Age and ageing
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A prospective study was carried out on 288 general surgical patients aged 65 years and over. Over 40% of patients suffered no post-operative complication. The commonest post-operative problem was respiratory, with 17% of patients having simple atelectasis, 12% acute bronchitis and 10% pneumonia. ⋯ Nine patients out of ten spent less than a month in hospital. The relation of post-operative morbidity and mortality to seven factors was examined: type of surgery, urgency of surgery, urgency of admission, age, number of pre-operative medical diagnoses, American Society of Anesthetists' grade, and pre-operative mobility level. It appears that pre-operative medical fitness rather than chronological age is the main determinant of post-operative outcome in the elderly surgical patient.
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Six elderly patients with accidental hypothermia were prospectively evaluated for impaired coagulation. All patients had abnormal coagulation profiles. ⋯ Despite investigation, no cause for disordered coagulation was found in four patients. We conclude that hypothermia per se contributes to disordered coagulation in the elderly.
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Three hundred and eighty admissions to a geriatric assessment unit had a routine chest radiograph. Forty-four per cent presented atypically with one or more of Isaacs' 'geriatric giants'--falls, immobility, incontinence or deteriorating mental function. The chest radiograph was abnormal in 164 (44%), of whom 57 had no classical clinical cardiopulmonary features. The chest radiograph was especially useful in the investigation of the geriatric giants, where 22% had evidence of cardiopulmonary disease, in the absence of classical clinical features.
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One hundred consecutive patients admitted to hospital because of acute diarrhoea are described. The commonest causes of diarrhoea were found to be faecal impaction, infection and drugs, although in a third of the cases no cause was found. Faecal impaction was significantly more common in those living alone or in institutions than in those living with their families. The study suggests that the elderly population is very intolerant of the symptom of diarrhoea, and a case is made for the provision of facilities for more efficient assessment and treatment.