Challenges in anaesthesia for elderly

The segment of elderly individuals comprises a growing proportion of the global population. Health care systems and health care providers worldwide need to understand the specific challenges related to treatment of this heterogeneous patient population. The process of ageing is complex and under constant influence by numerous factors, for which reason the way human age is extremely individual. It is important to understand and acknowledge how elderly differ from younger adults, and how management needs to be modified and tailored to the individual patient in order to improve outcomes. The goal of treatment of an elderly patient is not necessarily to increase human longevity regardless of the consequences, but to increase active longevity free from disability and functional dependence. For older people, deterioration in function can be devastating and is often precipitated by a stressful event such as an acute episode of illness or injury. Therefore a mainstay of treatment of the aged is prevention of functional decline. In this review, we will outline the extreme variability in the aging process, and its implications for tailoring the perioperative care for the elderly. We will provide an overview of the challenges, when dealing with the aged surgical population with emphasis on postoperative cognitive changes.