(Reuters Health) – Older adults living in nursing homes who require emergency abdominal surgery are more likely to die or have serious difficulties than colleagues living in the community, researchers say.
The study examined data on 18,326 patients with emergency abdominal surgery between 2011 and 2015, including 905 people living in trained nursing facilities.
Overall, 26% of residents of nursing homes died in hospital compared to 10% of patients who did not live in institutional settings, and who found the study. And 33% of residents of nursing homes died within 30 days of admission to hospital, compared to 26% of non-residents in nursing homes.
All of the health issues that have led to people living in nursing homes may have exacerbated surgical results, Dr. Dr. T Anne Mosenthal, researcher at Rutgers's New Jersey Medical School in Newark and senior author of the study.
“Difficulties with post-operative and mortality difficulties,” Mosenthal said by email. “Those who are unable to live independently are at a higher risk of being weak, and this increases their risk of surgery.” T
As the life expectancy of the US population continues to rise, an increasing number of older adults will face emergency surgery, Mosenthal and his colleagues are noted in the American Journal of Surgery. Almost a third of older adults undergo a surgical procedure during the final year of their life, often in the last month before death, the researchers state.
In the current study, nursing home residents were more likely to have complex chronic health issues and would rely solely on others for basic daily tasks such as dressing, swimming and eating.
The most common causes for surgery were gastrointestinal relief or barrier.
Two-thirds of nursing home residents had post-operative difficulties, compared to 42% of others in the study.
Nursing home residents were about twice as likely to have pneumonia, respiratory failure, cardiac arrest, septic shock and surgical wounds that do not close properly as other patients in the study.
Failure to rescue, or not be able to prevent death after prescribed difficulties, was 30% more common for nursing home residents than other patients.
While high-level care planning cannot always be done in advance of emergency surgery, these findings highlight the importance of patients and families setting up medical instructions which clearly explain what rescue measures would be required when difficulties arise. ahead.
It may be easier for residents of nursing homes and older elderly patients to receive palliative care rather than being put on machines to help them eat or breathe that they cannot save their lives, said Mosenthal.
“Conversations about patients' wishes for life-sustaining treatment and aggressive medical therapy must take place before they can decide or worse if a situation arises,” Mosenthal said.
“I can't stress enough how important these conversations are, even though people are healthy, to have these conversations early, so that designated center decision makers know how to proceed when the emergency situation occurs. So, Mosenthal said.
SOURCE: bit.ly/2nzsM0h American Surgical Journal, online September 19, 2019.
(TTTranslate tags) US (t) HEALTH (t) SURGERY (t) FRAILTY (t) Geriatrician / Aging (t) Surgery (t) Nursing (t) Terminal Care (t) Health / Medicine (t) Clinical Medicine (t) Care Health (TRBC) (t) Pain Management (t) Medical Ethics (t) Disasters / Accidents t