Perioperative Management of Elderly Patients (PriME): Recommendations from an Italian Intersociety Consensus
Aging Clinical & Experimental Research
Aceto, P., Antonelli Incalzi, R., et al. (2020).
Aging Clinical & Experimental Research, 32(9), 1647-1673.
These guidelines, formulated by a 14-member expert task force, provide recommendations for the integrated care of geriatric surgical patients. While the majority of the recommendations are geared toward physicians, a number of recommendations target assessment and/or treatment of swallowing or cognition.
SIAARTI (Italian Society of Anesthesia, Analgesia, Intensive Care and Intensive Care); SIGG (Italian Society of Gerontology and Geriatrics); SIC (Italian Society of Surgery); Society of Geriatric Surgery (SICGe; Italy); AIP (Italian Association of Psychogeriatrics)
"Visual and auditory aids must always be readily available and accessible to the patient, and should be removed only when their use conflicts with other needs" (Grade A Recommendation; Low Evidence, p. 1650)
Post-surgery, "we recommended that swallowing should be evaluated, and the presence of oral lesions excluded in patients with signs and symptoms of dysphagia or a history of aspiration pneumonia" (Grade A Recommendation; Moderate Evidence, p. 1652). Additionally, "we suggest that all older patients are seated during meals and for an hour after eating" (Grade B Recommendation; Moderate Evidence, p. 1652).
"We recommend cognitive assessment (e.g., Clock test, [Abbreviated Mental Test] AMT, and [Mini-Mental State Examination] MMSE) of all patients aged >65 years, even in the absence of a history of cognitive decline" as well as "second-level specialist neurocognitive assessment for patients with pathological test scores" (Grade A Evidence; Moderate Quality, p. 1650).
