The older adult surgical patient: a review of optimization and gaps in clinical practice

As the number of older adults undergoing surgery increases, the perioperative community must address the unique challenges of this vulnerable population. Age alone is not a sufficient indicator of risk and other factors like functional status, nutrition, and cognition also play a crucial role in determining a patient's vulnerability. Identifying high-risk patients requires targeted assessment to identify those who can most benefit from optimization. With an already strained perioperative workforce, integrating comprehensive geriatric programs, which rely on multidisciplinary teams to conduct frailty and geriatric assessments and to target prehabilitation and optimization, is a strategy to improve outcomes. By utilizing comprehensive geriatric programs that combine preoperative, intraoperative, and postoperative strategies to optimize care for older adults, the perioperative community can address the unique needs of high-risk older adults to reduce complications, mortality, and healthcare costs while improving the quality of life of these patients. In this review, we highlight strategies to optimize older adults undergoing surgery and identify significant gaps in practice that must also be addressed to improve the perioperative care of this often vulnerable patient population.