some areas of care have been shown to achieve better outcomes and efficiencies arising from economies of scale. We sought to produce a mathematical model using the historical critical care demand in two District General Hospitals to determine objectively the requisite critical care capacity in a newly built hospital. We also sought to determine how well the new single unit would be able to meet changes in demand. The intention is that the model should be generic and transferable for those looking to merge and rationalise services on to one site. One of the advantages of mathematical modelling is the ability to interrogate the model to investigate any number of different scenarios; some of these are presented.

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“…Currently, 8% of the population are now aged over 75 years and account for~23% of surgical procedures performed ( Fig. 1), but by 2025,~10% of the population will be aged over 75 years, which is likely to increase the economic and clinical burdens on the National Health Service, unless the effectiveness and efficiency of surgical care can be rapidly and significantly improved for this vulnerable patient group [12].…”

Section: Lines?mentioning

confidence: 99%

Peri‐operative care of the elderly 2014

Brown²,

et al. 2013

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Summary1 Increasing numbers of elderly patients are undergoing an increasing variety of surgical procedures. 2 There is an age-related decline in physiological reserve, which may be compounded by illness, cognitive decline, frailty and polypharmacy. 3 Compared with younger surgical patients, the elderly are at relatively higher risk of mortality and morbidity after elective and (especially) emergency surgery. 4 Multidisciplinary care improves outcomes for elderly surgical patients. Protocol-driven integrated pathways guide care effectively, but must be individualised to suit each patient. The AAGBI strongly supports an expanded role for senior geriatricians in coordinating peri-operative care for the elderly, with input from senior anaesthetists (consultants/associate specialists) and surgeons. 5 The aims of peri-operative care are to treat elderly patients in a timely, dignified manner, and to optimise rehabilitation by avoiding postoperative complications. Effective peri-operative care improves the likelihood of very elderly surgical patients returning to their same pre-morbid place of residence, and maintains the continuity of their community care when in hospital. 6 Postoperative delirium is common, but underdiagnosed, in elderly surgical patients, and delays rehabilitation.Multimodal intervention strategies are recommended for preventing postoperative delirium. 7 Peri-operative pain is common, but underappreciated, in elderly surgical patients, particularly if they are cognitively impaired. Anaesthetists should administer opioid-sparing analgesia where possible, and follow published guidance on the management of pain in older people. 8 Elderly patients should be assumed to have the mental capacity to make decisions about their treatment. Good communication is essential to this process. If they clearly lack that capacity, proxy information should be sought to determine what treatment, if any, is in the patient's best interests. 9 Anaesthetists must not ration surgical or critical care on the basis of age, but must be involved in discussions about the utility of surgery and/or resuscitation. 10 The evidence base informing peri-operative care for the elderly remains poor. Anaesthetists are strongly encouraged to become involved in national audit projects and outcomes research specifically involving elderly surgical patients.

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The ageing patient – sans everything?

Cited by 5 publications

References 23 publications

The ageing anaesthetist

The ageing anaesthetist

Mathematical modelling of patient flows to predict critical care capacity required following the merger of two district general hospitals into one

Peri‐operative care of the elderly 2014

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