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Nursing

Risk Assessment and Vulnerable Populations

The United States is experiencing the beginning of era where the aged population will expand at a torrential rate. The generation known as “baby boomers” are responsible for the expanding numbers as they enter old age en masse. People who fall in the older age categories face greater health risks than those who are younger. This discrepancy is somewhat self-explanatory as advanced age is commonly known to be associated with frailty. However, advances in medical preventions and treatments have resulted in a consistent increase in life expectancies. The impact of these improvements is most evident in the preservation of both very young and very old members of the population. Accordingly, the aged are functioning at record levels and face significantly lowered morbidity risks compared to the past (King et al., 2013). This improvement extends to the surgical environment as old patients have shown great resilience to distress from surgical procedures when they are elective and excellent care is provided through pre, intra, and post periods of the surgical process. However, the risks increase when the procedure is an emergency, requiring the highest possible level of care during assessment, operation, and recovery.

Evaluations are a critical part of the process encompassing the entire perioperative experience and may be the most vital factor when the surgery is in response to an emergency and the patient is classified as being old. In this case risk assessment and reduction measures are necessary to raise the chances of a successful outcome and to lessen the pain and other distress that may be experienced by the patient. Psychological concerns are among the primary assessment targets because older people respond poorly to related stressors. This issue is best addressed by preparing the patient for the perioperative process through education, discussion of expectations, and reassurance when appropriate. Other preparations include the achievement of stable nutrition and hydration states, evaluating comorbid conditions, and assessing the role of prescribed or other drugs taken by the patient.

Another key part of the preoperative stage when attending to the old is to record baseline data for all possible indicators related to the primary assessment targets described above (Clayton, 2008). These measurements serve several important purposes including providing a picture of the patient’s health status prior to surgery and serving as a baseline for subsequent readings. Indicators can also be used to confirm or discover comorbid conditions and other complicating factors, the consideration of which is essential to optimizing the perioperative process. Some of the most prominent conditions among the elderly include cataracts, glaucoma, arthritis, hearing loss, UTIs, and circulatory problems. Each of these possibilities should be tested for during preoperative assessments along with several other comorbid risks that are associated with old age. With these measurements perioperative participants can be prepared to prepare effectively and react appropriately given the patient’s health status.

The medication history of an older patient can provide valuable information about comorbid conditions, general health, and specific risks that may be associated with one or more of the surgical stages (Feringa et al., 2009). Antidepressants pose a complex risk because they can result in low blood pressure under anesthesia but may also result in withdrawal symptoms should immediate cessation be preferable. Drugs that act on acetylcholine can lead to increased confusion in older patients and describe a wide range of medications from anti-histamines like Dramamine to smoking cessation aids such as Zyban. Similar psychological problems like the display of dementia-like symptoms can be produced in older patients as a result of bromide accumulation. Asprin is known to cause bleeding, which is a serious issue during surgical processes, and non-steroidal anti-inflammatories can also cause bleeding issues in the form of stress ulcers. Additionally, steroids can suppress the immune response and are commonly used for several conditions among the aged population.

A thorough assessment will provide information about assistive devices and technologies that may benefit or harm an older patient. The skin is an especially sensitive area in the aged and requires proper evaluation to avoid the use of abrasive cleaning or other maintenance causing damage and becoming a potential site for the development of infections. Moisturizing lotions can pose a threat because they may contain bacteria, and even the removal of hair must be seriously approached to minimize the risk of damage. Older patients may also require the use of thromboembolic socks to reduce the risk of postsurgical embolism formation. Plans for the use of such socks should be made during the assessment phase to assure the appropriateness of the devices and risks that they may inadvertently introduce from usage. Catheters are often required in patients with advanced age because they typically have less bladder capacity than their younger counterparts. The insertion of a catheter must be made with utmost care because even slight abrasions can lead to devastating consequences (Talaat et al., 2010). Plans should then be made to prepare the patient for either safe insertion or to empty their bladders prior to surgery, should they be deemed able to withstand the time period.

There are many reasons that a complete assessment is necessary to prepare aged patients for successful and complication free surgical experiences. Older people are becoming a huge part of the population and will place significant stress on the health care system. This pressure must be met with improved efficiency and enhanced quality of care, which are characteristics that rely heavily on the execution of a high quality evaluation during the preoperative period. The importance of thorough assessments is multiplied when the surgery is an emergency because the preparation stage is extremely condensed, placing older patients at even higher levels of risk.

References

Clayton, J. L. (2008). Special needs of older adults undergoing surgery. AORN journal, 87(3), 557-574.

Feringa, H. H., Bax, J. J., Karagiannis, S. E., Noordzij, P., van Domburg, R., Klein, J., & Poldermans, D. (2009). Elderly patients undergoing major vascular surgery: risk factors and medication associated with risk reduction. Prognosis of Patients with Peripheral and Coronary Atherosclerotic Disease, 216.

King, D. E., Matheson, E., Chirina, S., Shankar, A., & Broman-Fulks, J. (2013). The status of baby boomers’ health in the United States: The healthiest generation? JAMA internal medicine, 173(5), 385-386.

Talaat, M., Hafez, S., Saied, T., Elfeky, R., El-Shoubary, W., & Pimentel, G. (2010). Surveillance of catheter-associated urinary tract infection in 4 intensive care units at Alexandria university hospitals in Egypt. American Journal of Infection Control, 38(3),222-228.