90 research outputs found
A qualitative exploration of the views of patients and their relatives regarding interventions to minimize the distress related to postoperative delirium
No full textBackgroundPostoperative delirium (POD) is common in older people and can be distressing for patients and their relatives. This study aimed to describe the experience of postoperative delirium and explore the views of patients and relatives in order to inform the codesign of an intervention to minimize distress related to postoperative delirium.MethodsQualitative study using a thematic analysis of semistructured interviews in patients (n = 11) and relatives (n = 12) who experienced and witnessed POD, respectively.ResultsPatients and relatives find POD distressing and desire information on the cause and consequences of delirium. This information should be delivered pre‐emptively where possible for patients and relatives during the episode for relatives and in post episode follow up for patients and their families. Information should be provided in person by a health care professional who has experience in managing delirium, supplemented by written materials. In addition, participants suggested training to improve staff and public awareness of delirium.ConclusionsThis qualitative study showed that patients and relatives find delirium distressing, report the need for an intervention to minimize this distress, and enabled codesign of a pilot intervention. Refinement and evaluation of this intervention should form the next step in this program of work
Mild Cognitive Impairment: A qualitative exploration of older adults' understanding, concerns and expectations
No full textBackground: With an increasing drive to diagnose dementia, more people with mild cognitive impairment (MCI) will be identified. It is not known how best to manage those with MCI.Aims: To examine older people’s understanding of MCI, explore attitudes towards disclosure of a hypothetical diagnosis of MCI and the experience of receiving a diagnosis of MCI.Methods: Qualitative study using thematic analysis of in depth, semi-structured interviews in cognitively intact older people (n7) and those following a diagnosis of MCI (n6).Results: In a hypothetical scenario older people expressed a wish for the honest disclosure of a diagnosis of MCI. Although participants thought that memory loss in old age is expected and may be preventable, they described associated stigma. Patients with MCI who prompted their own referral for memory assessment acknowledged and better understood the condition. Those who acknowledged MCI displayed both practical and emotional coping strategies.Conclusions: Clinical pathways for MCI should be patient centered and reflect the views and experience of older service users
Perioperative medicine for Older People undergoing Surgery (POPS): A guide to designing, developing and embedding POPS services
No full textVitamin D and neuromuscular function in older people who fall
No full textEThOS - Electronic Theses Online ServiceGBUnited Kingdo
Preoperative assessment and perioperative management
No full textThe demographic changes in the surgical population pose a new challenge for geriatricians. Despite symptomatic and survival benefits following surgery, older people consistently suffer from excess medical morbidity, mortality, and adverse functional outcomes. This is predominantly related to physiological change, multimorbidity, and geriatric syndromes. For these reasons, geriatricians are increasingly asked for their medical and rehabilitation expertise in the management of elective and emergency surgical patients. This chapter describes the goals of preoperative risk assessment, modification of risk through medical and functional optimization, and presents different models of care which can be employed in older patients. The evidence behind comprehensive geriatric assessment in the surgical setting is presented, including discussion about collaborative decision-making and effective communication involving older patients, their relatives, surgeons, anaesthetists, physicians, and allied health professionals in the perioperative period. The future challenges in terms of research, education, and service development are discussed.</p
The management of complicated colorectal cancer in older patients in a global perspective after COVID-19: the CO-OLDER WSES project
No full textBackground: Colorectal (CRC) cancer is becoming a disease of the elderly. Ageing is the most significant risk factor for presenting CRC. Early diagnosis of CRC and management is the best way in achieving good outcomes and longer survival but patients aged ≥75 years are usually not screened for CRC. This group of patients is often required to be managed when they are symptomatic in the emergency setting with high morbidity and mortality rates. Our main aim is to provide clinical data about the management of elderly patients presenting complicated colorectal cancer who required emergency surgical management to improve their care. Methods: The management of complicated COlorectal cancer in OLDER patients (CO-OLDER; ClinicalTrials.gov ID: NCT05788224; evaluated by the local ethical committee CPP EST III-France with the national number 2023-A01094-41) in the emergency setting project provides carrying out an observational multicenter international cohort study aimed to collect data about patients aged ≥75 years to assess modifiable risk factors for negative outcomes and mortality correlated to the emergency surgical management of this group of patients at risk admitted with a complicated (obstructed and perforated) CRC. The CO-OLDER protocol was approved by Institutional Review Board and released. Each CO-OLDER collaborator is asked to enroll ≥25 patients over a study period from 1st January 2018 to 30th October 2023. Data will be analyzed comparing two periods of study: before and after the COVID-19 pandemic. A sample size of 240 prospectively enrolled patients with obstructed colorectal cancer in a 5-month period was calculated. The secured database for entering anonymized data will be available for the period necessary to achieve the highest possible participation. Results: One hundred eighty hospitals asked to be a CO-OLDER collaborator, with 36 potentially involved countries over the world. Conclusions: The CO-OLDER project aims to improve the management of elderly people presenting with a complicated colorectal cancer in the emergency setting. Our observational global study can provide valuable data on the effectiveness of different management strategies in improving primary assessment, management and outcomes for elderly patients with obstructed or perforated colorectal cancer in the emergency setting, guiding clinical decision-making. This information can help healthcare providers make informed decisions about the best course of action for these patients
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