Normal aging is a process that involves loss of functional reserve of most organ systems of the human body, most significantly: cardiovascular, pulmonary, renal and nervous systems. Advancements in both surgery and an...Normal aging is a process that involves loss of functional reserve of most organ systems of the human body, most significantly: cardiovascular, pulmonary, renal and nervous systems. Advancements in both surgery and anesthesia have made it possible to operate more safely on the elderly population and those older patients with multiple severe co-morbidities that were not routinely possible in the recent past. Regional anesthesiologist have proven to be instrumental in this regard as regional anesthetic/analgesic techniques may now permit surgeons to operate on the elderly who were not ideal surgical candidates or unable to tolerate general anesthesia. In addition, regional techniques provide alternatives that may optimize acute pain control and reduce the incidence of devastating side effects during the perioperative period such as: myocardial infarction, pulmonary embolism, pneumonia, and also increases the opportunity to allow for early ambulation and shorter hospital stays. These anesthetic options now provide the elderly patient with better medical care alternatives, but also can show a significant financial impact on health care system resources. Further understanding on aging molecular biology, physiology and pathophysiology, together with technical improvements of regional anesthetic techniques will continue to make it safer and more efficacious to operate on the elderly population with evidence of reduced morbidity and mortality. Although there is only anecdotal evidence that regional anesthesia(RA) improves survival, there is little doubt that RA plays an important role in perioperative optimization of pain control and decreases pain management complications as well as a reduction in healthcare costs. Beyond traditional operating rooms, elderly patients may increasingly benefit from RA and acute pain management in Emergency Rooms, medical clinics and even within a patient's home. Therefore, the focus of this review is directed toward geriatric patients and beneficial effects of RA on outcomes in the elderl展开更多
Although fall experience is an important predictor of future falls, clinicians place too much emphasis on this factor during risk assessment of falls. This study aimed to determine individuals with high and low fall r...Although fall experience is an important predictor of future falls, clinicians place too much emphasis on this factor during risk assessment of falls. This study aimed to determine individuals with high and low fall risk on the basis of the relationship between physical function levels [competence in performing activities of daily living (ADL)] and risk factors for falls (fall experience, locomotive organ impairment, and potential for falling). Participants were 1057 independent community-dwelling elderly individuals. ADL competence and the status of risk factors for falls were evaluated using a questionnaire and the relationship between the two was determined. We calculated the cumulative relative frequency curves for ADL scores after categorizing the participants into several groups according to combinations of risk factors and analyzed those combinations that showed wide individual differences in the cumulative relative frequency curves. Intergroup differences when the participants were categorized on the basis of fall experience alone were small;however, those when the participants were categorized on the basis of locomotive impairment and potential for falling were much greater. On classifying the participants into eight groups on the basis of locomotive organ health, fall risk, and fall experience, we found that fallers with locomotive impairment and a high fall risk exhibited the lowest ADL scores while fallers without locomotive impairment and with a low fall risk exhibited the highest ADL scores. Fall risk assessments that are overtly dependent on fall experience are fundamentally limited. Grouping key risk factors can help in determining target groups, including highrisk fallers, low-risk fallers, and high-risk nonfallers, which require primary preventive measures among the community-dwelling elderly.展开更多
文摘Normal aging is a process that involves loss of functional reserve of most organ systems of the human body, most significantly: cardiovascular, pulmonary, renal and nervous systems. Advancements in both surgery and anesthesia have made it possible to operate more safely on the elderly population and those older patients with multiple severe co-morbidities that were not routinely possible in the recent past. Regional anesthesiologist have proven to be instrumental in this regard as regional anesthetic/analgesic techniques may now permit surgeons to operate on the elderly who were not ideal surgical candidates or unable to tolerate general anesthesia. In addition, regional techniques provide alternatives that may optimize acute pain control and reduce the incidence of devastating side effects during the perioperative period such as: myocardial infarction, pulmonary embolism, pneumonia, and also increases the opportunity to allow for early ambulation and shorter hospital stays. These anesthetic options now provide the elderly patient with better medical care alternatives, but also can show a significant financial impact on health care system resources. Further understanding on aging molecular biology, physiology and pathophysiology, together with technical improvements of regional anesthetic techniques will continue to make it safer and more efficacious to operate on the elderly population with evidence of reduced morbidity and mortality. Although there is only anecdotal evidence that regional anesthesia(RA) improves survival, there is little doubt that RA plays an important role in perioperative optimization of pain control and decreases pain management complications as well as a reduction in healthcare costs. Beyond traditional operating rooms, elderly patients may increasingly benefit from RA and acute pain management in Emergency Rooms, medical clinics and even within a patient's home. Therefore, the focus of this review is directed toward geriatric patients and beneficial effects of RA on outcomes in the elderl
文摘Although fall experience is an important predictor of future falls, clinicians place too much emphasis on this factor during risk assessment of falls. This study aimed to determine individuals with high and low fall risk on the basis of the relationship between physical function levels [competence in performing activities of daily living (ADL)] and risk factors for falls (fall experience, locomotive organ impairment, and potential for falling). Participants were 1057 independent community-dwelling elderly individuals. ADL competence and the status of risk factors for falls were evaluated using a questionnaire and the relationship between the two was determined. We calculated the cumulative relative frequency curves for ADL scores after categorizing the participants into several groups according to combinations of risk factors and analyzed those combinations that showed wide individual differences in the cumulative relative frequency curves. Intergroup differences when the participants were categorized on the basis of fall experience alone were small;however, those when the participants were categorized on the basis of locomotive impairment and potential for falling were much greater. On classifying the participants into eight groups on the basis of locomotive organ health, fall risk, and fall experience, we found that fallers with locomotive impairment and a high fall risk exhibited the lowest ADL scores while fallers without locomotive impairment and with a low fall risk exhibited the highest ADL scores. Fall risk assessments that are overtly dependent on fall experience are fundamentally limited. Grouping key risk factors can help in determining target groups, including highrisk fallers, low-risk fallers, and high-risk nonfallers, which require primary preventive measures among the community-dwelling elderly.
