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Yaşlı Cerrahi Hastaları ve Kırılganlık Sendromu

Year 2023, , 49 - 62, 29.04.2023
https://doi.org/10.47115/jshs.1118004

Abstract

Günümüzde yaşlı nüfusun artmasına paralel olarak yaşlı popülasyonda cerrahi
prosedürlerin oranı giderek artmaktadır. Yaşlı sayısındaki artışa paralel olarak
kırılganlık oranlarının da artış göstereceği ve ameliyat için başvuran kırılgan hasta
sayısının da artacağı beklenmektedir. Kırılganlık, birden fazla organ sisteminde
fizyolojik rezerv ve işlevdeki azalmadan kaynaklanan artan bir savunmasızlık durumudur.
Kırılgan bireyin stres faktörlerine dayanma yeteneği bozulur. Olumsuz
sağlık olayları ve ameliyat sonrası kötü sonuçlarla ilişkisi nedeniyle kırılganlık
cerrahide önemli bir konudur. Cerrahi süreç yaşlı hastaların çoğunda ameliyat
sonrası komplikasyonlara ve iyileşme durumlarında bozulmaya neden olurken,
kırılgan yaşlı hastalarda bu durum daha da önemlidir. Bu nedenle, ameliyat öncesi
dönemde hasta merkezli ve multidisipliner bir yaklaşımla kapsamlı bir geriatrik
değerlendirme yapılması önerilir. Ayrıca diğer bir önemli konuda, kırılganlığın erken
evrede tespit edildiğinde tersine çevrilebilen bir durum olmasıdır. Bu nedenle,
hemşirelerin ve diğer sağlık çalışanlarının kırılgan veya kırılganlık öncesi yaşlıyı
tespit etmeleri ve bu konuya yönelik önlemler almaları oldukça önemlidir. Kırılganlığın
tespitinde güvenilirliği kanıtlanmış birçok tarama testi, değerlendirme ve
ölçümler kullanılır. Bu derlemede, kırılganlık, risk faktörleri, özellikleri, değerlendirme
yöntemleri, cerrahi süreçte kırılganlığın etkileri ve kırılgan bireylerin yönetimine
ilişkin önerilere yer verilmiştir.

Supporting Institution

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Project Number

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Thanks

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References

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  • Abizanda, P., Romero L., Sanchez-Jurado, P.M., Martinez-Reig, M., AlfonsoSilguero, S.A. & Rodriguez-Manas, L. (2014). Age, Frailty, Disability, Institutionalization, 59 Multimorbidity or Comorbidity. Which are the main targets in older adults? J Nutr Health Aging, 18(6), 622-7.
  • Akın, S., Mazıcıoglu, M.M., Mucuk, S., Gocer, S., Deniz Şafak, E., Arguvanlı, S., et al. (2015). The Prevalence of Frailty and Related Factors In Community-Dwelling Turkish Elderly According To Modified Fried Frailty Index and FRAIL Scales. Aging Clin Exp Res, 27(5), 703–9.
  • Alkan, Ş.B.& Rakıcıoğlu, N. (2019). Kırılgan Yaşlılarda Beslenme. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi, 10(2), 184-18.
  • Amrock, L.G. & Deiner, S. (2014). Perioperative Frailty. Int Anesthesiol Clin, 52(4), 26-41.
  • Arslan, M., Keskin Arslan, E., Koç, E.M., Sözmen, M.K.& Kaplan, Y.C. (2020). Altmış Beş Yaş ve Üzeri Kişilerde Kırıl¬ganlık ile İlaç Kullanımı ve Polifarmasi Arasındaki İlişki. Med Bull Haseki, 58, 33-41.
  • Arslan, M., Koç, E.M.& Sözmen, M.K. (2018). The Turkish Adaptation of the Tilburg Frailty Indicator: A Validity and Reliability Study. Turkish Journal of Geriatrics, 21(2), 173-183.
  • Barnett, S.R. (2019). Preoperative assessment of older adults. Anesthesiol Clin, 37, 423–36.
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  • Bollwein, J., Volkert, D., Diekmann, R., Kaiser, M.J., Uter, W., Vidal, K., Sieber, C.C. & Bauer, J.M. (2013). Nutritional Status According to The Mini Nutritional Assessment (MNA(R)) and Frailty In Community Dwelling Older Persons: A Close Relationship. J Nutr Health Aging, 17(4), 351-6.
  • Boreskie, K.F., Hay, J.L., Boreskie, P.E., Arora, R.C. &Duhamel, T.A. (2022). Frailty-aware care: giving value to frailty assessment across different healthcare settings. BMC Geriatr, 22(1), 13.
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  • Chan, P.S., Ip, K.Y.& Irwin, M.G. (2019). Peri‐operative Optimisation of Elderly and Frail Patients: A Narrative Review. Anaesthesia, 74(1), 80-89.
  • Chen X, G Mao & SX Leng (2014). Frailty Syndrome: An Overview. Clinical interventions in aging, 9, 433. Clegg, A., Young, J., Iliffe, S., Rikkert, M.O., Rockwood, K. (2013). Frailty In Elderly People. Lancet, 381(9868), 752-62.
  • Collard, R.M., Boter, H., Schoevers, R.A.& Oude Voshaar, R.C. (2012). Prevalence of Frailty in Community-dwelling Older Persons: A Systematic Review. J Am Geriatr Soc, 60(8), 1487-1492.
  • De vries, N.M., Staal, J.B., van Ravensberg, C.D., Hobbelen, J.S., Olde Rikkert, M.G., Nijhuis-van der Sanden, M.W. (2011), Outcome instruments to measure frailty: a systematic review. Ageing Res Rev, 10(1), 104-14.
  • Dent, E., Lien, C., Lim, W.S., Wong, W.C., Wong, C.H., Ng, T.P., et al. (2017). The Asia-Pacific Clinical Practice Guidelines for The Management of Frailty. J Am Med Dir Assoc, 18(7), 564-575.
  • Düzgün, G., Üstündağ, S.& Karadakovan, A. (2021). Assessment of Frailty in The Elderly. Florence Nightingale J Nurs, 29(1), 2-8.
  • Eyıgör, S. (2012). Düşmelere Yaklaşım. Ege Tıp Dergisi, 51,43-51.
  • Eyigor, S., Kutsal, Y.G., Duran, E., Huner, B., Paker, N., Durmus, B. et al. (2015). Turkish Society of Physical Medicine and Rehabilitation, Geriatric Rehabilitation Working Group. Frailty prevalence and related factors in the older adult-FrailTURK Project. Age (Dordr), 37(3), 9791.
  • Feng, Z., Lugtenberg, M., Franse, C., et al. (2017). Risk Factors and Protective Factors Associated with Incident or Increase of Frailty Among Community-Dwelling Older Adults: A Systematic Review of Longitudinal Studies. PLoS One, 12(6), e0178383.
  • Gondal, A.B., Hsu, C.H., Zeeshan, M., Hamidi, M., Joseph, B.& Ghaderi, I. (2019). A frailty Index andTthe Impact of Frailty on Postoperative Outcomes in Older Patients After Bariatric Surgery. Surgery for Obesity and Related Diseases, 15(9), 1582-1588.
  • Graham, A. & Brown, C.H. (20179. 4th. Frailty, Aging, and Cardiovascular Surgery. Anesth Analg, 124(4), 1053-1060.
  • Guideline for Perioperative Care for People Living with Frailty Undergoing Elective and Emergency Surgery, 2021. https://www.cpoc.org.uk/sites/cpoc/files/documents/2021-09/CPOC-BGS-Frailty-Guideline-2021.pdf
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  • Hoover, M., Rotermann, M., Sanmartin, C.& Bernier, J. (2013). Validation of An Index to Estimate The Prevalence of Frailty Among Community-Dwelling Seniors. Health Reports, 24(9), 10-17.
  • Kapucu, S., Akyar, İ., Korkmaz, F. (20189. Pearson Hemşirelik Tanıları El Kitabı, 11.Basım, Pelikan yayınevi, Ankara
  • Kapucu, S.& Ünver, G. (2017). Kırılgan Yaşlı ve Hemşirelik Bakımı, Osmangazi Tıp Dergisi, 39, 122-129.
  • Kesimci, E. (2019). Kalp Cerrahisinde Yaş ve Frailite. GKDA Derg, 25(4), 223-228.
  • Khadaroo, R.G., Warkentin, L.M., Wagg, A.S., Padwal, R.S., Clement, F., Wang, X., Buie, W.D.& Holroyd-Leduc, J. (2020). Clinical Effectiveness of the Elder-Friendly Approaches to the Surgical Environment Initiative in Emergen¬cy General Surgery. JAMA Surg, 155(4), e196021.
  • Kurkcu, M., Meijer, R.I., Lonterman, S., Muller, M. & De van der Schueren, M.A.E. (2018). The Association Between Nut¬ritional Status and Frailty Characteristics Among Geriatric Outpatients. Clinical nutrition ESPEN, 23, 112-116.
  • Kweh, B.T.S., Lee, H.Q., Tan, T., Tew, K.S., Leong, R., Fitzgerald, M., et al. (2021). Risk Stratification of Elderly Patients Undergoing Spinal Surgery Using the Modified Frailty Index. Global Spine J, 22, 2192568221999650.
  • Lee, H., Lee, E.& Jang, I.Y. (2020). Frailty and Comprehensive Geriatric Assessment. J Korean Med Sci, 35(3), e16.
  • Levers, M.J., Estabrooks, C.A., Ross Kerr, J.C. (2006). Factors contributing to frailty: literature review. Journal of Advanced Nursing, 56(3), 282-291.
  • Lin, H.S., Watts, J.N., Peel, N.M. & Hubbard, R.E. (2016). Frailty and Post-Operative Outcomes in Older Surgical Patients: A Systematic Review. BMC Geriatrics, 16(1), 157.
  • McGuckin, D.G., Mufti, S., Turner, D.J., Bond, C.& Moonesinghe, S.R. (2018). The Association of Peri-operative Scores, Including Frailty, with Outcomes After Unscheduled Surgery. Anaesthesia, 73(7), 819-824.
  • Morley, J.E., Argiles, J.M., Evans, W.J., Bhasin, S., Cella, D., Deutz, N.E., et al. (2010). Society for Sarcopenia, Cachexia, and Wasting Disease. Nutritional recommendations for the management of sarcopenia. J Am Med Dir Assoc, 11, 391-6.
  • Mosquera, C., Spaniolas, K. & Fitzgerald, T.L. (2016). Impact of Frailty on Surgical Outcomes: The Right Patient For The Right Procedure. Surgery, 160(2), 272-80.
  • O’Caoimh, R., Sezgin, D., O’Donovan, M.R., Molloy, D.W., Clegg, A., Rockwood, K.& Liew, A. (2021). Prevalence of fra¬ilty in 62 countries across the world: a systematic review and meta-analysis of population-level studies, Age and Ageing, 50(1), 96–104.
  • Özdemir, S., Öztürk, Z.A., Türkbeyler, İ.H., Şirin, F.& Göl, M. (2017). Klinikte Yatan Geriatrik Hastalarda Farklı Ölçekler Kullanılarak Kırılganlık Prevalansının Belirlenmesi. KSU Medical Journal, 12(3), 1-5.
  • Pala, F.& Yalçın Gürsoy, M. (2020). Türkiye’de Yaşlı Kırılganlığını Konu Alan Araştırmalar: Sistematik Bir İnceleme. J. Akgöl (ed.). Farklı Boyutlarıyla Sağlık, Rating Academy Ar-Ge Yazılım Yayıncılık, Çanakkale, 67-75.
  • Palmer, K., Vetrano, D.L., Marengoni, A., Tummolo, A.M., Villani, E.R., Acampora, N. et al. (2018). The relationship between anaemia and frailty: a systematic review 43 and meta-analysis of observational studies. The Journal of Nutrition, Health & Aging, 22(8), 965-974.
  • Schlitzkus, L.L., Melin, A.A., Johanning, J.M.& Schenarts, P.J. (2015). Perioperative management of elderly patients. The Surgical Clinics of North America, 95(2), 391–415.
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ELDERLY SURGERY PATIENTS AND FRAILTY SYNDROME

Year 2023, , 49 - 62, 29.04.2023
https://doi.org/10.47115/jshs.1118004

Abstract

Today, in parallel with the increase in the elderly population, the rate of surgical
procedures in the elderly population is increasing. As many parts of the world
experience the demographic trend towards aging, fragility is becoming an increasingly
important issue. It is expected that frailty rates will increase in parallel with
the increase in the number of elderly people, and the number of fragile patients
who apply for surgery will also increase. Frailty is a state of increased vulnerability
that results from decreased physiological reserve and function in multiple organ
systems. The fragile individual’s ability to withstand stress factors is impaired. Frailty
is an important issue in surgery because of its association with adverse health events
and poor postoperative outcomes. While the surgical process causes post-operative
complications and deterioration in recovery in most elderly patients, this is even
more important in frail elderly patients. Therefore, a comprehensive geriatric evaluation
with a patient-centered and multidisciplinary approach is recommended in
the preoperative period. Another important issue is that vulnerability is reversible
when detected at an early stage. For this reason, it is very important for nurses and
other health professionals to identify the frail or pre-frail elderly and take precautions
for this issue. Many screening tests, evaluations and measurements with proven
reliability are used in the detection of frailty. In this review, frailty, risk factors,
characteristics, evaluation methods, the effects of frailty in the surgical process and
recommendations for the management of frail individuals are included

Project Number

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References

  • Aktaş, A., Aştı, T. A., Bakanoğlu, E., & Çelebioğlu, M. (2010). Determination of The Body Image Perception of A Nursing College Students. Florence Nightingale Nursing Journal, 18(2), 63-71. https://doi.org/10.17672/ fnhd.20903.
  • Abizanda, P., Romero L., Sanchez-Jurado, P.M., Martinez-Reig, M., AlfonsoSilguero, S.A. & Rodriguez-Manas, L. (2014). Age, Frailty, Disability, Institutionalization, 59 Multimorbidity or Comorbidity. Which are the main targets in older adults? J Nutr Health Aging, 18(6), 622-7.
  • Akın, S., Mazıcıoglu, M.M., Mucuk, S., Gocer, S., Deniz Şafak, E., Arguvanlı, S., et al. (2015). The Prevalence of Frailty and Related Factors In Community-Dwelling Turkish Elderly According To Modified Fried Frailty Index and FRAIL Scales. Aging Clin Exp Res, 27(5), 703–9.
  • Alkan, Ş.B.& Rakıcıoğlu, N. (2019). Kırılgan Yaşlılarda Beslenme. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi, 10(2), 184-18.
  • Amrock, L.G. & Deiner, S. (2014). Perioperative Frailty. Int Anesthesiol Clin, 52(4), 26-41.
  • Arslan, M., Keskin Arslan, E., Koç, E.M., Sözmen, M.K.& Kaplan, Y.C. (2020). Altmış Beş Yaş ve Üzeri Kişilerde Kırıl¬ganlık ile İlaç Kullanımı ve Polifarmasi Arasındaki İlişki. Med Bull Haseki, 58, 33-41.
  • Arslan, M., Koç, E.M.& Sözmen, M.K. (2018). The Turkish Adaptation of the Tilburg Frailty Indicator: A Validity and Reliability Study. Turkish Journal of Geriatrics, 21(2), 173-183.
  • Barnett, S.R. (2019). Preoperative assessment of older adults. Anesthesiol Clin, 37, 423–36.
  • Beğer, T. &Yavuzer, H. (2012). Yaşlılık ve Yaşlılık Epidemiyolojisi. Klinik Gelişim Dergisi, 25(3), 1-3.
  • Bollwein, J., Volkert, D., Diekmann, R., Kaiser, M.J., Uter, W., Vidal, K., Sieber, C.C. & Bauer, J.M. (2013). Nutritional Status According to The Mini Nutritional Assessment (MNA(R)) and Frailty In Community Dwelling Older Persons: A Close Relationship. J Nutr Health Aging, 17(4), 351-6.
  • Boreskie, K.F., Hay, J.L., Boreskie, P.E., Arora, R.C. &Duhamel, T.A. (2022). Frailty-aware care: giving value to frailty assessment across different healthcare settings. BMC Geriatr, 22(1), 13.
  • Canbolat Seyman, Ç. (2021). Kırılganlık, Sarkopeni ve Düşmeler. Yaşlı Hastalarda Hemşirelik Bakım ve Yönetimine Genel Bakış. Kırılganlık Kırığında Hemşirelik-Ortogeriatrik Hastalarda Bütüncül Bakım ve Yönetim Kitabı, Ankara,15-26.
  • Cesari, M., Calvani, R.& Marzetti, E. (2017). Frailty In Older Persons. Clin Geriat Med, 33, 293–303.
  • Chan, P.S., Ip, K.Y.& Irwin, M.G. (2019). Peri‐operative Optimisation of Elderly and Frail Patients: A Narrative Review. Anaesthesia, 74(1), 80-89.
  • Chen X, G Mao & SX Leng (2014). Frailty Syndrome: An Overview. Clinical interventions in aging, 9, 433. Clegg, A., Young, J., Iliffe, S., Rikkert, M.O., Rockwood, K. (2013). Frailty In Elderly People. Lancet, 381(9868), 752-62.
  • Collard, R.M., Boter, H., Schoevers, R.A.& Oude Voshaar, R.C. (2012). Prevalence of Frailty in Community-dwelling Older Persons: A Systematic Review. J Am Geriatr Soc, 60(8), 1487-1492.
  • De vries, N.M., Staal, J.B., van Ravensberg, C.D., Hobbelen, J.S., Olde Rikkert, M.G., Nijhuis-van der Sanden, M.W. (2011), Outcome instruments to measure frailty: a systematic review. Ageing Res Rev, 10(1), 104-14.
  • Dent, E., Lien, C., Lim, W.S., Wong, W.C., Wong, C.H., Ng, T.P., et al. (2017). The Asia-Pacific Clinical Practice Guidelines for The Management of Frailty. J Am Med Dir Assoc, 18(7), 564-575.
  • Düzgün, G., Üstündağ, S.& Karadakovan, A. (2021). Assessment of Frailty in The Elderly. Florence Nightingale J Nurs, 29(1), 2-8.
  • Eyıgör, S. (2012). Düşmelere Yaklaşım. Ege Tıp Dergisi, 51,43-51.
  • Eyigor, S., Kutsal, Y.G., Duran, E., Huner, B., Paker, N., Durmus, B. et al. (2015). Turkish Society of Physical Medicine and Rehabilitation, Geriatric Rehabilitation Working Group. Frailty prevalence and related factors in the older adult-FrailTURK Project. Age (Dordr), 37(3), 9791.
  • Feng, Z., Lugtenberg, M., Franse, C., et al. (2017). Risk Factors and Protective Factors Associated with Incident or Increase of Frailty Among Community-Dwelling Older Adults: A Systematic Review of Longitudinal Studies. PLoS One, 12(6), e0178383.
  • Gondal, A.B., Hsu, C.H., Zeeshan, M., Hamidi, M., Joseph, B.& Ghaderi, I. (2019). A frailty Index andTthe Impact of Frailty on Postoperative Outcomes in Older Patients After Bariatric Surgery. Surgery for Obesity and Related Diseases, 15(9), 1582-1588.
  • Graham, A. & Brown, C.H. (20179. 4th. Frailty, Aging, and Cardiovascular Surgery. Anesth Analg, 124(4), 1053-1060.
  • Guideline for Perioperative Care for People Living with Frailty Undergoing Elective and Emergency Surgery, 2021. https://www.cpoc.org.uk/sites/cpoc/files/documents/2021-09/CPOC-BGS-Frailty-Guideline-2021.pdf
  • Günel, B.& Özşaker, E. (2021). Nöroşirurji Kliniğinde Yatan Yaşlı Hastaların Kırılganlık Düzeyi Ile Iyileşme Kalitesi Arasındaki İlişkinin Incelenmesi. Ege Üniversitesi Sağlık bilimleri Enstitüsü, Yayınlanmamış Yüksek Lisans Tezi, İzmir.
  • Hoover, M., Rotermann, M., Sanmartin, C.& Bernier, J. (2013). Validation of An Index to Estimate The Prevalence of Frailty Among Community-Dwelling Seniors. Health Reports, 24(9), 10-17.
  • Kapucu, S., Akyar, İ., Korkmaz, F. (20189. Pearson Hemşirelik Tanıları El Kitabı, 11.Basım, Pelikan yayınevi, Ankara
  • Kapucu, S.& Ünver, G. (2017). Kırılgan Yaşlı ve Hemşirelik Bakımı, Osmangazi Tıp Dergisi, 39, 122-129.
  • Kesimci, E. (2019). Kalp Cerrahisinde Yaş ve Frailite. GKDA Derg, 25(4), 223-228.
  • Khadaroo, R.G., Warkentin, L.M., Wagg, A.S., Padwal, R.S., Clement, F., Wang, X., Buie, W.D.& Holroyd-Leduc, J. (2020). Clinical Effectiveness of the Elder-Friendly Approaches to the Surgical Environment Initiative in Emergen¬cy General Surgery. JAMA Surg, 155(4), e196021.
  • Kurkcu, M., Meijer, R.I., Lonterman, S., Muller, M. & De van der Schueren, M.A.E. (2018). The Association Between Nut¬ritional Status and Frailty Characteristics Among Geriatric Outpatients. Clinical nutrition ESPEN, 23, 112-116.
  • Kweh, B.T.S., Lee, H.Q., Tan, T., Tew, K.S., Leong, R., Fitzgerald, M., et al. (2021). Risk Stratification of Elderly Patients Undergoing Spinal Surgery Using the Modified Frailty Index. Global Spine J, 22, 2192568221999650.
  • Lee, H., Lee, E.& Jang, I.Y. (2020). Frailty and Comprehensive Geriatric Assessment. J Korean Med Sci, 35(3), e16.
  • Levers, M.J., Estabrooks, C.A., Ross Kerr, J.C. (2006). Factors contributing to frailty: literature review. Journal of Advanced Nursing, 56(3), 282-291.
  • Lin, H.S., Watts, J.N., Peel, N.M. & Hubbard, R.E. (2016). Frailty and Post-Operative Outcomes in Older Surgical Patients: A Systematic Review. BMC Geriatrics, 16(1), 157.
  • McGuckin, D.G., Mufti, S., Turner, D.J., Bond, C.& Moonesinghe, S.R. (2018). The Association of Peri-operative Scores, Including Frailty, with Outcomes After Unscheduled Surgery. Anaesthesia, 73(7), 819-824.
  • Morley, J.E., Argiles, J.M., Evans, W.J., Bhasin, S., Cella, D., Deutz, N.E., et al. (2010). Society for Sarcopenia, Cachexia, and Wasting Disease. Nutritional recommendations for the management of sarcopenia. J Am Med Dir Assoc, 11, 391-6.
  • Mosquera, C., Spaniolas, K. & Fitzgerald, T.L. (2016). Impact of Frailty on Surgical Outcomes: The Right Patient For The Right Procedure. Surgery, 160(2), 272-80.
  • O’Caoimh, R., Sezgin, D., O’Donovan, M.R., Molloy, D.W., Clegg, A., Rockwood, K.& Liew, A. (2021). Prevalence of fra¬ilty in 62 countries across the world: a systematic review and meta-analysis of population-level studies, Age and Ageing, 50(1), 96–104.
  • Özdemir, S., Öztürk, Z.A., Türkbeyler, İ.H., Şirin, F.& Göl, M. (2017). Klinikte Yatan Geriatrik Hastalarda Farklı Ölçekler Kullanılarak Kırılganlık Prevalansının Belirlenmesi. KSU Medical Journal, 12(3), 1-5.
  • Pala, F.& Yalçın Gürsoy, M. (2020). Türkiye’de Yaşlı Kırılganlığını Konu Alan Araştırmalar: Sistematik Bir İnceleme. J. Akgöl (ed.). Farklı Boyutlarıyla Sağlık, Rating Academy Ar-Ge Yazılım Yayıncılık, Çanakkale, 67-75.
  • Palmer, K., Vetrano, D.L., Marengoni, A., Tummolo, A.M., Villani, E.R., Acampora, N. et al. (2018). The relationship between anaemia and frailty: a systematic review 43 and meta-analysis of observational studies. The Journal of Nutrition, Health & Aging, 22(8), 965-974.
  • Schlitzkus, L.L., Melin, A.A., Johanning, J.M.& Schenarts, P.J. (2015). Perioperative management of elderly patients. The Surgical Clinics of North America, 95(2), 391–415.
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There are 50 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Review
Authors

Esma Özşaker 0000-0002-4878-1841

Project Number -
Early Pub Date April 29, 2023
Publication Date April 29, 2023
Submission Date May 17, 2022
Published in Issue Year 2023

Cite

APA Özşaker, E. (2023). Yaşlı Cerrahi Hastaları ve Kırılganlık Sendromu. Samsun Sağlık Bilimleri Dergisi, 8(1), 49-62. https://doi.org/10.47115/jshs.1118004
AMA Özşaker E. Yaşlı Cerrahi Hastaları ve Kırılganlık Sendromu. JSHS. April 2023;8(1):49-62. doi:10.47115/jshs.1118004
Chicago Özşaker, Esma. “Yaşlı Cerrahi Hastaları Ve Kırılganlık Sendromu”. Samsun Sağlık Bilimleri Dergisi 8, no. 1 (April 2023): 49-62. https://doi.org/10.47115/jshs.1118004.
EndNote Özşaker E (April 1, 2023) Yaşlı Cerrahi Hastaları ve Kırılganlık Sendromu. Samsun Sağlık Bilimleri Dergisi 8 1 49–62.
IEEE E. Özşaker, “Yaşlı Cerrahi Hastaları ve Kırılganlık Sendromu”, JSHS, vol. 8, no. 1, pp. 49–62, 2023, doi: 10.47115/jshs.1118004.
ISNAD Özşaker, Esma. “Yaşlı Cerrahi Hastaları Ve Kırılganlık Sendromu”. Samsun Sağlık Bilimleri Dergisi 8/1 (April 2023), 49-62. https://doi.org/10.47115/jshs.1118004.
JAMA Özşaker E. Yaşlı Cerrahi Hastaları ve Kırılganlık Sendromu. JSHS. 2023;8:49–62.
MLA Özşaker, Esma. “Yaşlı Cerrahi Hastaları Ve Kırılganlık Sendromu”. Samsun Sağlık Bilimleri Dergisi, vol. 8, no. 1, 2023, pp. 49-62, doi:10.47115/jshs.1118004.
Vancouver Özşaker E. Yaşlı Cerrahi Hastaları ve Kırılganlık Sendromu. JSHS. 2023;8(1):49-62.

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