Book contents
- Frontmatter
- Contents
- Editorial Advisory Committee
- Contributors
- Acknowledgments
- 1 Essential Principles in the Care of the Elderly
- 2 Assessment of the Older Patient
- 3 Prevention for Older Adults
- 4 Common Complaints in the Elderly
- 5 Appropriate Use of Medications in the Elderly
- 6 Nutrition and Aging
- 7 Using Exercise as Medicine for Older Adults
- 8 Diabetes Mellitus in the Older Adult
- 9 Lipid Management in Older Patients
- 10 Hypertension
- 11 Diagnosis and Management of Heart Disease in the Elderly
- 12 Peripheral Arterial Disease in the Elderly
- 13 Stroke in the Older Adult
- 14 Neurological Problems in the Elderly
- 15 Recognition and Management of Delirium
- 16 Evaluation and Management of Dementia
- 17 Clinical Geropsychiatry
- 18 Alcohol and Other Drug Abuse in Older Patients
- 19 Aging in Adults with Developmental Disabilities
- 20 Pulmonary Issues in the Elderly
- 21 Gastroenterological Disease in the Older Adult
- 22 Serious Infections in the Elderly
- 23 Human Immunodeficiency Virus in the Elderly
- 24 Principles of Fluid and Electrolyte Balance and Renal Disorders in the Older Patient
- 25 Urological Issues in Older Adults
- 26 Urinary Incontinence
- 27 Geriatric Gynecology
- 28 Disorders of the Endocrine Glands
- 29 Osteoporosis and Other Metabolic Disorders of the Skeleton in Aging
- 30 Common Rheumatic Diseases in the Elderly
- 31 Musculoskeletal Injuries in the Elderly
- 32 Foot Health for the Elderly: Podogeriatric Overview
- 33 Geriatric Dermatology
- 34 Pressure Ulcers: Practical Considerations in Prevention and Treatment
- 35 Anemia and Other Hematological Problems of the Elderly
- 36 Cancer in the Elderly
- 37 Eye Problems of the Aged
- 38 Geriatric Ear, Nose, and Throat Problems
- 39 Geriatric Dentistry
- 40 Surgical Principles in the Aged
- 41 Rehabilitation in Older Adults
- 42 Community-Based Long-Term Care
- 43 Institutional Long-Term Care
- 44 Care for the Elderly Patient at the End of Life
- 45 Assessment of Decision-Making Capacity
- 46 Injuries in Older Adults
- 47 The Mistreatment of Older Adults
- 48 Driving and the Older Adult
- 49 Integrative Medicine in the Care of the Elderly
- 50 Successful Aging: Optimizing Strategies for Primary Care Geriatrics
- 51 Cell Biology and Physiology of Aging
- 52 Implications of an Aging Society
- 53 Ethnogeriatrics
- 54 Retirement
- 55 Geriatric Sexuality
- 56 The Elderly, Their Families, and Their Caregivers
- 57 Systematic Approaches to Preventing Errors in the Care of the Elderly
- 58 Health Care Organization and Financing
- 59 Advance Care Planning: Values and Families in End-of-Life Care
- 60 Ethical Decision Making in Geriatric Medicine
- Index
- Plate section
40 - Surgical Principles in the Aged
Published online by Cambridge University Press: 19 May 2010
- Frontmatter
- Contents
- Editorial Advisory Committee
- Contributors
- Acknowledgments
- 1 Essential Principles in the Care of the Elderly
- 2 Assessment of the Older Patient
- 3 Prevention for Older Adults
- 4 Common Complaints in the Elderly
- 5 Appropriate Use of Medications in the Elderly
- 6 Nutrition and Aging
- 7 Using Exercise as Medicine for Older Adults
- 8 Diabetes Mellitus in the Older Adult
- 9 Lipid Management in Older Patients
- 10 Hypertension
- 11 Diagnosis and Management of Heart Disease in the Elderly
- 12 Peripheral Arterial Disease in the Elderly
- 13 Stroke in the Older Adult
- 14 Neurological Problems in the Elderly
- 15 Recognition and Management of Delirium
- 16 Evaluation and Management of Dementia
- 17 Clinical Geropsychiatry
- 18 Alcohol and Other Drug Abuse in Older Patients
- 19 Aging in Adults with Developmental Disabilities
- 20 Pulmonary Issues in the Elderly
- 21 Gastroenterological Disease in the Older Adult
- 22 Serious Infections in the Elderly
- 23 Human Immunodeficiency Virus in the Elderly
- 24 Principles of Fluid and Electrolyte Balance and Renal Disorders in the Older Patient
- 25 Urological Issues in Older Adults
- 26 Urinary Incontinence
- 27 Geriatric Gynecology
- 28 Disorders of the Endocrine Glands
- 29 Osteoporosis and Other Metabolic Disorders of the Skeleton in Aging
- 30 Common Rheumatic Diseases in the Elderly
- 31 Musculoskeletal Injuries in the Elderly
- 32 Foot Health for the Elderly: Podogeriatric Overview
- 33 Geriatric Dermatology
- 34 Pressure Ulcers: Practical Considerations in Prevention and Treatment
- 35 Anemia and Other Hematological Problems of the Elderly
- 36 Cancer in the Elderly
- 37 Eye Problems of the Aged
- 38 Geriatric Ear, Nose, and Throat Problems
- 39 Geriatric Dentistry
- 40 Surgical Principles in the Aged
- 41 Rehabilitation in Older Adults
- 42 Community-Based Long-Term Care
- 43 Institutional Long-Term Care
- 44 Care for the Elderly Patient at the End of Life
- 45 Assessment of Decision-Making Capacity
- 46 Injuries in Older Adults
- 47 The Mistreatment of Older Adults
- 48 Driving and the Older Adult
- 49 Integrative Medicine in the Care of the Elderly
- 50 Successful Aging: Optimizing Strategies for Primary Care Geriatrics
- 51 Cell Biology and Physiology of Aging
- 52 Implications of an Aging Society
- 53 Ethnogeriatrics
- 54 Retirement
- 55 Geriatric Sexuality
- 56 The Elderly, Their Families, and Their Caregivers
- 57 Systematic Approaches to Preventing Errors in the Care of the Elderly
- 58 Health Care Organization and Financing
- 59 Advance Care Planning: Values and Families in End-of-Life Care
- 60 Ethical Decision Making in Geriatric Medicine
- Index
- Plate section
Summary
The massive increase in the geriatric population has been more than paralleled by a vast increase in the number of patients older than the age of 65 years, or indeed, over any such benchmark, who now seek both elective and emergency surgical care. We discuss the topic of emergency surgery separately near the end of this chapter, because this is such a complex issue that involves by definition issues of life or death, especially in those without treatment. In the United States, 85,000 patients seek elective surgery every working day. A high proportion of these (approximately 50%) are Medicare beneficiaries, that is, older than the age of 65 years. Therefore, the practice of all surgical specialties in most countries is becoming, in fact, more and more a practice of geriatric surgery.
SURGEON–PATIENT COMMUNICATION ISSUES
Profoundly important ethical issues are involved, especially for the elderly who may be impaired and/or with an issue regarding informed consent. One of the most important principles is that the surgeon and the patient have a serious discussion and reach a real agreement about the goals of care. The surgeon should always inquire as to the presence of an advance directive from all older patients, which provides an important entry for discussion in a variety of areas.
This discussion really gets cast into bold relief when the presence of a living will and variably interpreted do not resuscitate orders exist. Under these circumstances, it is essential that the patient and a (preferably the) responsible family member, if at all possible, and the surgeon seriously discuss the patient's interpretation of the living will and the do not resuscitate standard.
- Type
- Chapter
- Information
- Reichel's Care of the ElderlyClinical Aspects of Aging, pp. 442 - 446Publisher: Cambridge University PressPrint publication year: 2009