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Questions :

1.What do you think this opinion is based on?
 
2. Discuss how this scenario could affect the patient?
 
3. What are the ramifications of a senior nurse expressing this opinion?
 
4. How would you respond to this statement?
 
 

Answers :

1.The senior nurse receiving handover of 87 year old gentleman is of the opinion that big surgeries should not be done on old people. This opinion is based on risky post-operative care of older adults. Nurse experience challenges in post-operative care of older adults as they are prone to high risk of complication as well as mortality due to the physiology of ageing, their frail body conditions and perioperative risk. Age related physiologic alterations increased the chanced of heart failure and delirium complications in elderly patients and so the nurse have this opinion (Baquero & Rich, 2015).
 
2.The short-term impact of surgeries on older adults include rise in delirium symptoms, poor recovery, longer stay in hospitals and side-effects of medications. Hence older people have high rate of post-operative complications which affects their health and recovery process. Delirium is the most frequent complications which has a deleterious effect on other outcomes (Bellelli et al., 2014). Secondly, the use of anesthesia during the surgery has a long-term effect on the cognitive functions of older people above 65 years old. This occurs due to the pharmacotoxic effect of the drug as well as age-related neuronal changes in individual. The neurotoxicity of anesthetics can be well-tolerated by young adults but not by older adults due to age-related losses in cerebral reserve and slow drug elimination rate in older people (Ancelin et al., 2010).
 
3.The senior nurse expresses the above opinion because of the challenges faced by them in post-operative care of older adults. Due to the high rate of post-operative complications in this age group, the daily challenges in care for nurses include maintaining the continuum of service due to the decline in physiological and psychosocial outcome in frail elderly people. Hence, they are often discharged with high level of stress and anxiety (Wang, Zhao, & Zang, 2014).
 
 


4.The personal opinion of a nurse to the statement is that the nurse agrees that complex surgeries are risky for older adults as they expose them to additional complications due to their decline in age-related physiology. Hence, surgery should be planned for them only when they are in immediate for them. Secondly, while preparing for surgery, all precautions should be taken to ensure that the elderly patient is not prone to any risk during the surgery. This can be done by comprehensive assessment of patient and evaluating the likelihood of complications during the surgery. Secondly, to minimize the burden of treatment and risk of post-operative functional impairment in older adults, it is necessary to engage in shared decision making process to promote favorable outcome for patients (Murthy et al., 2015).

 

Reference

Ancelin, M. L., De Roquefeuil, G., Scali, J., Bonnel, F., Adam, J. F., Cheminal, J. C., ... & Ritchie, K. (2010). Long-term post-operative cognitive decline in the elderly: the effects of anesthesia type, apolipoprotein E genotype, and clinical antecedents. Journal of Alzheimer's Disease, 22(s3), 105-113.

Baquero, G. A., & Rich, M. W. (2015). Perioperative care in older adults. Journal of geriatric cardiology: JGC, 12(5), 465.

Bellelli, G., Mazzola, P., Morandi, A., Bruni, A., Carnevali, L., Corsi, M., ... & Gustafson, Y. (2014). Duration of Postoperative Delirium Is an Independent Predictor of 6?Month Mortality in Older Adults After Hip Fracture. Journal of the American Geriatrics Society, 62(7), 1335-1340.

Murthy, S., Hepner, D. L., Cooper, Z., Bader, A. M., & Neuman, M. D. (2015). Controversies in anaesthesia for noncardiac surgery in older adults. British journal of anaesthesia, 115(suppl 2), ii15-ii25.

Wang, S. Y., Zhao, Y., & Zang, X. Y. (2014). Continuing care for older patients during the transitional period. Chinese Nursing Research, 1, 5-13.

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