Abstract
Older adults are the fastest growing segment of the US population. By the year 2050, the number of Americans aged 65 and older is projected to double from 40 million in 2010 to over 80 million. Older adults account for 40% of all inpatient operations performed on an annual basis, and they tend to undergo higher risk operations with more frequent and more severe postoperative complications. Older adults experience higher rates of morbidity, mortality, and complications such as delirium. They experience longer hospital stays and are less likely to return to their baseline functional status. A unique approach to the care of geriatric patients experiencing injury or acute care surgical conditions is necessary to ensure optimal outcomes. Thoughtful attention to advance care planning and goals of care is critical to ensure care plans align with the values and preferences of the patient. This chapter provides rationale for a geriatric-specific approach to trauma and acute care surgery, as well as an evaluation of the systems impact of geriatric-specific surgical care programs.
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References
Gale SC, Shafi S, Dombrovskiy VY, Arumugam D, Crystal JS. The public health burden of emergency general surgery in the United States: A 10-year analysis of the Nationwide Inpatient Sample–2001 to 2010. J Trauma Acute Care Surg. 2014;77(2):202–8. https://doi.org/10.1097/TA.0000000000000362.
Fakhry SM, Shen Y, Biswas S, Duane TM, McBride KM, Elkbuli A, Wyse RJ, Wilson NY, Garland JM, Kurek SJ, Plurad DS, Banton KL, Fisher C, Gage A, Hunt DLS, Lieser MJ, Shillinglaw WRC, Watts DD. The public health burden of geriatric trauma: analysis of 2,688,008 hospitalizations from Centers for Medicare and Medicaid Services inpatient claims. J Trauma Acute Care Surg. 2022;92(6):984–9. https://doi.org/10.1097/TA.0000000000003572.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol. 2001;56(3):M146–56.
Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601–8.
Plassman BL, Langa KM, Fisher GG, Heeringa SG, Weir DR, Ofstedal MB, et al. Prevalence of cognitive impairment without dementia in the United States. Ann Intern Med. 2008;148(6):427–34.
Kaiser MJ, Bauer JM, Ramsch C, et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010;58(9):1734–8.
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185(12):914–9.
Pope TM. Legal fundamentals of surrogate decision making. Chest. 2012;141(4):1074–81.
Kon AA, Shepard EK, Sederstrom NO, Swoboda SM, Marshall MF, Birriel B, Rincon F. Defining futile and potentially inappropriate interventions: a policy statement from the Society of Critical Care Medicine ethics committee. Crit Care Med. 2016;44:1769–74.
Kwok AC, Semel ME, Lipsitz SR, Bader AM, Barnato AE, Gawande AA, et al. The intensity and variation of surgical care at the end of life: a retrospective cohort study. Lancet. 2011;378:1408–13.
Morris RS, deRoon-Cassini TA, Duthie EH, Tignanelli CJ. Challenges in the development and implementation of older adult trauma prognostication tools to facilitate shared decision-making. J Surg Res. 2021;266:430–2. https://doi.org/10.1016/j.jss.2021.04.016.
Bryant EA, Tulebaev S, Castillo-Angeles M, Moberg E, Senglaub SS, O'Mara L, McDonald M, Salim A, Cooper Z. Frailty identification and care pathway: an interdisciplinary approach to Care for Older Trauma Patients. J Am Coll Surg. 2019;228(6):852–859.e1. https://doi.org/10.1016/j.jamcollsurg.2019.02.052.
Becher RD, DeWane MP, Sukumar N, Stolar MJ, Gill TM, Becher RM, Maung AA, Schuster KM, Davis KA. Hospital operative volume as a quality indicator for general surgery operations performed emergently in geriatric patients. J Am Coll Surg. 2019;228(6):910–23. https://doi.org/10.1016/j.jamcollsurg.2019.02.053. Erratum in: J Am Coll Surg 2020 Feb;230(2):263–268
Jones TS, Jones EL, Richardson V, Finley JB, Franklin JL, Gore DL, Horney CP, Kovar A, Morin TL, Robinson TN. Preliminary data demonstrate the geriatric surgery verification program reduces postoperative length of stay. J Am Geriatr Soc. 2021;69(7):1993–9. https://doi.org/10.1111/jgs.17154.
Berian JR, Zhou L, Hornor MA, Russell MM, Cohen ME, Finlayson E, Ko CY, Robinson TN, Rosenthal RA. Optimizing surgical quality datasets to care for older adults: lessons from the American College of Surgeons NSQIP geriatric surgery pilot. J Am Coll Surg. 2017;225(6):702–712.e1. https://doi.org/10.1016/j.jamcollsurg.2017.08.012.
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Briggs, A., Kodadek, L.M. (2023). A Rationale and Systems Impact for Geriatric Trauma and Acute Care Surgery. In: Petrone, P., Brathwaite, C.E. (eds) Acute Care Surgery in Geriatric Patients. Springer, Cham. https://doi.org/10.1007/978-3-031-30651-8_3
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DOI: https://doi.org/10.1007/978-3-031-30651-8_3
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