Physiologic aging, or "senescence," is defined as decreased functional reserve of critical organ systems. It is generally believed to occur at what age?
The cut off for the definition of senescence has increased from 55 years in the late 1960s to 70 years currently. This is a general definition as each patient should be assessed for their own capacity to respond to the stress of surgery.
Frailty is a major risk factor for postoperative complications. Which of the following measures does NOT contribute to frailty?
Frailty, disability (inability to perform more than one activity of daily living), and comorbidities such as anemia and hypoalbuminemia are the primary conditions which impact on the outcome of surgical procedures in the elderly. Each condition should be assessed preoperatively.
What is the most common indication for surgical intervention in the elderly?
Biliary tract disease due to pigmented or cholesterol stone formation and acute cholecystitis are common problems in the elderly and most likely to lead to surgical intervention. The mortality risk of emergency cholecystectomy is four times that of elective cholecystectomy in the elderly.
What is the leading cause of postoperative morbidity and mortality in the elderly?
Impaired cardiac reserve means that elderly patients cannot increase their ejection fraction as demand increases, but are dependent on ventricular filling and increased stroke volume to meet the need for increased output. Intravascular volume is therefore critically important, but fluid overload is poorly tolerated and can result in congestive heart failure.
Elderly patients with acute peritonitis may NOT present with typical symptoms of acute abdominal pain, fever, or leukocytosis due to an impaired immune response. A high index of suspicion is needed as the initial clinical diagnosis in elderly patients with acute appendicitis is correct in what percent of cases?
In elderly patients with acute appendicitis or acute cholecystitis, one-third lack symptoms of abdominal pain, one-third are afebrile, and one-third have a normal white blood cell count. Therefore an "unimpressive" abdominal examination is irrelevant in the evaluation of the elderly patient whose tolerance for food has suddenly changed.
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