This innovative, comprehensive book covers the key elements of perioperative management of older patients. The book's chapter structure coincides with the clinical path patients tread during their treatment, from preoperative evaluation to post-hospital care. Epidemiological aspects and aging processes are illustrated, providing keys to understanding the quick expansion of geriatric surgery and defining the clinical profile of older surgical patients in a cybernetic perspective. Preoperative evaluation and preparation for surgery, including medication reconciliation and pre-habilitation, are developed in the light of supporting decision-making about surgery in an evidence-based and patient-focused way. Intra- and postoperative management are discussed, aiming to tailor anesthetic, surgical and nursing approaches to specific patients' needs, in order to prevent both general and age-related complications. This volume also addresses issues relevant to geriatric surgery, from different organizational models to clinical risk management and systems engineering applied to hospital organization.
Foreword; Preface; Introduction: population aging, healthcare systems and surgery; Part I. Preoperative Evaluation: 1. Aging and age-related functional changes; 2. Preoperative evalution: a 360 Degrees perspective; 3. Comorbidities and multimorbidity; 4. Poly-medication and perioperative drugs management; 5. Assessment of functional reserves; 6. Cognitive and emotional evaluation; 7. Sensorial evaluation and impact of hearing and visual impairment on communication; 8. Preoperative testing; 9. Team-based discussion on preoperative evaluation and decision-making about surgery; 10. Communication and informed consent; 11. Preoperative care in emergency surgery; Part II. Preparation to Surgery: 12. Prehabilitation: how to enhance cardio-respiratory functional reserves before surgery; 13. Diagnosis and treatment of nutritional deficits; 14. Prevention of cognitive complications; 15. Psychological support in elderly surgical patients; 16. The role of geriatric nurses in preparing the elderly for surgery; Part III. Intraoperative Management: 17. Entering the operating theatre: a challenging experience; 18. Safety in the operating room: special needs of geriatric patients; 19. The geriatric patient and anesthesia; 20. Regional anesthesia techniques; 21. Fluids and electrolytes management; 22. Surgery in the elderly: general considerations; 23. Cancer surgery and the elderly; 24. Orthopedic surgery; 25. Cardiovascular surgery; 26. Thoracic surgery; 27. Abdominal surgery; 28. Day surgery; 29. Cataract surgery and other office-based procedures; Part IV: Postoperative Management: 30. The elderly in the recovery room; 31. Endocrine and metabolic response to surgical stress in the elderly; 32. Postoperative pain treatment; 33. General principles of postoperative recovery; 34. Fast-track and ERAS programs in geriatric surgery; 35. Postoperative nursing; 36. Cardiovascular complications; 37. Perioperative venous thromboembolism in the elderly: prevention and treatment; 38. Treatment of postoperative delirium; 39. Postoperative respiratory complications; 40. Renal complications; 41. Postoperative admission to the intensive care unit; 42. Prevention of postoperative geriatric syndromes; 43. Planning for discharge; 44. Ethics in geriatric surgery, end of life and palliative care; Part V. Key Issues for Optimal Organization: 45. Models of care and organizational solutions for geriatric surgery; 46. Hospital design; 47. Patient's safety, ergonomics and clinical risk management; 48. Systemic approach to management in GS: methods and tools; 49. Systems engineering in GS: the contribute of modelling and simulation; 50. Closing the loop with the client's perspective: how the elderly live the experience of surgery; Index.