Weight loss surgery in the elderly: is this the future

The UK population is ageing rapidly, and the proportion of people living with obesity is increasing. Obesity is a risk factor for diabetes, coronary artery disease, stroke and cancer. Older patients are admitted for obesity related complications at a similar rate compared to younger patients. However, the operations for people over 70-years are extremely infrequent. In this scoping review we summarize the recent data on bariatric operations in people over 70-years and the possible risk benefit ratio of bariatric surgery for this population

Major trauma in the elderly: Frailty decline and patient experience after injury

Introduction The prevalence of major trauma in the elderly is increasing with ageing western societies. Frailty is now a well-recognised predictor of poor outcome after injury; however, few studies have focused on the progression of frailty and patients’ perceptions of their injuries after discharge. Aim We hypothesised that the number of elderly patients that survive major trauma is low and, of those that do, frailty post injury worsens with overall negative views about quality of life. To investigate this, we examined mortality, frailty and patient experience for elderly major trauma admissions to a level 1 trauma centre at one year after admission. Method All consecutive patients > 75 with an injury severity score of > 15 were included in the study. Patients were invited to participate in a structured telephone interview to assess change in frailty status as well as assess patient experience after injury. Results A total of 79 patients met inclusion criteria; 34 patients had died and 17 were uncontactable; 88% had become more frail (p < 0.05), and more than half commented positively on their overall quality of life following injury. Conclusions These findings highlight the elevated mortality in elderly major trauma patients, but also indicate that preconceived opinions on quality of life, post injury, might not be appropriate

Does the weather contribute to admissions of neck of femur fractures?

Background: The effects of weather on overall mortality are well documented. Anecdotally, icy conditions are perceived to result in more falls and admissions for neck of femur (NOF) fractures. The aim of this pilot study was to determine whether relationships could be extracted or at least not ruled out by analysing a small dataset, and so give impetus to a larger project. Methods: Seven trauma units across North West London were identified and NOF fracture data extracted for five years. Visual inspection of the time series, consideration of the weather on specific days and correlation analysis were used to assess associations between fracture numbers and a variety of weather parameters (temperature, rainfall, wind and ice risk). Results: Overall, 10929 individuals with hip fractures were admitted over the five-year period. The highest number of admissions in a day was 14. No clear association was found between a weather parameter and daily admissions. However, when accumulated to a weekly timescale, a negative relationship with maximum temperature was found. No seasonal cycle was detected. Conclusion: The lack of a daily relationship and presence of a weekly relationship points to a possible delayed response to weather or insufficient daily data to extract a signal. The inconclusive results also indicate a larger data sample is required in future studies. In addition, even in cold weather an urban environment may not create icy conditions, being ameliorated by the heat island effect and gritting

Preventing ocular trauma: national survey of eye injuries in female lacrosse players

Aims: To identify ocular trauma and the sentiments towards the implementation of protective eyewear in female English lacrosse. Methods: Two anonymous retrospective questionnaires were devised, one for women’s lacrosse coaches and players respectively. Surveys were undertaken either anonymously online or in person during national secondary school and university tournaments. Results: Surveys were collected from 648 players and 85 coaches. 157 players reported sustaining an eye injury, 13 of those had long-term adverse consequences on their vision. 46% of coaches and 24% of players, reported ocular injuries involving doctor based care, including specialist units. The majority of coaches (64%) and players (52%) would recommend the implementation of protective eyewear, into English lacrosse. Conclusion: Data collected from this study suggests that ocular injuries, including serious visual loss, occur during lacrosse. The mandatory adoption of ocular protection should be considered in England as a matter of urgency

Perioperative anticoagulation for colorectal cancer patients

Population ageing has substantially contributed to the rising number of new cancer cases worldwide. Fifty percent of new diagnoses of colorectal cancer are made in patients aged over 70 years, and 25% are aged 80 years or over. Older patients present with more co-morbidities and frailty than younger patients. Here we describe the case of a 78-year-old lady with atrial fibrillation (AF) and previous stroke who had a right hemicolectomy for a caecal adenocarcinoma. Unfortunately, whilst off anticoagulation at day 5 post operatively she suffered a catastrophic stroke. For patients requiring surgical management of colorectal carcinoma who are on anticoagulation for AF, bespoke peri-operative planning is required to assess risks and benefits of bridging anticoagulation

Takotsubo cardiomyopathy in elderly female trauma patients - a case series and mini-review

Takotsubo cardiomyopathy is a syndrome characterised by acute left ventricular wall motion abnormalities leading to left ventricular systolic dysfunction. It remains an important differential diagnosis for acute coronary syndrome. For patients requiring surgical management, delays in the diagnosis of Takotsubo cardiomyopathy may lead to postponement of urgent operative management. This delay in surgery likely impacts on length of hospital stay, leading to an increasing morbidity and mortality. Here we describe three cases of Takotsubo cardiomyopathy occurring in three elderly trauma patients and the impact on their clinical course

Nasogastric tube feeding in older patients: a review of current practice and challenges faced

Nasogastric tube feeding is an essential way of delivering enteral nutrition when the oral route is insufficient or unsafe. Malnutrition is recognised as a reversible factor for sarcopenia and frailty. It is therefore crucial that malnutrition is treated in older inpatients who have dysphagia and require enteral nutrition. Despite five National Patient Safety Alerts since 2005, “Never Events” related to nasogastric feeding persist. In addition to placement errors, current practice often leads to delays in feeding, which subsequently result in worse patient outcomes. It is crucial that tube placement is confirmed accurately and in a timely way. Medical advancements in this area have been slow to find a solution which meets this need. In this paper, we provide an updated review on the current use of feeding nasogastric tubes in the older population, the issues associated with confirming correct placement, and innovative solutions for improving safety and outcomes in older patients.