Perioperative problems in elderly patients

The number of elderly patients is increasing in all countries. It is estimated that about half of those over 65 will require an operation at some time, most commonly for cataract, prostatic hypertrophy, hernia, gallstones or fractured hip. Whilst overall morbidity and mortality is considerably increased in this age group, it does not appear to result from an increased liability to surgical complications, but rather to the complications of old age itself. The fundamental factor of ageing is a decreased capacity for adaptation, and this applies to virtually all organs and systems. Surgeons and anaesthetists must make allowances for these changes. Most important are cardio-respiratory limitations and altered pharmacokinetics and pharmacodynamics affecting drug action and elimination. These will be discussed in relation to the perioperative period. Once these are understood there should be no hesitation in accepting elderly patients for any form of surgery, provided the likely benefits outweigh the increased risk. Much discomfort in old age can be alleviated by a careful choice of surgery.