Surgery in the Frail Elderly: Nursing Home Patients

  • Michael E. Zenilman


As our population ages, survivors will approach the limit of aging, or the life-span. As a result of primary and preventive medicine, heathier life styles, and decreased health risk, the population of the United States and other Western societies is trending toward this limit. A comparative study performed on life expectancy of 80-year-old persons in Western countries showed that American octogenarian men and women are expected to live 7.0 and 9.1 more years, respectively. In England the survival of octogenarians was 6.2 and 8.1 years, respectively; in France 6.7 and 8.6 years, respectively; in Sweden 6.5 and 8.3 years, respectively; and in Japan, 6.5 and 8.9 years, respectively.1


Percutaneous Endoscopic Gastrostomy Surgical Care Nurse Home Patient Percutaneous Cholecystostomy Frail Elderly Patient 
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  1. 1.
    Manton DG, Vaupel JW. Survival after the age of 80 in the United States, Sweden, France, England and Japan. N Engl J Med 1995;333:1232–1235.PubMedCrossRefGoogle Scholar
  2. 2.
    Katz S, Branch LG, Branson MH, Papsidero JA, Beck JC, Greer DS. Active life expectancy. N Engl J Med 1983;309: 1218.PubMedCrossRefGoogle Scholar
  3. 3.
    Roush W. Live long and prosper? Science 1996;273:42–46.PubMedGoogle Scholar
  4. 4.
    Fries JF. Aging, natural death and the compression of morbidity. N Engl J Med 1980;303:130–135.PubMedCrossRefGoogle Scholar
  5. 5.
    Duffy ME, Macdonald E. Determinants of functional health of older persons. Gerontologist 1990;30:503–509.PubMedCrossRefGoogle Scholar
  6. 6.
    Vita AJ, Terry RB, Hubert HB, Fries JF. Aging, health risks and cumulative disability. N Engl J Med 1998;338:1035–1041.PubMedCrossRefGoogle Scholar
  7. 7.
    Campion EW. Aging better. N Engl J Med 1998;338: 1064–1066.PubMedCrossRefGoogle Scholar
  8. 8.
    Fiatarone MA, O’Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 1994;330:1769–1775.PubMedCrossRefGoogle Scholar
  9. 9.
    Stevens J, Cai J, Pamuk ER, Williamson DF, Thun MJ, Wood JL. The effect of age on the association between body mass index and mortality. N Engl J Med 1998;338:1–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Kemper P, Murtaugh CM. Lifetime use of nursing home care. N Engl J Med 1991;324:595–600.PubMedCrossRefGoogle Scholar
  11. 11.
    Appelgate WB, Miller ST, Graney MJ, Elam JT, Burns R, Akins DE. A randomized controlled trial of a geriatric assessment unit in a community rehabilitation hospital. N Engl J Med 1990;322:1572–1578.CrossRefGoogle Scholar
  12. 12.
    Gracey DR, Viggiano RW, Naessens JM, Hubmayr RD, Silverstein MD, Koenig GE. Outcomes of patients admitted to a chronic ventilator-dependent unit in an acute care hospital. Mayo din Proc 1992;67:131–136.CrossRefGoogle Scholar
  13. 13.
    Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J. Arandomized trial of care in a hospital medical unit especially designated to improve the functional outcomes of acutely ill older patients. N Engl J Med 1995;332:1338–1344.PubMedCrossRefGoogle Scholar
  14. 14.
    Reuben DB, Borok GM, Wolde-Tsadik G, et al. A randomized trial of comprehensive geriatric assessment in the care of hospitalized patients. N Engl J Med 1995;332:1345–1350.PubMedCrossRefGoogle Scholar
  15. 15.
    Ferrell BA, Osterweil D, Christenson P. A randomized trial of low-air-loss beds for treatment of pressure ulcers. JAMA 1993;269:269–494.CrossRefGoogle Scholar
  16. 16.
    Inman KJ, Sibbald WJ, Rutledge FS, Clark BJ. Clinical utility and cost effectiveness of an air suspension bed in the prevention of pressure ulcers. JAMA 1993;269:1139–1143.PubMedCrossRefGoogle Scholar
  17. 17.
    Granick MS, McGowan E, Long CD. Outcome assessment of an in-hospital cross-functional wound care team. Plast Reconstr Surg 1998;101:1243.PubMedGoogle Scholar
  18. 18.
    Zenilman ME, Bender JS, Magnuson TH, Smith GS. General surgical disease in the nursing home patient: results of a dedicated geriatric surgery consult service. J Am Coll Surg 1996;183:361–370.PubMedGoogle Scholar
  19. 19.
    Rubenstein LZ, Wieland D, English P, Josephson K, Sayre JA, Abrass IB. The Sepulveda VA geriatric evaluation unit: data on four year outcomes and predictors of improved patient outcomes. J Am Geriatri Soc 1984;32:503–512.Google Scholar
  20. 20.
    Keller BK, Potter JF. Predictors of mortality in outpatient geriatric evaluation and management clinic patients. J Gerontol A Biol Sci Med Sci 1994;49:M246-M251.Google Scholar
  21. 21.
    Winograd CH, Gerety MB, Chung M, Goldstein MK, Dominquez F Jr, Vallone R. Screening for frailty: criteria and predictors of outcomes. J Am Geriatr Soc 1991;39: 778–784.PubMedGoogle Scholar
  22. 22.
    Van Dijk PTM, van de Sande HJ, Dippel DWJ, Habbema JDF. The nature of excess mortality in nursing home patients with dementia. J Gerontol A Biol Sci Med Sci 1992;47: M28-M34.Google Scholar
  23. 23.
    Perls TT, Morris JN, Ooi WL, Lipsitz LA. The relationship between age, gender and cognitive performance in the very old: the effect of selective survival. J Am Geriatr Soc 1993;41:1193–1201.PubMedGoogle Scholar
  24. 24.
    Brodaty H, McGilchrist C, Harris L, Peters KE. Time until institutionalization and death in patients with dementia: role of caregiver training and risk factors. Arch Neurol 1993;50:643–650.PubMedCrossRefGoogle Scholar
  25. 25.
    Folstein MF, Folstein SE, McHugh PR. The Mini Mental State: a practical method for grading the cognitive skills of patients for the clinician. J Psychiatr Res 1975;12:189–198.PubMedCrossRefGoogle Scholar
  26. 26.
    Skoog I, Nilsson L, Palmertz B, Andreasson LA, Svanborg A. A population-based study of dementia in 85 year olds. N Eng J Med 1993;328:153–158.CrossRefGoogle Scholar
  27. 27.
    Levine J, Michalski SA, Patel K, Kalemian M, Nelson M, Zenilman ME. Survival of patients in nursing homes referred for surgery. Surg Forum (in press).Google Scholar
  28. 28.
    Christakis NA, Escarce JJ. Survival of Medicare patients after enrollment in hospice programs. N Engl J Med 1996;335:172–178.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 2001

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  • Michael E. Zenilman

There are no affiliations available

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