Clinics in geriatric medicine
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Clin. Geriatr. Med. · Feb 1994
ReviewApproach to ischemic heart disease, coronary care, and severe heart failure (including cardiogenic shock).
Elderly patients with cardiovascular disease require slightly different management strategies compared with younger patients. Diagnosis is more difficult. ⋯ Decisions regarding these therapies are based on an incomplete data base and an understanding of the patients' needs. A review of the available data on cardiac surgery, angioplasty, myocardial infarction, and heart failure in the elderly is presented.
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Clin. Geriatr. Med. · Feb 1994
Review Comparative StudyNutritional support of the elderly patient in an intensive care unit.
Critically ill elderly patients are at high risk to develop protein-energy malnutrition as well as micronutrient deficiencies. They have characteristic metabolic alterations which must be understood in order to provide nutritional support. Current nutritional status can be assessed by clinical and laboratory parameters. The enteral and parenteral routes of administering nutrition and their advantages, disadvantages, complications, and monitoring are discussed.
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Certain endocrinologic disorders occur more frequently in the elderly than in younger patients. With the steady increase in the elderly population, acute endocrinologic disorders have become more common. Characteristics of elderly patients, such as diminished homeostatic reserve, increased medication use, and the presence of other diseases allow the transformation of symptoms into medical emergencies.
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Clin. Geriatr. Med. · Feb 1994
ReviewPreoperative evaluation and postoperative care of the elderly patient undergoing major surgery.
As the population ages and as surgical and anesthetic techniques advance, more and more elderly patients are referred for surgery. As a result, the physician must be increasingly aware of the aged response to surgery and the management of the geriatric surgical patient in the perioperative period. Elderly patients are prone to cardiac, respiratory, and infectious complications, and thus, they need to be screened for the presence of pre-existing disease. In addition, the geriatric patient needs to be carefully monitored in the proper postoperative environment to guard against untoward sequelae.
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Elderly populations are prone to both hyperthermia and hypothermia because of innate physiologic changes associated with aging, the presence of chronic disease, and the use of polypharmacy. Hyperthermia is a true medical emergency with a high mortality rate, requiring rapid cooling and aggressive supportive care. ⋯ Patients should be warmed in the least aggressive manner that will adequately treat their clinical situation. Hypothermia due to underlying disease carries a high mortality rate, as does the onset of ventricular fibrillation.