1290
GERIATRICS
Re: Patterns of Surgical Care and Complications in Elderly Adults S. Deiner, B. Westlake and R. P. Dutton Departments of Anesthesiology, Neurosurgery, and Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, New York J Am Geriatr Soc 2014; 62: 829e835.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.044 available at http://jurology.com/ Editorial Comment: More than 30% of all surgical procedures performed in the United States annually are done in patients older than 65 years. Despite this fact, comparatively less outcomes research has been conducted in this older population. Most published geriatric surgical research has focused on individual level clinical outcomes, such as cardiovascular risk stratification, pneumonia, frailty, and postoperative delirium and cognition.1 The authors sought to identify patterns of surgical care and perioperative complications in geriatric patients using data from NACOR (National Anesthesia Clinical Outcomes Registry) and the Anesthesia Quality Institute. Data on 2,851,114 patients older than 18 years were examined in the final outcomes assessment, with geriatric patients accounting for 972,505 (34.1%) of the subjects. The study is unique because it includes national data on procedures performed at community hospitals and not just those done at academic or tertiary care medical centers. Mortality rates increased with advancing age and were highest in patients older than 90 years. Interestingly urological procedures were not among the 10 most commonly performed operations in patients 18 to 64 years old. However, transurethral surgeries for excision, drainage or removal of urinary obstruction were in the top 10 for each of the older age groups, with 10,241 such procedures being performed in patients 70 to 79 years, 7,817 in those 80 to 89 years and 1,325 in those 90 years or older. These procedures represent the seventh, fifth and fourth most common operations overall in these age cohorts, respectively. From a public health perspective these important data can help to shape policy decisions that impact health care for older adults. Tomas L. Griebling, MD, MPH 1. Leung JM and Dzankic S: Relative importance of preoperative health status versus intraoperative factors in predicting postoperative adverse outcomes in geriatric surgical patients. J Am Geriatr Soc 2001; 49: 1080.
Re: Use of Herbal Medicines by Elderly Patients: A Systematic Review J. E. de Souza Silva, C. A. Santos Souza, T. B. da Silva, I. A. Gomes, jo, D. P. de Lyra-Ju nior, W. B. da Silva G. de Carvalho Brito, A. A. de Souza Arau and F. A. da Silva Department of Physiology, Federal University of Sergipe, Aracaju, Brazil Arch Gerontol Geriatr 2014; 59: 227e233.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.045 available at http://jurology.com/ Editorial Comment: Older adults, defined as those 65 years or older, currently comprise about 13% of the total United States population. Due to increased prevalence of chronic comorbid conditions, these patients consume about 3 times more prescription medications and more nonprescription products than younger people. This figure includes herbal preparations and other forms of phytotherapy. Despite widespread use, there are limited data on the safety and efficacy of such products, particularly in geriatric patients. The authors describe a systematic review of the published literature in English, Spanish and Portuguese examining clinical studies on this topic. Of 1,297 studies identified in the initial search only 16 met inclusion criteria for analysis. These series included 21,497 subjects, with mean ages ranging from 71 to 80 years. More than half of all subjects in each study were women. Ten studies were cross-sectional, 1 was longitudinal and 2 did not include descriptions of design methodology. The most common herbal supplements reported were Ginkgo biloba (50% of studies) and garlic (43.7%). Four series did not detail what herbal supplements were used.
GERIATRICS
1291
These data suggest that herbal supplement use is widespread but that overall information on safety and efficacy is limited. Ginkgo biloba and garlic have been identified to increase the risk of bleeding complications, particularly if combined with other anticoagulant medications. Use of herbal supplements needs to be identified as a routine part of the medication review in older adults. Tomas L. Griebling, MD, MPH
Suggested Reading Wilkinson S, Gomella LG, Smith JA et al: Attitudes and use of complementary medicine in men with prostate cancer. J Urol 2002; 168: 2505.
Re: Use of Complementary and Alternative Medicine by Older AdultsdA Cross-Sectional Survey K. Schnabel, S. Binting, C. M. Witt and M. Teut Universita€tsmedizin, Berlin, Germany Institute for Social Medicine, Epidemiology and Health Economics, Charite BMC Geriatr 2014; 14: 38.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.046 available at http://jurology.com/ Editorial Comment: Use of complementary and alternative medicine (CAM) treatments appears to be increasing for many clinical conditions. Older adults have been identified to consume more prescription and nonprescription medications compared to younger adults due to the increased incidence and prevalence of comorbid conditions that occur with advancing age. This study surveyed 400 older adults in Germany to identify rates and patterns of CAM use. Overall use was high, with 61.3% of subjects taking some type of CAM. The most common agents were diet supplements (35.9%), herbal supplements (33.3%) and external preparations (26.8%). Most subjects took these agents at the recommendation of friends or family (50%) or based on self-initiative (27.3%), and fewer took them based on the suggestion of a pharmacist (10.4%) or physician (25.8%). It is noteworthy that 57.9% of respondents could not determine if the CAM led to any side effects or even what potential side effects might be. There is a strong presumption that these treatments are safe and effective because they are “natural.” However, there are relatively few scientific data on many of these products. In some cases they can have potential interactions with other prescription or nonprescription medications, a risk identified in 3.0% of the subjects in this study. This finding highlights the need for additional research and public and professional education on CAM, including potential benefits and risks. Tomas L. Griebling, MD, MPH
Suggested Reading Feifer AH, Fleshner NE and Klotz L: Analytical accuracy and reliability of commonly used nutritional supplements in prostate disease. J Urol 2002; 168: 150.
GERIATRICS
Re: Patterns of Surgical Care and Complications in Elderly Adults S. Deiner, B. Westlake and R. P. Dutton Departments of Anesthesiology, Neurosurgery, and Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, New York J Am Geriatr Soc 2014; 62: 829e835.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.044 available at http://jurology.com/ Editorial Comment: More than 30% of all surgical procedures performed in the United States annually are done in patients older than 65 years. Despite this fact, comparatively less outcomes research has been conducted in this older population. Most published geriatric surgical research has focused on individual level clinical outcomes, such as cardiovascular risk stratification, pneumonia, frailty, and postoperative delirium and cognition.1 The authors sought to identify patterns of surgical care and perioperative complications in geriatric patients using data from NACOR (National Anesthesia Clinical Outcomes Registry) and the Anesthesia Quality Institute. Data on 2,851,114 patients older than 18 years were examined in the final outcomes assessment, with geriatric patients accounting for 972,505 (34.1%) of the subjects. The study is unique because it includes national data on procedures performed at community hospitals and not just those done at academic or tertiary care medical centers. Mortality rates increased with advancing age and were highest in patients older than 90 years. Interestingly urological procedures were not among the 10 most commonly performed operations in patients 18 to 64 years old. However, transurethral surgeries for excision, drainage or removal of urinary obstruction were in the top 10 for each of the older age groups, with 10,241 such procedures being performed in patients 70 to 79 years, 7,817 in those 80 to 89 years and 1,325 in those 90 years or older. These procedures represent the seventh, fifth and fourth most common operations overall in these age cohorts, respectively. From a public health perspective these important data can help to shape policy decisions that impact health care for older adults. Tomas L. Griebling, MD, MPH 1. Leung JM and Dzankic S: Relative importance of preoperative health status versus intraoperative factors in predicting postoperative adverse outcomes in geriatric surgical patients. J Am Geriatr Soc 2001; 49: 1080.
Re: Use of Herbal Medicines by Elderly Patients: A Systematic Review J. E. de Souza Silva, C. A. Santos Souza, T. B. da Silva, I. A. Gomes, jo, D. P. de Lyra-Ju nior, W. B. da Silva G. de Carvalho Brito, A. A. de Souza Arau and F. A. da Silva Department of Physiology, Federal University of Sergipe, Aracaju, Brazil Arch Gerontol Geriatr 2014; 59: 227e233.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.045 available at http://jurology.com/ Editorial Comment: Older adults, defined as those 65 years or older, currently comprise about 13% of the total United States population. Due to increased prevalence of chronic comorbid conditions, these patients consume about 3 times more prescription medications and more nonprescription products than younger people. This figure includes herbal preparations and other forms of phytotherapy. Despite widespread use, there are limited data on the safety and efficacy of such products, particularly in geriatric patients. The authors describe a systematic review of the published literature in English, Spanish and Portuguese examining clinical studies on this topic. Of 1,297 studies identified in the initial search only 16 met inclusion criteria for analysis. These series included 21,497 subjects, with mean ages ranging from 71 to 80 years. More than half of all subjects in each study were women. Ten studies were cross-sectional, 1 was longitudinal and 2 did not include descriptions of design methodology. The most common herbal supplements reported were Ginkgo biloba (50% of studies) and garlic (43.7%). Four series did not detail what herbal supplements were used.
GERIATRICS
1291
These data suggest that herbal supplement use is widespread but that overall information on safety and efficacy is limited. Ginkgo biloba and garlic have been identified to increase the risk of bleeding complications, particularly if combined with other anticoagulant medications. Use of herbal supplements needs to be identified as a routine part of the medication review in older adults. Tomas L. Griebling, MD, MPH
Suggested Reading Wilkinson S, Gomella LG, Smith JA et al: Attitudes and use of complementary medicine in men with prostate cancer. J Urol 2002; 168: 2505.
Re: Use of Complementary and Alternative Medicine by Older AdultsdA Cross-Sectional Survey K. Schnabel, S. Binting, C. M. Witt and M. Teut Universita€tsmedizin, Berlin, Germany Institute for Social Medicine, Epidemiology and Health Economics, Charite BMC Geriatr 2014; 14: 38.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.046 available at http://jurology.com/ Editorial Comment: Use of complementary and alternative medicine (CAM) treatments appears to be increasing for many clinical conditions. Older adults have been identified to consume more prescription and nonprescription medications compared to younger adults due to the increased incidence and prevalence of comorbid conditions that occur with advancing age. This study surveyed 400 older adults in Germany to identify rates and patterns of CAM use. Overall use was high, with 61.3% of subjects taking some type of CAM. The most common agents were diet supplements (35.9%), herbal supplements (33.3%) and external preparations (26.8%). Most subjects took these agents at the recommendation of friends or family (50%) or based on self-initiative (27.3%), and fewer took them based on the suggestion of a pharmacist (10.4%) or physician (25.8%). It is noteworthy that 57.9% of respondents could not determine if the CAM led to any side effects or even what potential side effects might be. There is a strong presumption that these treatments are safe and effective because they are “natural.” However, there are relatively few scientific data on many of these products. In some cases they can have potential interactions with other prescription or nonprescription medications, a risk identified in 3.0% of the subjects in this study. This finding highlights the need for additional research and public and professional education on CAM, including potential benefits and risks. Tomas L. Griebling, MD, MPH
Suggested Reading Feifer AH, Fleshner NE and Klotz L: Analytical accuracy and reliability of commonly used nutritional supplements in prostate disease. J Urol 2002; 168: 150.
