Brit J Hosp Med
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As a consequence of an ageing population greater numbers of elderly patients are presenting for both elective and emergency surgery. These older patients typically present with an increased burden of age-related problems and multimorbidity, which is associated with an increased risk of adverse postoperative outcomes. ⋯ This diagnostic phase then leads to the development and implementation of an individualized 'optimization' strategy across these domains. There is emerging evidence that comprehensive geriatric assessment and optimization in the surgical setting leads to improved outcomes, and it is reasonable to conclude that it would benefit the patient's long-term health.
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A majority of cancer cases now occur among older people, but this group is less likely to receive treatment and outcomes are poorer than in younger people. Age by itself can be a poor predictor of who will benefit from treatment with surgery, chemotherapy or radiotherapy. ⋯ Comprehensive geriatric assessment highlights areas that should be optimized before treatment and helps support a shared decision-making approach. Geriatricians, oncologists and surgeons now work together to help assess and support older people with cancer.
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Advance care planning is the process by which patients can make decisions about their future health care should they lose capacity. Such conversations are shown to improve quality of life and reduce institutionalization. This article explores the preferences and wishes of patients in terms of advance care planning. ⋯ The level of shared decision making that individuals personally want should be established. Open and honest conversations should be initiated at the earliest opportunity.