AGING ANESTHESIOLOGI

STDR. ABRAR AL-RAMYAN

KBA- R3

“ AT TEN, A CHILD; AT TWENTY, WILD; AT THIRTY, TAME, IF EVER; AT FORTY, WISE; AT FIFTY, RICH; AT SIXTY, GOOD OR NEVER”

“ I GROW OLD LEARNING SOMETHING NEW EVERYDAY”

OUTLINE • Age distribution

• Changes with aging

• Concerns

• Pros & cons

• Accommodation

• Solutions

• Examples

Population structure and ageing Data from May 2014. Most recent data: Further Eurostat information, Main tables and Database. Planned article update: May 2015.

 

Population structure and ageing Data from May 2014. Most recent data: Further Eurostat information, Main tables and Database. Planned article update: May 2015.  

CUTOFF POINT? • AGE > 60 YRS ?

• > 65 YRS ?

• > 70 YRS?

Series10%

5%

10%

15%

20%

25% 2013 Canadian survey of anesthesiologist

55-64yrs 65-74yrs >74yrs

22% between 55-64 yrs7% between 65-74yrs3% > 74 yrs

0%

5%

10%

15%

20%

25%

30%

ASA members > 55yrs

1994 2003

1994: 23% ASA members > 55 yrs2003 30% ASA members > 55yrs

In Kuwait ??

0.018

49%

27%

0.125

9%

0.006

20-30 yrs

31-40 yrs

41-50 yrs

51-60 yrs

61-70 yrs

> 70 yrs

6 main governmental hospitals

Total = 167 anesthesiologist

Average age ~ 43.36 yrs

CHANGES WITH AGING

CHANGES WITH AGING

- Decline in fluid intelligence

[ capacity to process information & reason; critical

To analyzing & solving complex problems]

- Reservation of crystallized intelligence

[ cumulative information acquired throughout life & include

Professional expertise & wisdom]

WHY BOTHER ??

Capability and maintenance of skills

Medical errors

Adequate functioning

“ anesthesiologist > 65 yrs in Ontario, Quebec and British Columbia had 50% more cases involving litigations and almost twice the number of cases involving severe patient injuries compared to anesthesiologists < 51 yrs”

- Well balanced clinical skills- Experience- Wisdom- Enhanced capacity for prudence and planning

Pros

- Predictable decrements in mental, physical and behavioral functions- Reduce cognitive function- Reduce ability to perform complex tasks rapidly and to multitasks- Reduces stamina to endure prolonged work rotations.- Increased adverse patient related events Cons

HOW TO ACCOMMODATE CHANGES ??

Stop procedural

work

Allocating more time

to each patient

Using memory

aids

Seeking advice from

trusted colleagues /2nd opinion

POSSIBLE SOLUTIONS

1) MENTAL, COGNITIVE AND EDUCATIONAL EVALUATION

EVALUATION TOOLS• Neuropsychological assessment…. e.g. Addenbrook’s cognitive examination-

revised ( ACE-R)

• Physician practice enhancement program- collage of physicians and surgeons of British Columbia

• physician achievement review in Alabasta

• Mini mental state examination

• PACE program [ physician assessment and clinical education program ]

- Peer review- PREP- SAPetc….

2) NO FURTHER ONCALL DUTIES FOR THOSE >65YRS OLD

3) NO FURTHER HIGH ACUITY PROCEDURES FOR THOSE > 65YRS OLD

4) RETIREMENT FROM OR CLINICAL PRACTICE WITH POSSIBLE CONTINUATION OF NON-OR CLINICAL OR OTHER NON-CLINICAL ACTIVITIES FOR THOSE > 70 YRS

5) SIMULATION TRAINING

@ Formative:

assessment for learning by identification of weakness and deficiencies for correction

@ Summative:

assessment of learning for achievement of an adequate standard of practice

@ Facilitate assessment of crisis resource management

RETIREMENT• Pre-determined age ??

• Fundamental principle: based on individual basis and not age.

• Routine cognitive evaluation of older physician

EXAMPLES

A) VICTORIA HEALTH PROFESSION REGISTRATION ACT 2005 AND ITS PREDECESSOR- THE MEDICAL PRACTICE

ACT 1994

- Preliminary investigations of medical practitioners/ medical students; based on: * Mental and physical health* Presence of incapacity* Alcohol of drug dependence

“RESULTS” - Youger medical practitioners are more likely to be notified to the board because of concerns about substance misuse or psychiatric disease- Older practitioners are more often notified because of concerns about cognitive functioning

From October 1st 2004 to

September 30th 2006, “

cognitive/other” notification made

up 50% of all notification.

OPTIONS AND SOLUTIONS

@ Counselling to consider retirement

@ cognitive problem ? + refusal to retire = for neuropsychiatric assessment

@ No agreed standards to the level of impairment sufficient to warrant suspension

B) PHYSICIAN PATENCY ASSESSMENT PROGRAM BETWEEN 1997-2001

Screening of 45 participants

(1) Physicians performing well = no or mild cognitive impairment

(2) Significant number performing poorly = significant neuro-psychological difficulty

(3) Cognitive impairment was more marked in elderly physicians.

con

clu

sio

n

REFERENCES CAN J ANAESTH. 2014 SEP;61(9):865-875. EPUB 2014 JUL 2.

*THE AGING ANESTHESIOLOGIST: A NARRATIVE REVIEW AND SUGGESTED STRATEGIES.

BAXTER AD1, BOET S, REID D, SKIDMORE G. 

ANESTHESIA & ANALGESIA:

JUNE 2001 - VOLUME 92 - ISSUE 6 - PP 1487-1492

DOI: 10.1097/00000539-200106000-00027

ECONOMICS AND HEALTH SYSTEMS RESEARCH: SPECIAL ARTICLE

* ISSUES OF CONCERN FOR THE AGING ANESTHESIOLOGIST

KATZ, JONATHAN D. MD

REFERENCES

MED J AUST. 2008 DEC 1-15;189(11-12):622-4.

KNOWING - OR NOT KNOWING - WHEN TO STOP: COGNITIVE DECLINE IN AGEING

DOCTORS.

ADLER RG1, CONSTANTINOU C.

ACAD MED. 2006 OCT;81(10):915-8.

COMPETENCE AND COGNITIVE DIFFICULTY IN PHYSICIANS: A FOLLOW-UP STUDY.

TURNBULL J1, CUNNINGTON J, UNSAL A, NORMAN G, FERGUSON B.

REFERENCESJRSM OPEN. 2014 APR 9;5(5):2042533313517687. DOI: 10.1177/2042533313517687. ECOLLECTION 2014.

A RETROSPECTIVE STUDY OF COGNITIVE FUNCTION IN DOCTORS AND DENTISTS WITH

SUSPECTED PERFORMANCE PROBLEMS: AN UNSUSPECTED BUT SIGNIFICANT CONCERN.

KATARIA N1, BROWN N1, MCAVOY P1, MAJEED A2, RHODES M1.

 

AN AOA CRITICAL ISSUE

FUTURE PHYSICIAN WORKFORCE REQUIREMENTS: IMPLICATIONS FOR ORTHOPAEDIC SURGERY EDUCATION

EDWARD S. SALSBERG, MPA; ATUL GROVER, MD, PHD; MICHAEL A. SIMON, MD; STEVEN L. FRICK, MD; MARSHALL A.

KUREMSKY, MD; DAVID C. GOODMAN, MD, MS

J BONE JOINT SURG AM, 2008 MAY 01;90(5):1143-1159. HTTP://DX.DOI.ORG/10.2106/JBJS.G.01305

POPULATION STRUCTURE AND AGEING

DATA FROM MAY 2014. MOST RECENT DATA: FURTHER EUROSTAT INFORMATION, MAIN TABLES AND DATABASE.

PLANNED ARTICLE UPDATE: MAY 2015.

REFERENCES • UC SAN DIEGO PACE PROGRAM LECTURES:

• PRACTICING MEDICINE LONGER: AGING PHYSICIAN POPULATION/

NEURPPSYCHOLOGICAL PERSPECTIVES. DR. WILLIAM PERRY – PHD

• QUEBEC AND ONTARIO EXPERIENCE. DR. WILLIAM MCCAULY, MD-CPSO

THANK YOU

Questions??