Peri-operative optimisation of elderly and frail patients: a narrative review

Anaesthesia. 2019 Jan;74 Suppl 1:80-89. doi: 10.1111/anae.14512.

Abstract

With increasing life expectancy and technological advancement, provision of anaesthesia for elderly patients has become a significant part of the overall case-load. These patients are unique, not only because they are older with more propensity for comorbidity but a decline in physiological reserve and cognitive function invariably accompanies ageing; this can substantially impact peri-operative outcome and quality of recovery. Furthermore, it is not only morbidity and mortality that matters; quality of life is also especially relevant in this vulnerable population. Comprehensive geriatric assessment is a patient-centred and multidisciplinary approach to peri-operative care. The assessment of frailty has a central role in the pre-operative evaluation of the elderly. Other essential domains include optimisation of nutritional status, assessment of baseline cognitive function and proper approach to patient counselling and the decision-making process. Anaesthetists should be proactive in multidisciplinary care to achieve better outcomes; they are integral to the process.

Keywords: anaesthesia; elderly; frailty; geriatric; peri-operative; surgery.

Publication types

  • Review

MeSH terms

  • Activities of Daily Living*
  • Aged
  • Aged, 80 and over
  • Cognition*
  • Frail Elderly*
  • Geriatric Assessment / methods*
  • Humans
  • Nutritional Status*
  • Perioperative Care / methods*