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Table of Contents
Intro
Foreword
Foreword
Prologue
Contents
1: Acute Care Surgery in the Geriatric Patient Population: General Principles
Acute Care Surgery Evolution
Acute Care Surgery Principles
Emergency General Surgery in Elderly Patients
Geriatric Trauma
Surgical Rescue
Goal Concordant Decision-Making
Summary
References
2: Healthcare Economics and Aging
Population Trends
How Medicare Rates Are Determined
Physician Charges (Medicare Part B)
Facility Charges (Part A)
Medicare Budgets and Projected Payment Levels
Medicare Rates are Insufficient and not Keeping Up with Cost Inflation
Physician and Surgeon Reimbursement
Hospital Reimbursement
Tactics Medicare Uses to Decrease Reimbursements
Bundled Payments: A Major Medicare Cost Savings Initiative
Impact on Facilities and Providers
Looking to the Future
References
3: A Rationale and Systems Impact for Geriatric Trauma and Acute Care Surgery
Introduction
Rationale for Geriatric Trauma and Acute Care Surgery
Medical Comorbidities and Surgical Risk
Frailty and Sarcopenia
Cognitive Impairment and Postoperative Delirium
Nutrition
Polypharmacy
Geriatric Vulnerabilities
Care Planning and Shared Decision-Making
Capacity
Surrogates
Palliative Care
Advance Care Planning and Goals of Care
Withdrawing and Withholding Therapy
Care at the End of Life
Geriatric-Specific Prediction Models in Trauma and EGS
Opportunities for Improvements in Geriatric Care
National Quality Programs for Geriatric Patients
Conclusions
References
4: Physiology of Aging
Introduction
Various Issues Specific to the Elderly Population
Frailty
Function
Nutritional Status
Medications/Polypharmacy
Medical Decision-Making in the Elderly Population
Elder Abuse
Neuropsychiatric
Physiology
Clinical Issues
Cardiovascular
Physiology
Clinical Context
Pulmonary
Physiology
Clinical Context
Gastrointestinal
Physiology
Clinical Context
Renal/Volume/Electrolytes
Physiology
Clinical Context
Endocrine
Physiology
Clinical Context
Common Emergency General Surgery Cases
Small Bowel Obstruction
Acute Mesenteric Ischemia
Diverticulitis
Trauma
Falls
Rib Fractures
Traumatic Brain Injury
References
5: Frailty in Geriatric Trauma and Emergency General Surgery
Overview
Frailty in Geriatric Trauma
Measuring Frailty
Association Between Frailty and Outcomes Among Geriatric Trauma Patients
Optimization of Frail Trauma Patients
Frailty in Geriatric Emergency General Surgery
Measuring Frailty
Association Between Frailty and Outcomes Among Geriatric EGS Patients
Optimization of Frail EGS Patients
Geriatric Specialists and Multidisciplinary Care
References
6: Hematologic Changes with Aging
Overview of the Hematologic System
Foreword
Foreword
Prologue
Contents
1: Acute Care Surgery in the Geriatric Patient Population: General Principles
Acute Care Surgery Evolution
Acute Care Surgery Principles
Emergency General Surgery in Elderly Patients
Geriatric Trauma
Surgical Rescue
Goal Concordant Decision-Making
Summary
References
2: Healthcare Economics and Aging
Population Trends
How Medicare Rates Are Determined
Physician Charges (Medicare Part B)
Facility Charges (Part A)
Medicare Budgets and Projected Payment Levels
Medicare Rates are Insufficient and not Keeping Up with Cost Inflation
Physician and Surgeon Reimbursement
Hospital Reimbursement
Tactics Medicare Uses to Decrease Reimbursements
Bundled Payments: A Major Medicare Cost Savings Initiative
Impact on Facilities and Providers
Looking to the Future
References
3: A Rationale and Systems Impact for Geriatric Trauma and Acute Care Surgery
Introduction
Rationale for Geriatric Trauma and Acute Care Surgery
Medical Comorbidities and Surgical Risk
Frailty and Sarcopenia
Cognitive Impairment and Postoperative Delirium
Nutrition
Polypharmacy
Geriatric Vulnerabilities
Care Planning and Shared Decision-Making
Capacity
Surrogates
Palliative Care
Advance Care Planning and Goals of Care
Withdrawing and Withholding Therapy
Care at the End of Life
Geriatric-Specific Prediction Models in Trauma and EGS
Opportunities for Improvements in Geriatric Care
National Quality Programs for Geriatric Patients
Conclusions
References
4: Physiology of Aging
Introduction
Various Issues Specific to the Elderly Population
Frailty
Function
Nutritional Status
Medications/Polypharmacy
Medical Decision-Making in the Elderly Population
Elder Abuse
Neuropsychiatric
Physiology
Clinical Issues
Cardiovascular
Physiology
Clinical Context
Pulmonary
Physiology
Clinical Context
Gastrointestinal
Physiology
Clinical Context
Renal/Volume/Electrolytes
Physiology
Clinical Context
Endocrine
Physiology
Clinical Context
Common Emergency General Surgery Cases
Small Bowel Obstruction
Acute Mesenteric Ischemia
Diverticulitis
Trauma
Falls
Rib Fractures
Traumatic Brain Injury
References
5: Frailty in Geriatric Trauma and Emergency General Surgery
Overview
Frailty in Geriatric Trauma
Measuring Frailty
Association Between Frailty and Outcomes Among Geriatric Trauma Patients
Optimization of Frail Trauma Patients
Frailty in Geriatric Emergency General Surgery
Measuring Frailty
Association Between Frailty and Outcomes Among Geriatric EGS Patients
Optimization of Frail EGS Patients
Geriatric Specialists and Multidisciplinary Care
References
6: Hematologic Changes with Aging
Overview of the Hematologic System