Clinics in geriatric medicine
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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.
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Elderly people in the United States often receive treatment through an enormous array of medical technology when they become critically ill. Some, or all, such interventions may be unwanted, and patients have the right to be informed about what prospects lie ahead. CPR, with survival rates of 2% to 20%, rarely has the effect for which it was intended, as studies over the last two decades have repeatedly demonstrated. ⋯ This is unfortunate, because both surrogates and physicians are poor judges of patients' resuscitation preferences. Advance directives, especially when coupled with effective physician-patient communication, will aid elderly persons in making decisions about life support. We encourage all physicians who care for the elderly to avert many of tomorrow's ethical dilemmas by communicating with their healthy patients today.
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Symptoms and signs of impaired thermal homeostasis are protean. Clinical encounters with the geriatric patient, whether acute or chronic, are often marked by imprecise historical detail, ambiguous physical findings, differing laboratory values, and unexpected responses to therapeutic modalities. In addition, geriatric patients presenting with disorders of thermoregulation have a greater morbidity and mortality than other groups. This article briefly reviews thermoregulation as well as some of the causes and treatments for both hypothermia and hyperthermia.