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33 - Management of the surgical patient with dementia

Published online by Cambridge University Press:  12 January 2010

By
Madhav Thambisetty ,
James J. Lah  and
Allan I. Levey
Edited by
Michael F. Lubin ,
Robert B. Smith ,
Thomas F. Dodson ,
Nathan O. Spell  and
H. Kenneth Walker
Madhav Thambisetty
Affiliation:
MRC Centre for Neurodegenerative Research Institute of Psychiatry at the Maudsley King's College, London, UK
James J. Lah
Affiliation:
Wesley Woods Center, Atlanta, GA
Allan I. Levey
Affiliation:
Emory University School of Medicine, Atlanta, GA
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Robert B. Smith
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Nathan O. Spell
Affiliation:
Emory University, Atlanta
H. Kenneth Walker
Affiliation:
Emory University, Atlanta
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Summary

Introduction

Aging and dementia: magnitude of the problem

Health problems affecting an aging population constitute a major public health concern. Management of the elderly in the hospital, particularly those with cognitive impairment in need of surgery, represents a major challenge. These individuals often have multiple medical problems, and are susceptible to superimposed complications such as delirium that increase hospital stay and further increase risk. In the year 2000, the US census recorded 35.0 million people over the age of 65 years in this country. The proportion of the population aged 65 years and older is estimated to be more than 12% of the population. It is also estimated that the group aged 85 years and older is the fastest growing segment of the US population. Moreover, there is a dramatic increase in the incidence of dementia with increasing age. Early studies using review of medical records in the study population reported an incidence of dementia per 1000 person–years to be about 1.6 in the age group 65–69 years, increasing dramatically to 41.4 in the 85–89-year age group. More recent cohort-based studies have reported incidence of dementia from 4.3–7.0 per 1000 person–years in the 65–69-year age group, increasing substantially to 54–118 in the 85–89-year age group. A significant number of persons with dementia are often unrecognized by physicians in a primary care setting. Moreover, the prevalence of dementia in hospitalized patients is considerably higher and has been estimated at 12% to 20%.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 411 - 422
Publisher: Cambridge University Press
Print publication year: 2006

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