"The Big Three" of geriatrics: A review of perioperative cognitive impairment, frailty and malnutrition.

المقال يركز على "الكبار الثلاثة" في طب الشيخوخة: ضعف الإدراك المحيط بالعمليات الجراحية، والهشاشة، وسوء التغذية، والتي تؤثر بشكل كبير على نتائج الصحة للسكان المسنين. يبرز المقال الزيادة المتزايدة في انتشار هذه الحالات مع تقدم السكان في العمر، حيث تشير التوقعات إلى أن عدد الأفراد الذين تزيد أعمارهم عن 60 عامًا سيتضاعف تقريبًا بحلول عام 2050. يؤكد المؤلفون على ضرورة تقييم الأطباء وإدارة هذه القضايا لدى المرضى الجراحيين لتحسين نتائج العمليات الجراحية وتقليل المراضة والوفيات. على الرغم من وجود أدلة تدعم التدخلات مثل فحص الهشاشة قبل العملية وتحسين التغذية، إلا أن هذه الممارسات لم تُطبق بعد بشكل روتيني في البيئات السريرية. تهدف المراجعة إلى تزويد أطباء التخدير وأطباء العناية المركزة بفهم شامل لهذه التحديات لتعزيز الرعاية للمرضى المسنين. [Extracted from the article]

Cognitive impairment, frailty, and malnutrition are three of the most impactful pathologies facing an aging population, having dramatic effects on morbidity and mortality across nearly all facets of medical care and intervention. By 2050, the World Health Organization estimates that the population of individuals over the age of sixty worldwide will nearly double, and the public health toll of these demographic changes cannot be understated. With these changing demographics comes a need for a sharpened focus on the care and management of this vulnerable population. The average patient presenting for surgery is getting older, and this necessitates that clinicians understand the implications of these pathologies for both their immediate medical care needs and for appropriate procedural selection and prognostication of surgical outcomes. We believe it is incumbent on clinicians to consider the frailty, nutritional status, and cognitive function of each individual patient when offering a surgical intervention, as well as consider interventions that may delay the progression of these pathologies. Unfortunately, despite excellent evidence supporting things like routine pre-operative frailty screening and nutritional optimization, many interventions that would specifically benefit this population still have not been integrated into routine practice. In this review, we will synthesize the existing literature on these topics to provide a pragmatic approach and understanding for anesthesiologists and intensivists faced with this complex population. [ABSTRACT FROM AUTHOR]

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