Geriatric Preoperative Optimization: A Review.

Autor:	Zietlow KE; Division of Geriatrics and Palliative Medicine, Department of Medicine, Michigan Medicine, Ann Arbor. Electronic address: Kaheliza@med.umich.edu., Wong S; Division of Geriatrics, Department of Medicine, Duke Health, Durham, NC., Heflin MT; Division of Geriatrics, Department of Medicine, Duke Health, Durham, NC; Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC., McDonald SR; Division of Geriatrics, Department of Medicine, Duke Health, Durham, NC; Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC., Sickeler R; Department of Anesthesiology, Stamford Hospital, Conn., Devinney M; Department of Anesthesiology, Duke University School of Medicine, Durham, NC., Blitz J; Department of Anesthesiology, Duke University School of Medicine, Durham, NC., Lagoo-Deenadayalan S; Department of Surgery, Duke Health, Durham, NC., Berger M; Department of Anesthesiology, Duke University School of Medicine, Durham, NC.
Jazyk:	angličtina
Zdroj:	The American journal of medicine [Am J Med] 2022 Jan; Vol. 135 (1), pp. 39-48. Date of Electronic Publication: 2021 Aug 18.
DOI:	10.1016/j.amjmed.2021.07.028
Abstrakt:	This review summarizes best practices for the perioperative care of older adults as recommended by the American Geriatrics Society, American Society of Anesthesiologists, and American College of Surgeons, with practical implementation strategies that can be readily implemented in busy preoperative or primary care clinics. In addition to traditional cardiopulmonary screening, older patients should undergo a comprehensive geriatric assessment. Rapid screening tools such as the Mini-Cog, Patient Health Questionnaire-2, and Frail Non-Disabled Survey and Clinical Frailty Scale, can be performed by multiple provider types and allow for quick, accurate assessments of cognition, functional status, and frailty screening. To assess polypharmacy, online resources can help providers identify and safely taper high-risk medications. Based on preoperative assessment findings, providers can recommend targeted prehabilitation, rehabilitation, medication management, care coordination, and/or delirium prevention interventions to improve postoperative outcomes for older surgical patients. Structured goals of care discussions utilizing the question-prompt list ensures that older patients have a realistic understanding of their surgery, risks, and recovery. This preoperative workup, combined with engaging with family members and interdisciplinary teams, can improve postoperative outcomes. (Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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