Foot and Ankle Surgery: Considerations for the Geriatric Patient

ArticleinThe Journal of the American Board of Family Medicine 22(3):316-24 · May 2009with19 Reads
DOI: 10.3122/jabfm.2009.03.080122 · Source: PubMed
The growing number of lower-extremity abnormalities that are seen in inpatient and outpatient settings has paralleled the increased number of elderly in the population. Foot and ankle deformities, disorders, and arthritis, which are not manifested until late in life, have become more common as more individuals attain longer lifespans. Although conservative therapies are a priority when addressing the geriatric population, surgical options may be overlooked secondary to a misunderstanding of their ability to overcome perioperative management. Advanced minimally invasive surgical procedures for the foot and ankle have decreased the complications associated with foot surgery, making surgical intervention a viable option for many of the elderly. The newer procedures do not, however, minimize strict perioperative management, including pharmacological and nutritional assessment, and cardiopulmonary precautions. Outpatient surgical intervention may effectively address many ongoing problems associated with pain, decreased ambulation, and decreased quality of life. Current techniques in joint reconstruction in the forefoot and midfoot allow weight bearing from the day of surgery. Most hindfoot and ankle surgeries now permit minimal bone resection and incision through arthroscopy, resulting in improved muscle and tendon repair and early weight bearing. The changes in surgical approaches for the geriatric foot have permitted more effective and rapid intervention in problems affecting ambulation and quality of life in our aged population.
  • Full-text · Article · May 2009
  • [Show abstract] [Hide abstract] ABSTRACT: To review the rational for use of the many regional anesthetic/analgesic techniques and acute pain management modalities in the elderly and cognitively impaired high-risk patients, as increasing numbers of older adults are presenting for surgery. There are numerous studies examining short and long-term consequences of regional anesthesia/analgesia along with identification of the many potential advantages, but those studying the influence and potential benefits in elderly and cognitively impaired patients are only beginning to be developed as issues related to cognitive dysfunction associated with surgery/anesthesia are beginning to be observed. Pain management therapy, including regional anesthesia, along with multimodal analgesia may help reduce the risk of negative influences in the elderly patient along with reducing postoperative delirium and cognitive dysfunction. Improvements in analgesic efficacy with regional anesthesia may attenuate pathophysiological surgical responses, reduce the length of hospitalization, and accelerate patient rehabilitation and recovery. Analgesic techniques that provide optimal pain control and low side effect profiles with minimal opioid exposure should always be considered for elderly high-risk and cognitively impaired patients.
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