Surgical Innovations: Impact on the Quality of Life of the Older Patient
Section snippets
Risks of surgery in elderly patients
The surprising feature of the increase in the rate of surgery in older patients is that the concern for risk for complications is unabated. With increasing age and accumulated chronic diseases, physiologic reserves decline, leaving older individuals at greater risk for adverse clinical outcomes under conditions of stress. The stress of surgery (and anesthesia) is great and can have catastrophic effects on high-risk elders. Postoperative complications occur more frequently in the older patient.
Health-related quality of life as an outcome for surgery
Whether for cure or symptom relief, surgical interventions are performed with the intention of improving a person's overall health. In chronic disease states, the definition of improvement is less straightforward than survival and the morbidity of surgery. Death has been the best studied outcome in the surgical literature; however, it is infrequent and does not distinguish levels of physical or cognitive impairment among survivors. Long-term survival rates for cancer surgeries are useful for
Quality of life measurement
Many scales are used for general measurement of HRQOL. Some of these scales are questionnaires designed as a global health instrument. Among the commonly used measures included in studies of surgery and other health interventions is the short-form-36 (SF-36) and its shortened version, the short-form-12 (SF-12). These scales measure domains of mental and physical health: physical functioning, role physical (problems with work or other daily activities as a result of physical problems), bodily
Health-related quality of life and joint replacement surgery
Osteoarthritis (OA) is the most common articular disease of older persons. Significant pain associated with OA is reported by approximately 40% to 60% of those older than 65 years, and it leads to decreased physical functioning [24]. Decreased activity secondary to arthritis is reported in 17% of those aged 75 to 85 years and in more than 25% of those older than age 85 years (see Fig. 1). Disabling OA of the weightbearing joints commonly leads to replacement, with 418,000 total knee
Health-related quality of life and cardiac surgery
Heart disease is the second most common cause of disability after arthritis in the very old. Coronary artery disease is prevalent in those older than 80 years and accounts for a quarter of morbidity and more than half of mortality in this age group [33]. Open heart surgery is becoming common in octogenarians and is even reported in 90-year-olds. Surgical mortality in this group is expected to be higher in this age group than other elective surgery because of the degree of risk involved,
Health-related quality of life and cataracts
Cataracts are the most common cause of visual impairment in the world, and in the United States an estimated 24.5% of those 70 years of age and older report having a cataract, with a prevalence of 5.1 million cataracts [48]. The prevalence of cataracts, defined as opacity of the lens, increases with age. Vision impairment from any cause has been associated with substantial activity limitations: difficulty walking, difficulty managing medications, difficulty preparing meals, and an increased
Summary
As surgery has been extended into the elderly population, HRQOL has been appropriately added as a parameter to evaluate surgical success. Surgery remains of significant risk in older patients, and an estimate of the type of outcome, including morbidity, mortality, and HRQOL can aid in that decision. New techniques, such as laparoscopic or minimally invasive surgery show great promise for reduction in perioperative stress [58], [59] and improved HRQOL [60] in younger patients, but have not been
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