Perioperative care of the elderly patient: special considerations
Donna L. Miller, DOAddress reprint requests to D.L.M., Department of Internal Medicine, Section of Geriatric Medicine, A72, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Unlike older studies, which cited age as an independent risk factor for surgical mortality, recent studies indicate that the presence of underlying diseases and the type, duration and urgency of surgery are better predictors of outcome than age alone. A preoperative assessment that defines medical, functional, and psychosocial problems of elderly patients can lead to interventions to improve surgical outcomes.KEY POINTS
Before any surgery, the patient, family, and physician should discuss its potential risks and anticipated benefits within the context of the patient's value system.
Older patients vary widely in their response to illness, even if they are the same age. Thus, every older patient must be evaluated as an individual, taking into account the physiologic changes of aging and any underlying diseases.
A thorough medication history is an essential component of the preoperative assessment, as older Americans use an average of 4.5 prescription medications and 3.5 over-the-counter drugs.
Because length of stay is decreasing, discharge planning needs to be initiated early as part of the preoperative assessment by an interdisciplinary team.
Recognition of neuropyschiatric problems, such as dementia, delirium, and depression, is crucial.
Postoperative management includes specific measures to minimize functional decline, malnutrition, and pressure ulcers.