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Elderly patients commonly have injuries or other medical conditions requiring surgery. Due to physiologic and pathologic changes that occur with age, these patients are at higher risk of perioperative morbidity and mortality. This activity reviews the evaluation and treatment of geriatric patients and highlights the role of the interprofessional team in managing these patients while undergoing anesthesia. Objectives: Describe physiologic changes in elderly patients and their relevance to perioperative care. Identify risk factors for perioperative morbidity and mortality in elderly patients and explain the importance of a geriatric-focused preoperative assessment. Review anesthetic techniques and intraoperative management of elderly patients. Summarize common perioperative geriatric complications and their management by an interprofessional team. Access free multiple choice questions on this topic.

Advances in modern healthcare over the past century have significantly increased the average lifespan worldwide, and the fastest-growing population in healthcare is that of the elderly. Since 1975, the number of Americans over the age of 70 has more than doubled. More and more patients each year are undergoing anesthesia for surgery and other procedures. While advances in primary and perioperative care have increased the safety of anesthesia for geriatric patients, they are at considerable risk for severe morbidity and mortality. Age increases perioperative risks associated with anesthesia; it also correlates with many pathologic processes that further increase morbidity and mortality. Understanding typical physiologic and pathologic aging and performing a thorough preoperative exam can improve patient safety and outcomes.[1][2]

Anesthetic care of elderly patients is a challenging aspect of perioperative medicine. As patients with more comorbidities and physiologic changes require anesthesia for procedures, an interprofessional team with adequate training and excellent communication is vital to decreasing morbidity and mortality. The role of the interprofessional team may include anesthesiologists, surgeons, nurses, surgical technicians, geriatricians, palliative care physicians, pharmacists, chaplains, and more. Failure of the team in assessing the patient and forming a surgical plan to maximize benefits while minimizing risks can result in poor outcomes and preventable patient harm. Before the patient arrives in the procedure room, assessments by team members should focus on determining the patient's physiologic reserve and be directed at cardiopulmonary risk factors, cognitive function, and common geriatric pathologies.[75] [Level I] Intraoperatively, the surgical and anesthetic plans should minimize known risks for elderly patients. General anesthesia in geriatric patients is associated with acute respiratory failure, lengthier hospital stays, and higher mortality in hip fractures. Some studies suggest spinal anesthesia to be a safer primary anesthetic, but more research is needed to evaluate this hypothesis.[76] [Level II] Finally, the incidence of Postoperative Cognitive Dysfunction is increasing each year. Early detection and thorough postoperative assessment of cognition changes should be a joint effort by physicians and nurses. Guidelines should be implemented at the institutional level and taught to all perioperative employees to improve neurologic outcomes.[77] [Level I]