Surgical Considerations for the Geriatric Urology Patient.

INTRODUCTION: As the number of geriatric patients continues to increase, urologists will encounter more elderly patients who require counseling about medical or surgical management of their conditions. In this review we provide a practical pathway for the elderly patient being considered for urological surgery. METHODS: Our review includes preoperative evaluation and assessment for cognition, frailty, functional status, falls, cardiovascular and pulmonary status, and nutritional state. RESULTS: Intraoperative concerns include operative procedure choice (with minimally invasive approaches emphasized), positioning, hypothermia, and antibiotic and venous thromboembolism prophylaxis. Postoperative attention requires assessment for delirium, early ambulation, fall prevention, lung expansion, avoidance of nasogastric tubes, early oral feeding and adequate but age adjusted pain control. Appropriate discharge from the hospital must follow, with planning started in the preoperative phase. CONCLUSIONS: Special attention to these adjustments in the operative pathway lead to high operative success rates with a lower risk of complications.

Major urologic problems in geriatrics: assessment and management.

Elderly urologic patients require the same cautions as used in development of treatment programs for them in other disciplines. Because of potential interference with poor renal function or crossover effects with central or peripheral nervous system, however, many urologic drugs must be titrated appropriately. In treating cancer, erectile dysfunction, incontinence or urinary infection, patient quality of life and life span become dominant factors in making therapeutic decisions, by behavioral change, medication, or surgical intervention.

Geriatrics for residents in the surgical and medical specialties: implementation of curricula and training experiences.

In 1994, under the leadership of the late Dennis Jahnigen, the American Geriatrics Society, with support of the John A. Hartford Foundation, began a project to improve the amount and quality of geriatrics education that surgical and related medical specialty residents receive. The targeted disciplines initially were general surgery, emergency medicine, gynecology, orthopedic surgery, and urology and, later, anesthesiology, ophthalmology, otolaryngology, physical medicine and rehabilitation, and thoracic surgery. A key element of this project was to develop model programs within surgical and related specialty residency education. The Geriatrics Education for Specialty Residents (GESR) program has supported 29 residencies to pilot methods for integration of geriatrics within residency programs, encouraged and inspired development of curricular content, and helped to develop faculty leaders to support these efforts in the long term and at a national level. This paper describes the GESR program, the status of curriculum development, steps for other programs to use in developing a geriatrics education program, and some of the common barriers likely to be encountered during implementation along with solutions to those barriers.

Geriatric urology.

Urology is one of the surgical specialties that has been most affected by the growing demographic of older adults in the United States. Urological problems are common in elderly people, and care of patients aged 65 and older represents a large proportion of many urologists' practices. However, this has also presented unique challenges to the development of the field of geriatric urology as an identified subspecialty. Until recently, formal educational requirements and opportunities in geriatric urology were limited. In addition, there is a paucity of basic science and clinical research related specifically to urological problems in older adults, despite the growing numbers of patients in this age group. This article reviews recent efforts to increase the activity, content, and visibility of the field of geriatric urology. Curriculum materials have been developed for urology training programs, research needs have been assessed and targeted, and a new professional organization (the Geriatric Urology Society) has been established. Current activities in the field of geriatric urology at the local, regional, and national levels, and goals for the future are reviewed.