The Elderly Patient with a Hip Fracture

  • Jonathan Halevy

Abstract

A 83-year-old white female was brought to the hospital complaining of left hip pain after falling at home. She had been living alone, ambulating well prior to her admission, and was receiving daily assistance via the Meals on Wheels program in her neighborhood. Past history was significant for hypertension, which was controlled with a “water pill,” and diabetes for which she took chlorpropamide every morning. Previous anesthetic experience included two D&Cs, and a right breast biopsy approximately 50 years ago. All procedures were without anesthetic sequelae. She smoked approximately half a pack of cigarettes per day for many years but had stopped 10 years before. Alcohol use was denied. Review of systems was negative for complaints of chest pain, shortness of breath, or syncope; however, she did report feeling weaker recently.

Keywords

Infective Endocarditis Functional Residual Capacity Anesthetic Drug Sick Sinus Syndrome Closing Volume 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Hospital Mortality, PAS Hospital U.S. 1974–1975. Ann Arbor, Mich., Commission on Professional & Hospital Activities, 1977.Google Scholar
  2. 2.
    Marx G.F., Mateo C.V., Orkin L.: Computer analysis of postanesthetic deaths. Anesthesiology 59: 54–8, 1973.CrossRefGoogle Scholar
  3. 3.
    Wilson L.A., Lawson I.R., Porass W.: Multiple disorders in the elderly. A clinical and statistical study. Lancet 2:841–3, 1962.PubMedCrossRefGoogle Scholar
  4. 4.
    Evans T.I.: The physiological basis of geriatric general anesthesia. Anesth Intensive Care 1:319–22, 1973.Google Scholar
  5. 5.
    Bay J., Nunn J.F., Prys-Roberts C.: Factors influencing arterial P02 during recovery from general anesthesia. Br J Anaesth 40:398–407, 1968.PubMedCrossRefGoogle Scholar
  6. 6.
    Engquist A., Backer O.G., Jarnum S.: Incidence of postoperative complications in patient subjected to surgery under steroid cover. Acta Chir Scand 140:343, 1974.PubMedGoogle Scholar
  7. 7.
    Rowe J.W., Andres R., Tobin J.D., et al: The effect of age on creatinine clearances in man-a cross sectional and longitudinal study. J Gerontol 31: 155–63, 1976.PubMedGoogle Scholar
  8. 8.
    D’Hollander A., Massaux F., Nevelsteen M., et al: Age-dependent doseresponse relationship of ORG-NC45 in anesthetized patients. Br J Anaesth 54:653–7, 1982.PubMedCrossRefGoogle Scholar
  9. 9.
    Thompson E.N., William R.: Effect of age on liver function with particular reference to bromsulphtalein excretion. Gut 6: 266–9, 1965.PubMedCrossRefGoogle Scholar
  10. 10.
    Lytle L.D., Altar A.: Diet, central nervous system, and aging. Fed Proc 38:2017–22, 1979.PubMedGoogle Scholar
  11. 11.
    Fujishima M., Sadoshima S., Ogatha J., et al: Autoregulation of CBF in young and aged spontaneously hypertensive rats (SHR). Gerontology 30:30–6, 1984.PubMedCrossRefGoogle Scholar
  12. 12.
    Pontoppidan H., Beecher H.K.: Progressive loss of protective reflexes in the airway with advance of age. JAMA 174: 2209–13, 1960.PubMedGoogle Scholar
  13. 13.
    Wahba W.M.: Influence of aging on lung function-clinical significance of changes from age 20. Anesth Analg 62: 764–76, 1983.PubMedCrossRefGoogle Scholar
  14. 14.
    Kronenberg R.S., Drage G.W.: Attenuation of the ventilatory and heart rate responses to hypoxia and hypercapnia with aging in normal men. J Clin Invest 52: 1812–9, 1973.PubMedCrossRefGoogle Scholar
  15. 15.
    Martin A.: Cardiac rhythms in healthy elderly patients, in Coodley E.L. (ed), Geriatric Heart Disease. Littleton, Mass., PGS Publishing, 1985, pp 20–30.Google Scholar
  16. 16.
    Port S., Cobb F.R., Coleman R.E., et al: Effect of age on the response of the ventricular ejection to exercise. N Engl J Med 303: 1133–7, 1980.PubMedCrossRefGoogle Scholar
  17. 17.
    Lakatta E.G., Yin F.C.P.: Myocardial aging: Function alterations and related cellular mechanisms. Am J Physiol 242:H927–41, 1982.PubMedGoogle Scholar
  18. 18.
    Fisch C.: Electrocardiogram in the aged: An independent marker of heart disease. AM J Med 70: 4–6, 1981.PubMedCrossRefGoogle Scholar
  19. 19.
    Pomerance A.: Cardiac pathology in the elderly. Cardiovasc Clin 12(1): 5–9, 1981.Google Scholar
  20. 20.
    Del Guercio R.M., Cohn J.D.: Monitoring operative risk in the elderly. JAMA 243:1350–5, 1980.PubMedCrossRefGoogle Scholar
  21. 21.
    Hurwitz N.: Predisposing factors in adverse reactions to drugs. Br Med J 1:536–9, 1969.PubMedCrossRefGoogle Scholar
  22. 22.
    Chein C.P., Towsend E.J., Ross-Towsend A.: Substance use and abuse among the community elderly: The medical aspect. Addict Dis 3: 337–56, 1978.Google Scholar
  23. 23.
    Nagashima H.: Drug interaction in the recovery room, in Frost E., Andrews I.C. (eds): Recovery Room Care. International Anesthesia. Clinics, Boston, Little Brown, 1983, pp 93–106.Google Scholar
  24. 24.
    Thompson T.L. II, Moran M.G., Nies A.S.: Psychotropic drug use in the elderly (Part 1). N Engl J Med 308: 134–8, 1983.PubMedCrossRefGoogle Scholar
  25. 25.
    Dagnino J., Prys-Roberts C.: Anesthesia in the aged hypertensive patient, in Stephen C.R., Assaf R.A.E. (eds): Geriatric Anesthesia. Boston, Butterworth Publishing Co, 1986, p 264.Google Scholar
  26. 26.
    Schmucher D.L.: Alterations in drug disposition, in Stephen C.R., Assaf R.A.E. (eds): Geriatric Anesthesia. Boston, Butterworth Publishing Co, 1986, pp 155–188.Google Scholar
  27. 27.
    Lerman J., Gregory G.A., Willis M.M., et al: Age and solubility of volatile anesthetics in blood. Anesthesiology 61: 139–43, 1984.PubMedCrossRefGoogle Scholar
  28. 28.
    McLaren A.D., Stockwell M.C., Reid V.T.: Anaesthetic techniques for surgical correction of fractured neck of femur. A comparative study of spinal and general anesthesia in the elderly. Anaesthesia 33: 10–4, 1978.PubMedCrossRefGoogle Scholar
  29. 29.
    McKenzie P.J., Wishart H.Y., Smith G.: Longterm outcome after repair of fractured neck of femur. Comparison of subarachnoid and general anesthesia. Br J Anaesth 56: 581–5, 1984.PubMedCrossRefGoogle Scholar

Copyright information

© Birkhäuser Boston 1988

Authors and Affiliations

  • Jonathan Halevy

There are no affiliations available

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