Ann Acad Med Singap
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Ann Acad Med Singap · Nov 2019
ReviewPersonalising Care in the Older Woman with Primary Breast Cancer.
The incidence of breast cancer increases with age. Despite this, most research in the field is targeted at younger patients. Age-specific guidelines are not widely referred to and guidelines which allude to the older woman as an individual are based solely on conventional factors. ⋯ This means that they are likely to have less aggressive cancers such as those who are oestrogen receptor-positive. Geriatric assessment (GA) has been used in clinical practice to identify patients that are suitable for certain treatments. More research on this group of patients' unique biological features and GA will help tailor personalised care for them.
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Ann Acad Med Singap · Nov 2019
ReviewThe Elderly Emergency Laparotomy Patient - More Than Just the Operation.
The elderly patient presenting with an acute surgical abdomen or bowel obstruction has become a common and challenging situation. These patients bring comorbidity and frailty that necessitate appropriate risk assessment and comprehensive perioperative management. ⋯ Successful management of the elderly laparotomy patient requires close coordination between surgeons, anaesthetists and physicians. The ANZELA-QI study will help establish the role of collaborative models of care and the need for perioperative care teams.
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As the world's population ages rapidly, many elderly people are living to a much more advanced age than before. Consequently, medical conditions that require surgical interventions such as solid organ cancers are also getting more common. While young and fit patients may be able to withstand surgical stresses and recover rapidly after operation, older adults may find these challenging. ⋯ However, recent studies have shown that prehabilitation may be more effective in bringing the fitness level of elderly patients to a higher level before they go for surgery. There are many controversies regarding the effectiveness of prehabilitation, the components of this intervention-be it mono- or multimodalities-and the duration of prehabilitation. This paper looks at the current evidence of this hot topic revolving geriatric surgery.
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Global demographic changes have resulted in an older, frailer surgical population with significant multimorbidity causing higher frequency of adverse postoperative outcomes. The need for restructuring of perioperative care pathways to address this issue has been recognised. Comprehensive geriatric assessment (CGA) and optimisation are emerging as innovative perioperative pathways. ⋯ Similar models are being established in Singapore in hip fracture, colorectal and vascular populations. The challenges in the widespread adoption of such models of care are similar across settings. The global nature of translation is also discussed in this paper.
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Ann Acad Med Singap · Nov 2019
The Changing Epidemiology of Serious Trauma in the Elderly Population: An Increasing Concern of a Tertiary Hospital in Singapore.
Although trauma is often seen in the young, there is a recent shift in this trend as more elderly patients are hospitalised for traumatic injuries. This study examined serious trauma in young and elderly patients and hypothesised that the increase in incidence of elderly serious trauma has led to greater burden of care in hospitals and health services. ⋯ The number of elderly trauma patients were thrice that of all trauma patients seen and they also required longer hospitalisation. This trend has led to greater burden of care in hospitals and health services in Singapore.