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Chapter 17 - Perioperative Medical Management of Older People

Lessons from Hip Fracture Patients

Published online by Cambridge University Press:  04 April 2024

By
Atef Michael  and
Nonyelum Obiechina
Edited by
George Tadros  and
George Crowther
George Tadros
Affiliation:
Aston University, Birmingham
George Crowther
Affiliation:
Leeds and York Partnership NHS Foundation Trust, Leeds
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Summary

The population of the world is ageing. This has led to an increase in interventions and surgical procedures that would have been unheard of about fifty years ago. In this chapter we discuss the perioperative management of older patients, and the emphasis is on hip fracture patients. Factors such as limited physiological reserve, comorbidities, and the trauma of surgery itself are discussed, together with their perioperative management. The impact of pre-existing dementia and of post-operative delirium and depression is also covered here. The pre-operative management of fluid and electrolyte imbalance, the reversal of anticoagulation before surgery, and the treatment of infections are included. The evidence base around cut-offs for haemoglobin levels acceptable for surgery is also discussed. Finally, the post-operative management of acute kidney injury, infections, myocardial infarction, congestive cardiac failure, post-operative delirium, post-operative cognitive dysfunction, and depression is explored in conjunction with their evidence base.

Keywords

perioperative managementpostoperative deliriumdepressiondementiapreoperative anaemiahip fractures
Type
Chapter
Information
Handbook of Old Age Liaison Psychiatry , pp. 246 - 265
Publisher: Cambridge University Press
Print publication year: 2024

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