Perioperative Care in Geriatrics

Perioperative Care in Geriatrics
Presentation by
Tomas L. Griebling, MD, FACS, FGSA
Department of Urology
The Landon Center on Aging

Surgical Care in Older Adults
ACOVE Surgical Indicators
Preoperative Care
Capacity to Consent
Discussion of Goals of Care
Preoperative Pulmonary Evaluation
Preoperative Cardiovascular Evaluation
Preoperative Diabetes Evaluation
Preoperative Delirium Risk Factor Assessment
Prevention of Surgical Site Infection
Perioperative Beta-blockade
Anticoagulation for Hip Fracture and Replacement
Anticoagulation Prophylaxis in Other Surgical Cases
Diabetes Control
Screen for Postoperative Delirium
Cognition and Function at Discharge
Summary


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Common Problems in Geriatrics for Orthopedic Surgeons

Common Problems in Geriatrics for Orthopedic Surgeons
Presentation by
Steven Zweig, MD

Family and Community Medicine
MU School of Medicine

Goals

* Recognize the importance of aging physiology in the development and treatment of specific problems
* Prevent and treat delirium
* Recognize the significance of polypharmacy
* Identify patients at risk for elder abuse

Case 1 - 80 year old woman with hip fracture
Delirium
* Physical exam for VS, neuro, skin, infections
* Mental status exam
* Lab and x-ray for infections (lung, urine), fluid and lytes, hypoxia, BS, new trauma, systemic dx

Mental Status Evaluation

Case 2 - 76 year old woman with osteoarthritis
Altered Drug Distribution
Altered Drug Metabolism
Altered Renal Excretion
Common Adverse Drug Reactions
Principles of Geriatric Prescribing


Case 3- 75 year old woman with upper arm pain

X- ray and lab findings
Elder Abuse
Risk factors
Management

Tips for Coordinating Care

* Medicare home care - requires need for skilled nurse or PT
* Admission to SNF requires 3 day hospital stay - contact the NH physician to plan
* PPS means capitated reimbursement to SNFs
* Medicare does not cover costs of drugs
* Get SW involved if any care problems anticipated

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Geriatrics in a Nutshell

Geriatrics in a Nutshell
Presentation by: Karen E. Hall, M.D., Ph.D.

Clinical Associate Professor of Internal Medicine
University of Michigan, Ann Arbor VA Health Systems
Research Scientist,
Geriatric Research, Education and Clinical Center

Covers the following topics
Geriatric Syndromes
Common Diseases in Elderly
Documentation/Skills
First rule of history and physical exam
Physical Exam
Diagnosis belongs in the Impression / Plan
Develop a Plan rather than a Diagnosis
Social, Ethical, Cultural

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