In issue 12 six papers are published connected with surgical treatment of patients in advanced age. The papers concern problems of flatal and faecal incontinence, injuries and multifaceted perioperative and post-operative rehabilitation – respiratory, motor and psychological rehabilitation. The problem of bedsores is also discuss.

Faecal incontinence is an embarrassing but very frequent problem in an ageing society. Faecal incontinence is frequently the cause of isolation of ill persons; it is even a basis to place them in care homes, in which the frequency of incontinence is assessed at 50% of residents. The authors of the article on faecal incontinence discuss causes, pathomechanism and methods of treatment. Modification of diet, drugs or biofeedback exercises often reduce the unpleasantness of faecal incontinence. Surgical treatment is recommended in precisely selected cases and should be carried out in reference centres providing coloproctology.

Older people have injuries more often than younger individuals. Because of the consequences of injuries patients in advanced age are hospitalized twice as often as younger people. Insufficiency of numerous organs in patients in advanced age increases post-traumatic prevalence; this concerns in particular hypoventilation, hypotension and consciousness disorders. Falls are the most frequent causes of injuries in people in advanced age. The most typical injuries for advanced age are rib fractures, head injuries, and fractures of the spine, thigh bone and radial bone. The basis for treatment success in older patients is early surgical treatment, appropriate and competent anaesthetization, and perioperative and post-operative rehabilitation.

Rehabilitation is one of the fundamental conditions for health improvement and treatment success in people of advanced age. In the next articles respiratory, motor and psychological rehabilitation are discussed. For many years in advanced age surgery the so-called fast track approach – i.e. the quickest post-operative and post-traumatic streamlining of patients – has been recommended.

Respiratory disorders occur in approximately 16-25% of patients treated in surgical wards. Respiratory complications occur more often in ill persons operated due to urgent or sudden recommendations. Respiratory rehabilitation should be started already in the preoperative period. It is important that nurses, doctors, physiotherapists and psychologists be familiar with the basics of rehabilitation. The authors of three papers concerning rehabilitation discuss causes and pathomechanisms of post-operative complications and present the principles of modern rehabilitation.

If the principles of rehabilitation are not obeyed then the development of bedsores may ensue. The problem of bedsores is the subject of the next publication. Over 70% of registered bedsores occur in patients of advanced age. Bedsores significantly prolong the duration of stay in hospital, and increase illness, mortality and costs of treatment. Nursing care plays an essential role in preventing development of bedsores. It is necessary to change the patient´s position every two hours. The worse the nursing care and the fewer the nurses employed in the ward the more frequent are bedsores. We are leaving this issue with the organizers and directors of the relevant institutions of health protection to consider the matter.

Articles published in issues 11 and 12 of „Postępy Nauk Medycznych” [Progress in Medical Sciences] discuss essential problems of advanced age surgery. We recommend that the knowledge contained in the articles be urgently implemented in clinical practice.

Prof. dr hab. med. Krzysztof Bielecki