Perioperative care in older adults

Over the last 20 years, the number of older adults requiring surgical interventions has substantially increased and will continue to escalate as the population ages. Perioperative management of older patients poses challenges not encountered in younger individuals. People over 70 years of age are more likely to have multiple comorbidities, physical and cognitive impairments, and reduced cardiac, pulmonary, and renal reserve. These factors predispose older patients to increased risk for perioperative complications and prolonged length of hospital stay, which in turn increase risk for iatrogenesis, nosocomial infections, and perioperative mortality. Current recommendations for perioperative assessment and management for older patients are derived from data collected in predominantly younger cohorts. Given the paucity of evidence-based guidelines for this patient population, it is vital to understand the pathophysiologic changes that occur in the older patient in order to reduce their perioperative risk. The objectives of this review are to briefly summarize age-related effects on organ system reserve, identify comorbidities and geriatric conditions that pose increased risk for perioperative complications, and increase awareness of the essentials of perioperative evaluation and therapy in the older surgical patient. The overall goals are to ensure appropriate perioperative assessment and medical management and to minimize the risk of complications in older patients undergoing surgical procedures.