Perioperative care in older adults: a narrative review

The perioperative care of older patients is challenging due to clinical complexity. In this narrative review, we summarized the most important aspects of perioperative care of very old adults.

We performed a non-systematic narrative review of available studies to summarize evidence to support best clinical practice in perioperative care of very old patients. When appropriate, evidence was supplemented with data from broader population of older adults.

The preoperative assessment should take into consideration comorbidities and cardiac risk as well as geriatric syndromes, including cognitive decline, sarcopenia, frailty, and malnutrition. Identification of geriatric syndromes should prompt intervention or involvement of an interdisciplinary team. In the perioperative period, caution regarding medication is advised due to frequent polypharmacy and altered pharmacodynamics of drugs. Perioperative delirium should be prevented and adequately managed. Due to a significant risk of postoperative functional decline, rehabilitation and coordinated post-discharge care play a pivotal role in the postoperative period.

Our review briefly summarizes the most important clinical problems in the perioperative care of very old adults, drawing where necessary on evidence from broader older populations. Despite increase of high-quality evidence in the field, an individualized approach and involvement of an interdisciplinary team are frequently required in this group of patients.