Assessment and management of the geriatric patient

OBJECTIVE: To describe the potential critical care problems that arise as a result of aging and to identify some of the methods that may be used to minimize these problems. DATA SYNTHESIS: The population of the United States is aging. This is reflected in the age of our surgical patients. Aging is associated with myriad physiologic changes and an increased susceptibility to disease, all of which renders older patient more susceptible to the negative sequela of anesthetic and surgical stress. Minimizing the effects of aging begins preoperatively by assessing the impact of these changes on the individual patient. Once deficits are identified, efforts can be made to correct what is correctable preoperatively and to address what is not by designing an intra- and postoperative plan that limits additional stress to the compromised system. Although good data regarding optimal perioperative management of the elderly patient are presently lacking, awareness of the areas of potential vulnerability allows the anesthesiologist and surgeon to design their treatment plans with these limitations in mind. CONCLUSION: By identifying the limitations imposed by aging, critical care problems in elderly patients can be anticipated and addressed, and surgical outcomes can be improved.