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New guidelines released for geriatric perioperative care

Accreditation Insider, January 12, 2016

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In 2013, 44.7 million Americans were over the age of 65 with current trends predicting that number to grow to 98 million by 2060. In response, the American College of Surgeons (ACS) and the American Geriatrics Society (AGS) have created a new set of best practices for treating elderly surgery patients. The guidelines cover pre-, intra-, and post-operative care for geriatric patients.
"The AGS recognizes that expanding geriatrics expertise means ensuring that all healthcare professionals—not just geriatrics experts—know and can employ principles of excellence in elder care," AGS CEO Nancy E. Lundebjerg, MPA, said in the news release. "This collaboration builds on the legacy of our Geriatrics-for-Specialists Initiative, which itself underscores the unique importance of geriatrics awareness for surgeons and related medical specialists."
Some of the recommendations include:
•    Discussing the patient's personal goals and treatment preferences before surgery, including advance directive and a designated healthcare proxy.
•    Providing an early postoperative palliative care consultation for patients with a poor prognosis.
•    Using a structured process to determine each patient’s risk for venous thromboembolism and bleeding.
•    Developing an appropriate, multimodal analgesic plan before surgery, including opioid-sparing techniques and avoiding potentially inappropriate analgesics and anxiolytics.
•    Properly positioning and padding of bony prominences to maintain skin integrity and limit pressure on peripheral nerves.
•    Assessing patients for delirium risk factors: age older than 65 years, chronic cognitive decline, dementia, poor vision/hearing, critical illness, and infection.
•    Giving patients with postoperative delirium multicomponent nonpharmacologic interventions. Pharmacologic interventions should only be given if the delirious patient poses a substantial risk to themselves or others.



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