[Preoperative Evaluation and Arrangements: The Elderly Patient]

Area of Science:

• Geriatric Medicine
• Anesthesiology
• Surgical Care

Background:

• The aging population and medical advancements increase the number of elderly patients undergoing surgery.
• Aging is associated with physiological instability, increased risks of complications, morbidity, and cognitive deficits.
• Standard preoperative assessments may not adequately address age-specific risks in older adults.

Purpose of the Study:

• To highlight the special perioperative risks faced by aged and very aged patients.
• To emphasize the need for extended preoperative evaluation beyond anesthesia fitness.
• To outline strategies for preventing postoperative cognitive deficits and delirium in the elderly.

Main Methods:

• Comprehensive assessment of frailty, functional status, and cognitive deficits.
• Evaluation of malnutrition and polypharmacy in elderly surgical patients.
• Implementation of age-adapted perioperative care strategies, including medication adjustments and patient support.

Main Results:

• Elderly patients exhibit a higher rate of complications and cognitive issues post-surgery.
• Specific interventions like omitting benzodiazepines and BIS-controlled anesthesia can mitigate risks.
• Adequate time and attention throughout the perioperative phase are essential for this demographic.

Conclusions:

• The unique physiological profile and risk factors of aging necessitate specialized perioperative care.
• Proactive management of frailty, cognition, and polypharmacy is vital for surgical outcomes in the elderly.
• Hospitals will likely adopt more age-adapted structures and processes to meet the needs of the growing elderly surgical population.