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Review
. 2022 Jan;135(1):39-48.
doi: 10.1016/j.amjmed.2021.07.028. Epub 2021 Aug 18.

Geriatric Preoperative Optimization: A Review

Kahli E Zietlow  1 , Serena Wong  2 , Mitchell T Heflin  3 , Shelley R McDonald  3 , Robert Sickeler  4 , Michael Devinney  5 , Jeanna Blitz  5 , Sandhya Lagoo-Deenadayalan  6 , Miles Berger  5
Affiliations
Review

Geriatric Preoperative Optimization: A Review

Kahli E Zietlow et al. Am J Med. 2022 Jan.

Abstract

This review summarizes best practices for the perioperative care of older adults as recommended by the American Geriatrics Society, American Society of Anesthesiologists, and American College of Surgeons, with practical implementation strategies that can be readily implemented in busy preoperative or primary care clinics. In addition to traditional cardiopulmonary screening, older patients should undergo a comprehensive geriatric assessment. Rapid screening tools such as the Mini-Cog, Patient Health Questionnaire-2, and Frail Non-Disabled Survey and Clinical Frailty Scale, can be performed by multiple provider types and allow for quick, accurate assessments of cognition, functional status, and frailty screening. To assess polypharmacy, online resources can help providers identify and safely taper high-risk medications. Based on preoperative assessment findings, providers can recommend targeted prehabilitation, rehabilitation, medication management, care coordination, and/or delirium prevention interventions to improve postoperative outcomes for older surgical patients. Structured goals of care discussions utilizing the question-prompt list ensures that older patients have a realistic understanding of their surgery, risks, and recovery. This preoperative workup, combined with engaging with family members and interdisciplinary teams, can improve postoperative outcomes.

Keywords: Delirium; Frailty; Older adults; Optimization; Perioperative.

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Figures

Figure 1.
Figure 1.. Perioperative Care of the Geriatric Patient
A comprehensive interprofessional approach to preoperative workup and postoperative care is recommended for older adults. Family caregivers can provide support throughout this process.
See this image and copyright information in PMC

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