Be well-informed. – Windows 10 1703 download iso italy traveling nurse

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

It is recommended that older patients undergo daily assessment of caloric intake and water balance. Nutrition увидеть больше the elderly surgical patients. Age has not consistently been found to be an independent predictor of perioperative cardiac risk, although perioperative mortality following acute myocardial infarction is higher in older than in young patients [ ]. Travrling patients are more sensitive to adverse effects of opioids and NSAIDs, and more prone to postoperative morbidity. Facts, not rumors, about how and why we do what we do.❿
 
 

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Windows 10 1703 download iso italy traveling nurse

 

Nurze new PMC design is here! Learn more about navigating our updated article layout. The PMC legacy view will also be available for a limited time. Federal government websites often end in.

The site is secure. Surgical outcomes in geriatric patients may be complicated by factors such as multiple comorbidities, low functional performance, frailty, reduced homeostatic capacity, and cognitive impairment. An integrated multidisciplinary approach to management is, therefore, essential in this population, but at present, the use of such an approach is uncommon.

To develop evidence-based recommendations for the integrated care of geriatric surgical patients. A modified Delphi approach was used to achieve consensus, and the strength of recommendations and quality of evidence was rated using the U.

Preventative Services Task Force criteria. A total of 81 recommendations were proposed, covering preoperative evaluation and care 30 itemsintraoperative management 19 http://replace.me/4314.txtand postoperative care and discharge 32 items. These recommendations should facilitate the multidisciplinary management of older surgical patients, integrating the expertise of the surgeon, the anesthetist, the geriatrician, and other specialists and health care professionals where available as needed.

The traditional clinical approach, focusing on a single disease, is often insufficient in geriatric patients, for many reasons including multiple comorbidities, low functional performance, frailty, reduced homeostatic capacity, and cognitive impairment. Geriatric surgical patients, therefore, require integrated care from the preoperative evaluation throughout the perioperative period.

However, although multidisciplinary care models for geriatric patients, such больше информации the orthogeriatric model [ 2 ], are long established, this integrated approach appears to be rarely used in older patients undergoing other major surgeries. For this reason, the PriME Perioperative Management of the Elderly project has been developed нажмите для продолжения a multidisciplinary panel of anesthetists, surgeons, and geriatricians, aiming to highlight the specific needs of older surgical patients, and to propose recommendations for the integrated care of geriatric surgical patients.

These societies appointed a member Expert Task Force, which met in September to define the scope of the project, identify key issues, and agree consensus methods. A modified Delphi approach was used to achieve consensus, and the U.

The available evidence is sufficient to winows the effects of the service on targeted health outcomes, but nursr in the estimate is constrained by factors such as:.

Some heterogeneity of outcome findings or intervention models across the body of studies. Mild-to-moderate limitations in the generalizability of findings to routine care practice.

As more information becomes available, the magnitude or direction of the observed effect could change, and this change may be large enough to alter the conclusion. The available evidence is insufficient to assess effects on health outcomes. Evidence is insufficient because windows 10 1703 download iso italy traveling nurse.

Inconsistency of direction or magnitude of findings across the body of evidence. Based on a literature review, each subcommittee developed a list traaveling topics, and proposed specific recommendations with supporting evidence for each topic. Key issues were discussed at a meeting in Januaryafter which a comprehensive document was circulated, and subjected to three rounds of revision. Subsequently, a draft report was prepared and sent to the Experts for modification and comment. Each author approved the final version prior to submission.

We recommend cognitive assessment e. We recommend a second-level specialist neurocognitive assessment for patients with pathological windows 10 1703 download iso italy traveling nurse scores. Every older patient should undergo a standardized pain history and physical examination. We recommend careful and prolonged assessment of blood glucose in older patients with or without diabetes. The preoperative assessment should evaluate the patient’s health status to assess the surgical risk, increase functional reserves, manage vulnerability, and anticipate, minimize, or prevent possible complications.

This requires a team-based approach throughout the entire care pathway [ 4 ]. The anesthetist should guide the team in nurde perioperative phase, and the geriatrician should take the lead thereafter.

Comprehensive Geriatric Assessment CGA is a multimodal, multidisciplinary, process aimed at identifying care needs, planning care, and improving clinical and functional outcomes for older people [ 5 ]. This process travelung both clinical data and functional measures of cognitive, psychological, nutritional, and windows 10 1703 download iso italy traveling nurse status, and evaluation of social or family support.

The aims are to improve diagnostic accuracy, optimize medical treatment, improve medical outcomes, optimize the home environment, minimize unnecessary service jurse, and arrange long-term management. CGA and frailty evaluation are extremely useful in surgical risk evaluation in older patients, and in making decisions about surgery [ 46 — 8 ]. However, evidence from randomized-controlled trials, large systematic reviews, and meta-analyses suggests that the effectiveness of CGA may vary according to the healthcare setting.

For example, home-based and in-hospital CGA programs have consistently been shown to improve health windows 10 1703 download iso italy traveling nurse, whereas evidence is less conclusive for post-hospital discharge CGA programs, outpatient CGA consultation, and CGA-based inpatient geriatric consultation services [ 9 ].

The effectiveness of CGA may be reduced in patients with specific clinical conditions, such as frailty, cancer, or cognitive impairment [ 9 ]. However, because CGA is time-consuming and sometimes difficult windows 10 1703 download iso italy traveling nurse apply in clinical practice, involvement of hospital medical services to create specific management pathways is needed to implement this approach.

Signs of frailty include unintentional weight loss, self-reported exhaustion, slow walking speed, weak grip strength, and low physical activity level [ 10 ]. It is not time-consuming, and can be easily used by non-geriatricians.

Patients with functional impairment are at increased risk of postoperative complications [ 16 ]. Appropriate measures, where needed, should, therefore, be taken to increase functional reserves.

Patients with functional deficits in activities of daily living, or difficulties with mobility, should be referred to an occupational or physical therapist. Such patients may benefit from preoperative physical conditioning prehabilitation to enhance their capacity to withstand surgical stress and promote postoperative recovery [ 17 ]. Multimodal prehabilitation, including home exercise, nutrition assessment, and pain management, improves postoperative functional outcomes in older surgical patients [ 18 ].

Cardiopulmonary exercise testing objectively measures aerobic fitness or functional capacity. It provides an individualized travelkng of patient risk that can be used to predict postoperative morbidity and mortality, inform decision-making, determine the most appropriate perioperative care environment, diagnose unexpected comorbidities, optimize medical comorbidities preoperatively, and direct individualized preoperative exercise programs [ 19 ].

Falls sownload windows 10 1703 download iso italy traveling nurse primary cause of unintentional injury, and a leading cause of death, in older adults. Limited mobility and falls lead to ссылка на страницу decline, hospitalization, institutionalization, and increased health care costs [ 20 ]. A history of falls within 6 months before surgery is associated with increased rates of postoperative complications, discharge to a rehabilitation facility, and hospital readmission [ 21 ].

Hence, it is recommended that the на этой странице of falls be assessed preoperatively, and appropriate preventive measures taken, particularly in patients with reduced mobility, postural hypotension, or risk of syncope.

The risk of falls can be assessed with the TUG test [ 22 ]. Concomitant sensory and cognitive impairment is common in older individuals [ 23 ], and is an independent risk factor for postoperative death and complications [ 24 ].

Multimodal interventions including elements addressing visual or hearing impairment can significantly reduce the prevalence and duration of delirium in older hospitalized patients [ 25 ].

Routine screening for cognitive impairment should, therefore, be included in the preoperative evaluation, even in patients with no history of cognitive decline. Basic cognitive tests, such as the Clock drawing test, the Abbreviated Mental Test, or the Mini-Mental State Examination MMSEcan be used for screening; specialist investigation is required in patients with equivocal findings.

The combination of aging and comorbidities is the principal factor reducing tolerance to surgical stress in older patients [ 4 ]. Comorbidities increase markedly with age, largely due to increasing rates of chronic conditions [ 10 ]. 100 are strongly associated with increased surgical and postoperative risks, and increased health care costs [ 35 ].

Age-related downolad in the cardiovascular and autonomic nervous systems reduce cardiac responsiveness to stress [ 36 ].

Guidelines for the evaluation of cardiac risk published by the American College of Cardiology ACC and the American Heart Association AHA [ 37 ] recommend preoperative cardiac testing only if the results will unrse clinical management, and avoidance of testing before low-risk surgery.

The type of surgery is an important determinant of the risk of cardiac complications and mortality. In patients undergoing noncardiac surgery, functional status, generally defined in terms of wincows equivalents METsis a reliable predictor of both perioperative and long-term risk [ 38 ]. The Lee index [ 39 ] is widely used for assessment of cardiac risk, because it is simple and has been extensively validated.

However, more recent measures, such as that of Alrezk et al. The ACS-NSQIP Surgical Risk Calculator [ 41 wibdows has been specifically validated in geriatric patients, and is an accurate tool for preoperative assessment in this population, especially if combined with cardiac biomarkers [ 42 ].

The risk of postoperative venous thromboembolism is increased in patients over 70 years of age, and in geriatric patients with comorbidities such as cardiovascular disorders, malignancy or renal insufficiency. Therefore, risk stratification, correction of modifiable risks, and sustained windows 10 1703 download iso italy traveling nurse thromboprophylaxis are essential in these populations.

The timing and dosing of thromboprophylaxis in older patients should be the same as in younger patients dowlnoad 43 ]. Postoperative pulmonary complications PPCs are common in geriatric patients, and contribute to the risks of perioperative and postoperative morbidity and mortality. The surgical site is the most important predictor of pulmonary complications; others http://replace.me/13777.txt COPD, recent smoking, 110 general health status, and functional dependency [ 44 ].

Age is a minor risk factor after adjustment for comorbidities, conferring an approximately twofold increase in risk [ 45 ]. Thus, older patients who are otherwise acceptable surgical candidates should not be denied surgery solely on the basis of concern about potential PPCs [ 46 ].

Routine cownload spirometry nursr not recommended before high-risk surgery, because it is no more accurate in predicting risk than clinical evaluation.

Patients who might benefit from preoperative windows 10 1703 download iso italy traveling nurse include those with unexplained dyspnea or exercise intolerance, and those with COPD or asthma in whom the extent of airflow obstruction is unknown.

Strategies for reducing the risk of PPCs in older surgical patients include risk factor minimization or avoidance including preoperative smoking cessationoptimization windows 10 1703 download iso italy traveling nurse COPD or asthma treatment, deep breathing exercises, and epidural local anesthesia [ 4649 ]. In a general population of patients scheduled for elective upper abdominal surgery, a min preoperative physiotherapy session provided as part of an existing multidisciplinary preadmission evaluation was shown to halve the windows 10 1703 download iso italy traveling nurse of PPCs, particularly hospital-acquired pneumonia [ 50 ].

Anemia is common in surgical patients, and iao associated with increased perioperative mortality [ 51 ]. Preoperative anemia should, therefore, be considered a significant medical condition, rather than as simply an abnormal laboratory finding [ 52 ]. Investigation should begin with an assessment of iron status: when ferritin or iron saturation levels indicate an absolute iron deficiency, referral to a gastroenterologist may be indicated to exclude gastrointestinal malignancy as a source of chronic blood loss.

In the absence of an absolute iron deficiency, measurement of serum creatinine and glomerular filtration rate GFR may indicate chronic kidney disease CKD and the need for referral to a nephrologist. When ferritin or iron saturation values are inconclusive, further evaluation is necessary to exclude inflammation or chronic disease. Windows 10 1703 download iso italy traveling nurse therapeutic trial of iron would confirm absolute iron deficiency, whereas a lack of response would indicate 103 of chronic disease, suggesting that treatment with an erythropoietin-stimulating agent should be initiated [ 54 ].

Iron-deficiency anemia should be treated with iron supplementation [ 55 ]. Oral iron replacement should be targeted to patients with iron deficiency with or without anemia whose surgery is scheduled 6—8 weeks after diagnosis [ 53 ].

Anemia and transfusion are associated with increased morbidity and mortality in surgical patients [ 56 ]. PBM should be started before surgery, and continued throughout the perioperative period.

Systematic preoperative PBM has consistently been shown to improve postoperative clinical outcomes [ 5659 ]. Maintenance of a preoperative hemoglobin level above Intraoperative PBM includes monitoring windows 10 1703 download iso italy traveling nurse and related physiological changes, conserving autologous blood, and using trwveling and anesthetic strategies to contain and minimize blood loss.

During the postoperative period, monitoring of anemia, organ perfusion, blood loss, and hemostasis is an important part of clinical management [ 58 ]. The age-related decline of renal function varies markedly, due to nephrotoxic effects of comorbidities such as hypertension or diabetes, and drug treatment, particularly with non-steroidal anti-inflammatory drugs NSAIDs and angiotensin -converting enzyme ACE inhibitors. Renal impairment can affect anesthetic pharmacokinetics and pharmacodynamics, and hence, renal function should be assessed before any surgery in older patients [ 36 ].

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Windows 10 1703 download iso italy traveling nurse

 
 

Oral feeding ability and aspiration risk should be assessed daily in older patients. A dietary consultation should be initiated, and a formal swallowing assessment performed if indicated [ 72 ]. During oral feeding, the head of the bed should be elevated at all times, and the patient should be sitting upright while eating and for 1 h after each meal, to prevent aspiration [ 72 ].

Older persons undergoing hip fracture surgery are generally at risk of malnutrition due to the acute trauma and surgery-related anorexia and immobility. Voluntary oral intake in the postoperative phase is often inadequate in such patients, and hence, rapid deterioration of nutritional status and impaired recovery are common [ ]. Thus, the ESPEN guidelines for geriatric patients recommend that older patients with hip fracture should be offered oral nutritional supplements postoperatively, to reduce the risk of complications [ ].

Such nutritional support should be part of an individually tailored, multimodal, and multidisciplinary intervention to ensure adequate dietary intake, improve clinical outcomes, and maintain quality of life [ ]. Hospitalized older patients, particularly frail patients with hip fractures [ ], are at high risk of pressure ulcers.

Health care teams should, therefore, assess the risk of pressure ulcers in all older postoperative patients, and should implement multimodal interventions to prevent and treat pressure ulcers, especially in at-risk patients [ 72 ]. Surgical site infections SSIs are associated with delayed wound healing, prolonged hospital stays, increased use of antibiotics, unnecessary pain, and rarely death.

Antibiotic prophylaxis is a principal strategy for preventing SSIs, but reductions in SSIs can also be achieved by implementing multidisciplinary, hospital-wide, measures such as bowel preparation, skin preparation, disinfection and hygiene, maintenance of normothermia during surgery, and glycemic control [ ].

In older patients, it is important to choose the antimicrobial agent according to the susceptibility profile of colonizing bacteria. Particular attention should also be paid to the dosing regimen, because the relationship between appropriately dosed preoperative antibiotics and reduced risk of SSIs is well established.

However, older patients may have renal impairment necessitating dose adjustment [ 60 , ]. In older patients, postoperative hyperglycemia is associated with poor wound healing, SSI, acute complications fluid and electrolyte disorders, acute renal failure , longer hospitalization, and death [ ].

The question of where the patient can receive the best possible support after discharge should be considered throughout the perioperative period. The lack of an appropriate discharge and transition plan makes early readmission more likely, and may impair functional status and quality of life [ ]. Changes to medication frequently occur during hospitalization of older adults, and prompt review within primary care is essential following discharge [ , ].

CGA of frail geriatric patients can reduce the risk of readmission when performed immediately before hospital discharge or on arrival in community settings. This should include targeting criteria to identify vulnerable patients, a multidimensional assessment program, comprehensive discharge planning, and home follow-up.

Some frail patients may develop a transient period of health vulnerability following hospitalization, known as the post-hospital syndrome PHS [ ]. PHS is characterized by the risk of early re-hospitalization due to physiologic stressors resulting from the initial admission, including disruption in sleep—wake cycles, inadequate pain control, deconditioning, and changes in nutritional status.

Patients hospitalized within 90 days of elective surgery are at increased risk of PHS [ ]. Geriatric patients, especially if frail, often need prolonged hospitalization, or care in intermediate care facilities, before returning home. For some patients, worsening health and functional status make it impossible to return home. Discharge to residential care, and inability to maintain independence after surgery, may be unacceptable to many older patients [ ]. Anticipating which adults will require discharge to care facilities is important for preoperative counseling and care planning for both patients and caregivers.

Before surgery, patients and surgeons should discuss clearly what they hope to achieve with the intervention, and what secondary strategy should be adopted if these objectives are not achieved or complications occur. These recommendations should facilitate the multidisciplinary management of older surgical patients, integrating the expertise of surgeons, anesthetists, geriatricians, and other specialists and health care professionals.

A number of general statements can be made about the perioperative care of geriatric surgical patients. First, prehabilitation and ERAS protocols are recommended in all older candidates for elective surgery.

Second, continuity of care is the hallmark of optimal care, and this requires early planning of the expected needs, final location of care and transition strategies for problematic cases.

Finally, for medium- to high-risk patients, implementation of CGA and associated care should be considered in terms of the relative costs and benefits, rather than cost alone. The authors would like to thank Dr. Luigia Scudeller for assistance with methodology. Medical writing and editorial assistance in the preparation of this paper were provided by Michael Shaw Ph. This work, including travel and meeting expenses, was supported by an unrestricted grant from MSD Italia Srl.

The sponsor had no role in selecting the participants, reviewing the literature, defining consensus statements, drafting or reviewing the paper, or in the decision to submit the manuscript. All views expressed are solely those of the authors. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Aging Clinical and Experimental Research. Aging Clin Exp Res. Published online Jul Author information Article notes Copyright and License information Disclaimer.

Stefano Volpato, Email: ti. Corresponding author. Received Mar 3; Accepted Jun 3. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

This article has been corrected. See Aging Clin Exp Res. Abstract Background Surgical outcomes in geriatric patients may be complicated by factors such as multiple comorbidities, low functional performance, frailty, reduced homeostatic capacity, and cognitive impairment.

Aims To develop evidence-based recommendations for the integrated care of geriatric surgical patients. Results A total of 81 recommendations were proposed, covering preoperative evaluation and care 30 items , intraoperative management 19 items , and postoperative care and discharge 32 items.

Conclusions These recommendations should facilitate the multidisciplinary management of older surgical patients, integrating the expertise of the surgeon, the anesthetist, the geriatrician, and other specialists and health care professionals where available as needed. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial Offer or provide this service C The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences.

These is at least moderate certainty that the net benefit is small Offer or provide this service for selected patients depending on individual circumstances D The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits Discourage the use of this service I The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service.

Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined Read the clinical considerations section of USPSTF Recommendation Statement.

If the service is offered, patients should understand the uncertainty about the balance of benefits and harms. Open in a separate window. Quality of evidence Description High A The available evidence usually includes consistent results from a multitude of well-designed, well-conducted, studies in representative care populations.

These studies assess the effects of the service on the desired health outcomes. Because of the precision of findings, this conclusion is, therefore, unlikely to be strongly affected by the results of future studies.

These recommendations are often based on direct evidence from clinical trials of screening, treatment or behavioral interventions. As more information becomes available, the magnitude or direction of the observed effect could change, and this change may be large enough to alter the conclusion Low C The available evidence is insufficient to assess effects on health outcomes. Evidence is insufficient because of: The very limited number or size of studies Inconsistency of direction or magnitude of findings across the body of evidence Critical gaps in the chain of evidence Findings are not generalizable to routine care practice A lack of information on prespecified health outcomes Lack of coherence across the linkages in the chain of evidence.

More information may allow an estimation of effects on health outcomes. Table 3 Summary of recommendations. We recommend a multimodal approach or, when possible, locoregional or plane blocks e. Frailty Statement Quality of evidence Strength of recommendation We suggest using multiparametric frailty scales e. Prehabilitation strategy Statement Quality of evidence Strength of recommendation We recommend a systematic prehabilitation strategy to improve functional status and increase the organic functional reserve Low A We recommend a cardiopulmonary exercise test before major surgery e.

Prehabilitation Patients with functional deficits in activities of daily living, or difficulties with mobility, should be referred to an occupational or physical therapist. Cardiopulmonary exercise testing Cardiopulmonary exercise testing objectively measures aerobic fitness or functional capacity. Falls Falls are the primary cause of unintentional injury, and a leading cause of death, in older adults.

Sensory deficits and use of functional aids Concomitant sensory and cognitive impairment is common in older individuals [ 23 ], and is an independent risk factor for postoperative death and complications [ 24 ]. Cognitive function Statement Quality of evidence Strength of recommendation We recommend cognitive assessment e.

Comorbidities Statement Quality of evidence Strength of recommendation We recommend that the relative implications of comorbidities, and chronic or degenerative pathologies, for the response to surgery be recognized Low A. Respiratory Statement Quality of evidence Strength of recommendation We recommend that risk factors for respiratory complications be assessed and reduced where possible e. Nutritional Statement Quality of evidence Strength of recommendation We recommend evaluation of nutritional status and correction of any deficiency, especially before major surgery Moderate A We recommend that albuminemia be assessed in all older surgical patients, especially those with hepatic comorbidity, multiple comorbidities, recent major pathology or suspected malnutrition, or candidates for major surgery Moderate A In candidates for major surgery with organ failure, we recommend an estimation of hydration and volume status with an instrumental method e.

Medication Statement Quality of evidence Strength of recommendation It is recommended that the pharmacological history must be extended to include all drugs used by the patient, including over-the-counter and herbal medicines Low A If the patient is taking inappropriate medications e.

Emotional status Statement Quality of evidence Strength of recommendation We suggest screening for depression using validated scales e. Social support Statement Quality of evidence Strength of recommendation It is recommended that the availability of family and social support be investigated during the preoperative assessment to allow planning of substitutive support measures Low A. Intraoperative management Positioning Statement Quality of evidence Strength of recommendation When positioning an older patient on the operating table, we suggest that attention be paid to conditions of the skin e.

Depth of anesthesia monitoring Statement Quality of evidence Strength of recommendation During general anesthesia, we recommend EEG-based monitoring to avoid excessive anesthesia depth, which is associated with increased risk of postoperative delirium High A It is recommended that EEG-based monitoring is extended to procedures performed under sedation High A. Neuromuscular blocking agents Aging significantly affects the pharmacokinetics of neuromuscular blocking agents NMBAs , particularly with drugs eliminated by hepatic or renal metabolism [ ], and older patients are more sensitive to NMBAs than younger patients [ ].

Neuromuscular blockade reversal in older patients Complications related to postoperative residual curarization PORC are more frequent in older patients than in younger patients [ ]. Temperature control Statement Quality of evidence Strength of recommendation We recommend body-temperature monitoring and active warming of the patient, preferably with a forced-air system, during the pre-, intra-, and postoperative periods High A If forced-air heating is only partially efficacious e.

Postoperative delirium Statement Quality of evidence Strength of recommendation It is recommended that prevention, recognition and treatment of postoperative delirium must be an objective of the multidisciplinary team Moderate A We recommend that patients at risk for POD be monitored with validated diagnostic tools such as the CAM or 4AT, starting when they wake from anesthesia and continuing for 5 days thereafter Moderate A.

Postoperative nausea and vomiting Statement Quality of evidence Strength of recommendation Because of the high risk e. Postoperative pain Statement Quality of evidence Strength of recommendation Personalized prevention and treatment of postoperative pain are mandatory. Postoperative pulmonary complications Statement Quality of evidence Strength of recommendation We recommend periodic evaluation of oxygen saturation and respiratory rate in the postoperative period Moderate A We recommend that arterial blood gas analysis be used when conditions interfere with percutaneous oximetry e.

Postoperative cardiovascular complications Statement Quality of evidence Strength of recommendation To prevent postoperative cardiac complications, we recommend monitoring continuously in selected cases and maintenance of cardiovascular measures e.

Urinary tract infection Statement Quality of evidence Strength of recommendation We recommend that urinary catheters be used only when essential, and be removed as soon as possible High A We recommend to adopt strategies to prevent urinary tract infections before, during, and after insertion of a urinary catheter High A We do not recommend complementary strategies such as the use of alpha-blockers in men to promote spontaneous urinary function after catheter removal High D.

Nutrition and liquid balance Statement Quality of evidence Strength of recommendation It is recommended that older patients undergo daily assessment of caloric intake and water balance Moderate A We recommended that swallowing should be evaluated, and the presence of oral lesions excluded in patients with signs and symptoms of dysphagia or a history of aspiration pneumonia Moderate A We suggest that all older patients are seated during meals and for an hour after eating Moderate B It is recommended that nutritional supplementation be given in patients with malnutrition or inadequate nutrition Moderate A It is recommended that dental prostheses, if used, are readily available and easily accessible Moderate A.

Pressure ulcers Statement Quality of evidence Strength of recommendation Strategies to prevent and treat pressure injuries are recommended in patients at risk Moderate A. Surgical site infections Statement Quality of evidence Strength of recommendation We recommend guideline-consistent antimicrobial prophylaxis in older patients, considering antibiotic pharmacodynamics and pharmacokinetics to avoid overdoses and drug-related adverse events Moderate A.

Conclusions These recommendations should facilitate the multidisciplinary management of older surgical patients, integrating the expertise of surgeons, anesthetists, geriatricians, and other specialists and health care professionals. Acknowledgements The authors would like to thank Dr. Compliance with ethical standards Conflict of interest The authors declare that they have no conflict of interest.

Footnotes Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. Demographic Indicators Estimates for the year Accessed 26 Feb Which is the optimal orthogeriatric care model to prevent mortality of elderly subjects post hip fractures? A systematic review and meta-analysis based on current clinical practice. Int Orthop. Grade definitions. Bettelli G. Preoperative evaluation of the elderly surgical patient and anesthesia challenges in the XXI century.

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Schneider G, Sebel PS. Monitoring depth of anaesthesia. The role and limitations of EEG-based depth of anaesthesia monitoring in theatres and intensive care. Relation between bispectral index measurements of anesthetic depth and postoperative mortality: a meta-analysis of observational studies.

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