|LETTER TO EDITOR
|Year : 2023 | Volume
| Issue : 1 | Page : 45-46
Pre-operative evaluation in geriatric patients – Demography does matter
Department of Medicine, KG's Medical University, Lucknow, Uttar Pradesh, India
|Date of Submission||14-Oct-2022|
|Date of Decision||18-Jan-2023|
|Date of Acceptance||08-Feb-2023|
|Date of Web Publication||24-Feb-2023|
Dr. Harish Gupta
Department of Medicine, KG's Medical University, Lucknow - 226 003, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta H. Pre-operative evaluation in geriatric patients – Demography does matter. Curr Med Res Pract 2023;13:45-6
'New @WHO report highlights the increasing use of sophisticated online marketing techniques for alcohol that target young people despite the clear health risks. We call for better enforced and more consistent regulation of alcohol marketing to save and improve young lives worldwide.'
-Dr Tedros Adhanom Ghebreyesus, Director General of World Health Organization, 10 March 2022.
Sharma et al. review pre-operative evaluation in geriatric patients and wonder if we are over-investigating this patient population nowadays in their article published in the Journal on 30th August 2022. Therein they share their working experiences by making online search and thereafter under various headings compile and construct the write up in an easy-to-understand manner. When we are generating a lot of information in the current era at a breakneck speed-some of which may not be correct or appropriate for us-such compositions provide us a refreshing novel perspective and we are indebted to the authors for putting up their efforts in this direction. When absolute as well as relative number of the senior citizens are steadily increasing in this era, we need to pay more attention to their concerns so as to make a fine balance between cost and usefulness while utilising the finite resources to their most productive outcomes.
Nevertheless, there are few points of disagreement too therein and we need to discuss in the spirit of modern-day scientific inquiry. Under a heading of 'Additional Considerations', the researchers write, 'The elderly also are susceptible to substance abuse, such as alcohol consumption. 13% of men and 8% of women over 65 consume at least two alcoholic beverages per day' However, to my experience, it is unusual to admit an elderly female in an inebriated state in my hospital who then coughs up a history of regular alcohol consumption. Various surveys support the contention. Recently, Global Burden of Disease Collaborators published their global analysis of 'Population-level risks of alcohol consumption by amount, geography, age, sex and year: a systematic analysis for the global burden of disease study 2020'.
The study has a Supplementary appendix 2 and therein it has a Figure S1. Figure shows 'Percent of the population consuming harmful amounts of alcohol in excess of the non-drinker equivalence, 2020'. On its page number 37, it has a figure for South Asia and there it shows that females here in India consume alcohol in unsafe amount less frequently than their male counterparts. Therefore, I urge the authors to make necessary corrections in the article on this specific point. Alcohol industry is there to confuse us like the cigarette industry, but by experience earned at indoors, we know what happens at the bedside.
Then under a heading of 'Investigations', the authors enlist investigations and then recommend who should undergo the test/s. There under a point number 7 they advise that electrocardiogram (ECG) strip should be taken not for asymptomatic patients. Moreover, then recommend other group of patients where it should be recorded. Nonetheless, now we assess a sizeable number of diabetic patients on a regular basis and it is a common finding to discover an elderly diabetic who is asymptomatic but on ECG or other tests is found to have silent ischemia. Gazzaruso et al. discover silent coronary artery disease in type 2 diabetes mellitus and analyse the role of lipoprotein (a), homocysteine and apo (a) polymorphism in its causation in their article.
Hernández et al. study the prevalence and risk factors accounting for true silent myocardial ischemia by a pilot case − control study comparing type 2 diabetic with non-diabetic controls. They too find that when they routinely assess diabetic subjects for cardiovascular disease without symptoms, they commonly find it. Hence if we don't make an attempt to find the pathology in this subgroup, we may miss some cases, I suspect. The writers underscore that it (the test) is mandatory in those patients with a history of myocardial infarction.
However, we find several patients without such history in OPD who get an evidence of past myocardial infarction detected in their tracing only after the test-strip is recorded. I am afraid that if we put a bar high to run the simple test routinely conducted by a technician without some sophisticated training on a not-very-costly machine, we may miss some cases which may get complicated on the table or immediately thereafter. Framingham Risk Score provides us a simple tool to calculate a person's near-term risk of having a cardiovascular disease. Hence, a simple message may be given to the beginners-for example-that if you are evaluating an elderly for an operative stress and he is a diabetic and smoker, it will be beneficial to run an ECG.
More are the number of risk factors, higher is the risk and in presence of diabetes mellitus, the disease may remain silent. The point I want to emphasise is that without actively looking for the underground entity, we may overlook them. Purpose of the evaluation is to reduce the number of complications on the table and later on. Moreover, that is possible if we have a wider vision to notice what is obvious and also what is not.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
The Lancet. Measuring the future of humanity for health. Lancet 2022;400:137.
GBD 2020 Alcohol Collaborators. Population-level risks of alcohol consumption by amount, geography, age, sex, and year: A systematic analysis for the global burden of disease study 2020. Lancet 2022;400:185-235.
McKee M. The tobacco industry: The pioneer of fake news. J Public Health Res 2017;6:878.
Gazzaruso C, Garzaniti A, Giordanetti S, Falcone C, Fratino P. Silent coronary artery disease in type 2 diabetes mellitus: The role of lipoprotein (a), homocysteine and apo (a) polymorphism. Cardiovasc Diabetol 2002;1:5.
Hernández C, Candell-Riera J, Ciudin A, Francisco G, Aguadé-Bruix S, Simó R. Prevalence and risk factors accounting for true silent myocardial ischemia: A pilot case-control study comparing type 2 diabetic with non-diabetic control subjects. Cardiovasc Diabetol 2011;10:9.