Clinics in geriatric medicine
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Normal physiologic changes of aging increase the likelihood of renal-electrolyte disorders in the elderly surgical patient. The most important of these changes are a decrease in the GFR, decreased urinary concentrating ability, and narrowed limits for the excretion of water, sodium, potassium, and acid. Because of the decrease in GFR, the elderly surgical patient is at increased risk for virtually every cause of acute renal failure, an outcome associated with a mortality of greater than 50%. ⋯ The most important principles of prevention in the elderly surgical patient are to maintain normal intravascular volume and avoid hypovolemia. Meticulous attention must be paid to salt and water balance and to drug dosing. Should perioperative renal insufficiency occur, evaluation and management in the elderly patient are similar to usual practices in a younger individual.
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Hip surgery is the most common major orthopedic procedure performed in the elderly. The indications are fracture and pain secondary to degenerative arthritis. Patients undergoing hip replacement for arthritis have excellent outcomes with decreased pain, increased mobility, and a low mortality. ⋯ Pressure ulcers, delirium, deep venous thrombosis, urinary retention and urinary tract infection, and cardiac events are the most frequent complications seen. These complications can be anticipated and prevented with careful preoperative assessment and post-operative prophylactic management. A team approach including the orthopedic surgeon, primary care physician, nursing staff, and physical therapists is essential for optimal outcome.