The older orthopaedic patient: general considerations

Area of Science:

• Geriatric Medicine
• Orthopaedic Surgery
• Perioperative Care

Background:

• Individuals over 65 are increasingly undergoing orthopaedic surgery, experiencing significant benefits despite higher risks.
• Age-related physiological changes can increase perioperative complications, necessitating specialized care strategies.
• Polypharmacy in older adults requires meticulous management during the perioperative period.

Purpose of the Study:

• To review age-related considerations in orthopaedic surgery.
• To highlight strategies for preventing and managing perioperative complications in elderly patients.
• To optimize medication management and reduce the incidence of delirium.

Main Methods:

• Review of age-related physiological changes impacting surgical risk.
• Analysis of medication management protocols for older surgical patients.
• Discussion of strategies for delirium prevention and management in the orthopaedic setting.

Main Results:

• Certain pain medications (meperidine, propoxyphene) should be avoided due to CNS sensitivity in older adults; alternatives like morphine and oxycodone are preferred.
• Adverse drug reactions are a significant cause of postoperative delirium.
• Preventive measures for delirium include early mobilization, judicious drug selection, avoiding restraints, maintaining hydration, and addressing sensory deficits.

Conclusions:

• Careful perioperative management, including medication review and delirium prevention, is crucial for older adults undergoing orthopaedic surgery.
• Strategies such as early mobilization and avoiding specific medications can mitigate risks.
• Involving families in decision-making is important for informed consent, especially for patients with dementia.