Amirfarzan Houman, Azocar Ruben J, Shapeton Alexander D
Department of Anesthesia, Critical Care and Pain Medicine, Tufts University School of Medicine, Boston, MA, USA.
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Saudi J Anaesth. 2023 Oct-Dec;17(4):509-516. doi: 10.4103/sja.sja_532_23. Epub 2023 Aug 18.
Cognitive impairment, frailty, and malnutrition are three of the most impactful pathologies facing an aging population, having dramatic effects on morbidity and mortality across nearly all facets of medical care and intervention. By 2050, the World Health Organization estimates that the population of individuals over the age of sixty worldwide will nearly double, and the public health toll of these demographic changes cannot be understated. With these changing demographics comes a need for a sharpened focus on the care and management of this vulnerable population. The average patient presenting for surgery is getting older, and this necessitates that clinicians understand the implications of these pathologies for both their immediate medical care needs and for appropriate procedural selection and prognostication of surgical outcomes. We believe it is incumbent on clinicians to consider the frailty, nutritional status, and cognitive function of each individual patient when offering a surgical intervention, as well as consider interventions that may delay the progression of these pathologies. Unfortunately, despite excellent evidence supporting things like routine pre-operative frailty screening and nutritional optimization, many interventions that would specifically benefit this population still have not been integrated into routine practice. In this review, we will synthesize the existing literature on these topics to provide a pragmatic approach and understanding for anesthesiologists and intensivists faced with this complex population.
认知障碍、身体虚弱和营养不良是老年人群面临的三种最具影响力的病症，几乎在医疗护理和干预的各个方面对发病率和死亡率都有显著影响。世界卫生组织估计，到2050年，全球60岁以上的人口将几乎翻倍，这些人口结构变化对公共卫生的影响不容小觑。随着人口结构的变化，需要更加关注对这一弱势群体的护理和管理。接受手术的患者平均年龄越来越大，这就要求临床医生了解这些病症对患者当前医疗护理需求以及手术方式选择和手术结果预测的影响。我们认为，临床医生在提供手术干预时，有责任考虑每个患者的身体虚弱程度、营养状况和认知功能，同时也要考虑可能延缓这些病症进展的干预措施。不幸的是，尽管有充分的证据支持常规术前身体虚弱筛查和营养优化等措施，但许多对这一人群有特殊益处的干预措施仍未纳入常规实践。在本综述中，我们将综合有关这些主题的现有文献，为面对这一复杂人群的麻醉医生和重症监护医生提供一种实用的方法和理解。
