Oncogeriatrics (part 2.). Normal and pathological ageing

There are two ageing processes, one physiological, also known as normal ageing, and that of pathological ageing, which depends on the occurrence of chronic diseases. The essence of the former is a gradual, progressive, and a very indivi­dual restriction of the organs’ functional reserve with age. The changes occur in all cells, tissues and systems and do not affect each organ at the same time, and the rate of change can vary between organs. Therefore, the chronological age alone cannot be the factor determining the terapeutic decisions, including surgical treatment. Among the elderly, there is a distinct situation where acute stress response associated with surgery is imposed on the otherwise ageing-related, reduced physiological reserves and the cumulative effect of any accompanying diseases. Standard preparation for surgery and routine perioperative management in such patients can lead to serious complications. In older persons, even mini­mal injury can exceed the body’s capacity to compensate, especially among those with frailty syndrome. It is critical to understand the physiological changes associated with ageing to better understand the differences in the management of these elderly patients.