World J Surg DOI 10.1007/s00268-015-3047-z
LETTER TO THE EDITOR
Global Surgery in the Elderly must Focus on Education S. B. Patel1,2
Ó Socie´te´ Internationale de Chirurgie 2015
To the Editor, I read with interest the recent article on the operative care of elderly patients in low-resource settings [1]. With over 2 billion people worldwide identified as not having adequate access to surgical care, an increasing number of these will be elderly patients. Hence, it is important to identify the specific differences in surgical needs and barriers accessing care compared to that of younger demographics. One major difference this study highlighted was the surprising lack of emergency operations performed on the elderly compared to younger age groups. One would logically assume the opposite would be the case, especially as research undertaken in higher-resource countries showed that the number of urgent operations performed was higher in older demographic groups [2]. However, as the article mentioned, a lack of infrastructure surrounding hospital care (such as established emergency vehicle services) often means that patients die before surgical care can be provided. Another reason for the lack of urgent procedures on the elderly may stem from families’ perceptions that surgical interventions are not as useful in older patients. Thus, these patients would be less likely to be taken to hospital
& S. B. Patel [email protected] 1
Peninsula College of Medicine and Dentistry, Devon, UK
2
Royal Devon and Exeter Hospital, Devon EX2 5WD, UK
and other interventions may be preferred regardless of medical precedent. Studies such as these provide evidence for public health professionals to instigate rational measures to counteract barriers in accessing surgery. Building infrastructures that allow for emergency services to transport patients, often without any other means of transportation, to hospital is integral to the care of the elderly; this is even more paramount in low-resource settings where other means of public transport may not exist. It is also important to note that education will play a big role in reducing pre-surgical mortality. Surgical care is often the only known source of curative interventions and making sure the public understand this is essential. A recent systematic review focusing on barriers to surgical care found that the biggest factor was a lack of knowledge about the care itself [3]. This would provide an explanation as to why many were not aware of the importance of surgical care—especially with regard to the elderly. Public health programs can be put in place to stop these negative perceptions and hopefully increase the urgency of transporting elderly patients to hospital. The newly emerged field of global surgery is rightly concentrating on educating more surgeons in low-resource settings while funding equipment and twinning programs. In addition, the public perception must also be changed in order to accommodate a society where surgical care is a right and not a luxurious intervention reserved for those with a higher income. Local campaigns advocating the essential nature of surgery and the importance of fast referral would help drastically. The elderly are often reliant on others and therefore, this education must be aimed at all age demographics.
Conflict of interest
None.
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World J Surg
References 1. Wong E, Trelles M, Dominguez L, Mupenda Mwania J, Kasonga Tshibangu C, Haq Saqeb S et al (2014) Operative procedures in the elderly in low-resource settings: a review of me´decins sans frontie`res facilities. World J Surg 39(3):652–657. doi:10.1007/ s00268-014-2855-x
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2. Deiner S, Westlake B, Dutton R (2014) Patterns of surgical care and complications in elderly adults. J Am Geriatr Soc 62(5):829–835 3. Grimes C, Bowman K, Dodgion C, Lavy C (2011) Systematic review of barriers to surgical care in low-income and middleincome countries. World J Surg 35(5):941–950. doi:10.1007/ s00268-011-1010-1
LETTER TO THE EDITOR
Global Surgery in the Elderly must Focus on Education S. B. Patel1,2
Ó Socie´te´ Internationale de Chirurgie 2015
To the Editor, I read with interest the recent article on the operative care of elderly patients in low-resource settings [1]. With over 2 billion people worldwide identified as not having adequate access to surgical care, an increasing number of these will be elderly patients. Hence, it is important to identify the specific differences in surgical needs and barriers accessing care compared to that of younger demographics. One major difference this study highlighted was the surprising lack of emergency operations performed on the elderly compared to younger age groups. One would logically assume the opposite would be the case, especially as research undertaken in higher-resource countries showed that the number of urgent operations performed was higher in older demographic groups [2]. However, as the article mentioned, a lack of infrastructure surrounding hospital care (such as established emergency vehicle services) often means that patients die before surgical care can be provided. Another reason for the lack of urgent procedures on the elderly may stem from families’ perceptions that surgical interventions are not as useful in older patients. Thus, these patients would be less likely to be taken to hospital
& S. B. Patel [email protected] 1
Peninsula College of Medicine and Dentistry, Devon, UK
2
Royal Devon and Exeter Hospital, Devon EX2 5WD, UK
and other interventions may be preferred regardless of medical precedent. Studies such as these provide evidence for public health professionals to instigate rational measures to counteract barriers in accessing surgery. Building infrastructures that allow for emergency services to transport patients, often without any other means of transportation, to hospital is integral to the care of the elderly; this is even more paramount in low-resource settings where other means of public transport may not exist. It is also important to note that education will play a big role in reducing pre-surgical mortality. Surgical care is often the only known source of curative interventions and making sure the public understand this is essential. A recent systematic review focusing on barriers to surgical care found that the biggest factor was a lack of knowledge about the care itself [3]. This would provide an explanation as to why many were not aware of the importance of surgical care—especially with regard to the elderly. Public health programs can be put in place to stop these negative perceptions and hopefully increase the urgency of transporting elderly patients to hospital. The newly emerged field of global surgery is rightly concentrating on educating more surgeons in low-resource settings while funding equipment and twinning programs. In addition, the public perception must also be changed in order to accommodate a society where surgical care is a right and not a luxurious intervention reserved for those with a higher income. Local campaigns advocating the essential nature of surgery and the importance of fast referral would help drastically. The elderly are often reliant on others and therefore, this education must be aimed at all age demographics.
Conflict of interest
None.
123
World J Surg
References 1. Wong E, Trelles M, Dominguez L, Mupenda Mwania J, Kasonga Tshibangu C, Haq Saqeb S et al (2014) Operative procedures in the elderly in low-resource settings: a review of me´decins sans frontie`res facilities. World J Surg 39(3):652–657. doi:10.1007/ s00268-014-2855-x
123
2. Deiner S, Westlake B, Dutton R (2014) Patterns of surgical care and complications in elderly adults. J Am Geriatr Soc 62(5):829–835 3. Grimes C, Bowman K, Dodgion C, Lavy C (2011) Systematic review of barriers to surgical care in low-income and middleincome countries. World J Surg 35(5):941–950. doi:10.1007/ s00268-011-1010-1
