Perioperative care of the geriatric patient

Abstract

Increasing numbers of older patients will be undergoing surgery in the future, with benefits including symptom relief and extended longevity. Despite these advantages from successful surgery, geriatric patients are at risk of adverse perioperative events, particularly those who are frail. Anatomical and physiological changes due to ageing occur in all organ systems and can have a profound impact on the surgical stress response and recovery. Deciding whether older patients will benefit from surgery can be a difficult task. Due to the diversity of age-related physiological changes and comorbidities in individual patients, differentiation between the fit and the frail elderly is an important step. Despite older age, some studies demonstrated that the odds of a favourable outcome can be improved with preoperative optimisation, leading to better outcomes. Better outcomes are beneficial for patients and can also relieve the growing burden on the healthcare system. A patient-centred care plan, understanding an individual patient's potential risks and integrating a multidisciplinary approach are key principles of good perioperative care. Also, the patient's willingness and short- and long-term goals, such as maintaining functional independence, or pain relief must be considered. However, if surgical treatment is deemed futile and death is to be expected as an unavoidable outcome, multidisciplinary collaboration in guiding patient care and supporting the family can be of great value. It helps to relieve suffering, and supports a dignified and meaningful dying process. This narrative review aims to explore key aspects of perioperative care in older surgical patients, with particular attention to frailty, shared decision-making, and advance care planning.