[Geriatric problems in the perioperative management of surgical interventions]

Abstract

Improved healthcare and longer life expectancy have led to more and overall, healthier older patients. As a consequence, we now see more surgical complications attributable to an ever-increasing spectrum of the physiologic changes of aging. These include functional decline, psychiatric as well as medical co-morbidities, medication effects and peri-operative environmental changes. To maintain high patient care standards in geriatric operative patients, surgeons face challenges in peri-operative care (co-morbidities), anesthesia (intra-operative circulatory depression, cardiac insufficiency and limited organ reserve), and intensive care (cardiopulmonary surveillance and delirium). In contrast to the normally temporary surgical period, interdisciplinary approaches are essential during extended peri-operative, convalescent, rehabilitation and follow-up phases of care in the geriatric patient. This will require competency in the realm of geriatrics, on behalf of the treating surgeon who, as a result, will become increasingly more specialized in the future. This article addresses current epidemiology and symptomatology of particular diseases, and as well, offers treatment suggestions with explanations of geriatric pathophysiology and functional decline from a clinically relevant perspective. This review highlights the increased difficulty in treatment of multiple disease processes in the elderly as a result of natural decline in function of all organ systems.