ABSTRACT
A atenção a pacientes idosos submetidos à cirurgia ortopédica, particularmente os que necessitam de cirurgia de urgência, deve levar em conta a análise da capacidade física e de riscos específicos dos indivíduos idosos, na tentativa de reduzir riscos que, no entanto, permanecem elevados neste grupo. Apesar dos riscos, procedimentos desenvolvidos com prontidão têm efeito positivo na evolução destes pacientes. A atenção coordenada integrada por equipe clínica/geriátrica, ortopédica, anestésica, intensivistas e demais profissionais de saúde pode ser altamente benéfica neste grupo de pacientes.
Care for elderly patients undergoing orthopedic surgery, particularly for those requiring emergency surgery, needs to take into account an analysis of physical capacity and risks specific to elderly individuals, in an attempt to reduce the risks. Nevertheless, these remain high in this group. Despite the risks, procedures developed promptly have a positive effect on these patients' evolution. Coordinated care, composed of teams of specialists within clinical medicine, geriatrics, orthopedics, anesthesiology and critical care, along with other healthcare professionals, may be highly beneficial for this group of patients.
Subject(s)
Humans , Male , Female , Aged , Emergency Medicine , Orthopedic Procedures , Risk-Taking , Signs and SymptomsABSTRACT
OBJECTIVE: To evaluate the profile of osteoporosis treatment among patients hospitalized due to hip fractures at a tertiary-level university hospital. To compare the impact of hospitalization on approaches toward treating bone mass losses. METHOD: The medical records of 123 hip fracture patients aged 60 years and over at the Institute of Orthopedics, Hospital das Clínicas, University of São Paulo School of Medicine, between 2004 and 2006 were reviewed and analyzed with respect to approaches towards investigating osteoporosis and treatments before and after fracture. RESULTS: The patients' mean age was 78 ± 8.3 years, and the majority were women (71.54 percent). The patients had a mean of 2.72 comorbidities and used 3.26 medications on average. Among these patients, 12.3 percent reported a previous diagnosis of osteoporosis, and 5.83 percent were on medication for this. The mean waiting time for surgery was 6.3 ± 7.54 days, and seven patients (5.7 percent) died during the hospitalization. There were no investigations using bone densitometry, no changes in osteoporosis therapy between admission and discharge (p = 0.375), and no reports of referrals for the patient to have access to treatment. CONCLUSIONS: Investigations and treatments of osteoporosis and strategies for preventing new fractures were not implemented during the hospitalization of these elderly patients with hip fractures, even though this is the most feared complication of osteoporosis. These data need to be disseminated so that professionals dealing with elderly patients are attentive to the need for primary and secondary prevention of osteoporosis because of the impact of fractures on these patients' quality of life, independence, morbidities, and mortality.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Hip Fractures/etiology , Osteoporosis/diagnosis , Osteoporosis/drug therapy , Hip Fractures/prevention & control , Hip Fractures/therapy , Hospitalization/statistics & numerical data , Osteoporosis/complications , Patient Discharge/standards , Patient Discharge/statistics & numerical data , Time FactorsABSTRACT
Delirium é uma apresentação comum de distúrbios agudos na população geriátrica. Tem sido associado a um pior prognóstico, aumento de permanência hospitalar e dos custos, bem como maiores taxas de morbidade e mortalidade entre os idosos. Os fatores predisponentes e precipitantes são hoje mais conhecidos e estão associados aos cuidados hospitalares.Estudos controlados demonstram que intervenções preventivas podem reduzir de 30% a 40% a incidência de delirium, essas intervenções estão essencialmente ligadas a melhor qualidade no cuidado hospitalar. Este artigo revisa recentes estudos sobre epidemiologia, diagnóstico, fisiopatologia, tratamento e prevenção do delirium na população idosa.
ABSTRACT
PURPOSE: To ascertain perioperative morbimortality and identify prognostic factors for mortality among patients >55 years who undergo non-cardiac surgery. METHODS: A retrospective cohort of 403 patients relating to perioperative morbidity-mortality. Data were collected from a standardized protocol on gender, age, comorbidities, medications used, smoking, alcohol abuse, chronic use of benzodiazepine, nutritional status, presence of anemia, activities of daily living, American Society of Anesthesiology classification, Detsky's modified cardiac risk index - American College of Physicians, renal function evaluation, pulmonary risk according to the Torrington scale, risk of thromboembolic events, presence of malignant disease and complementary examinations. RESULTS: The mean age of the subjects was 70.8 ± 8.1 years. The "very old" (>80 years) represented 14 percent. The mortality rate was 8.2 percent, and the complication rate was 15.8 percent. Multiple logistic regression showed that a history of coronary heart disease (OR: 3.75; p=0.02) and/or valvular heart disease (OR: 31.79; p=0.006) were predictors of mortality. The American Society of Anesthesiology classification was shown to be the best scale to mark risk (OR: 3.01; p=0.016). Nutritional status was a protective factor, in which serum albumin increases of 1 mg/dl decreased risk by 63 percent. DISCUSSION: The results indicate that serum albumin, coronary heart disease, valvular heart disease and the American Society of Anesthesiology classification could be prognostic predictors for aged patients in a perioperative setting. In this sample, provided that pulmonary, cardiac and thromboembolic risks were properly controlled, they did not constitute risk factors for mortality. Furthermore, continuous effort to learn more about the preoperative assessment of elderly patients could yield intervention possibilities and minimize morbimortality.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Geriatric Assessment/statistics & numerical data , Perioperative Care , Surgical Procedures, Operative/mortality , Age Factors , Brazil/epidemiology , Cardiovascular Diseases/etiology , Epidemiologic Methods , Nutrition Assessment , Preoperative Care , Prognosis , Postoperative Complications/etiologySubject(s)
Humans , Aged , Aged , Geriatrics , Health Services for the Aged , Pain , Therapeutics , Anemia , Constipation , Dementia , Depression , Diabetes Mellitus , Erectile Dysfunction , Hyperlipidemias , Hypertension , Urinary IncontinenceABSTRACT
Com o envelhecimento progressivo da populaçäo e por ser maior a incidência de câncer com o avançar da idade nos defrontaremos cada vez mais com pacientes idosos portadores de câncer para os quais será necessária uma abordagem clínica ampla e que enfoque tanto aspectos geriátricos como oncológicos. Este artigo visa revisar os princípios da avaliaçäo, tratamento, prevençäo e cuidados paliativos de pacientes idosos com câncer.
Subject(s)
Humans , Male , Female , Aged , Aged , Aging , Geriatrics , Neoplasms , Hospice Care , HospitalizationABSTRACT
A assistência à saúde do idoso vem evoluindo significativamente nas últimas décadas por vários motivos, incluindo o aumento de demanda pelas alterações demográficas, o maior conhecimento sobre o processo natural de envelhecimento e o acesso às técnicas diagnósticas e terapêuticas anteriormente reservadas aos jovens. Nada, porém, foi tão importante para este incremento qualitativo quanto a progressiva associação de conhecimentos, previamente restrita a cada profissão ou a cada especialidade profissional
Subject(s)
Humans , Male , Female , Aged , Aged , Old Age Assistance/trends , Interprofessional Relations , Aging , Patient Care Team/trends , Holistic Health , Medical CareABSTRACT
Foram estudados 26 pacientes com idades variando entre 65 e 75 anos (média 68,1 anos), sendo seis com coronariopatia em tratamento clínico, 11 com revascularizaçäo miocárdica e nove assintomáticos. Todos foram submetidos a um teste ergométrico inicial e a um programa de condicionamento físico. Os testes de avaliaçäo foram realizados aos três e/ou seis meses. As variáveis avaliadas foram: freqüência cardíaca, pressäo arterial, duplo produto, manifestaçöes clínicas, trabalho total, consumo máximo de oxigênio e resultados dos testes. Observou-se diminuiçäo do cansaço e dos sintomas durante os testes de controle, bem como elevaçäo do trabalho total e de consumo máximo de oxigênio aos três e, principalmente, aos seis meses de treinamento, com conseqüente melhora da capacidade aeróbica do grupo. Conclui-se que, na faixa etária estudada, o exercício induz evidente melhora das variáveis utilizadas na eletrocardiografia de esforço, sendo um método para avaliaçäo inicial, programaçäo e acompanhamento dos efeitos do condicionamento físico