Preoperative Assessment of the Elderly Patient

Precise assessment of physical status and appropriate selection and management of the anesthetic plan for the elderly surgical patient represents a great challenge to all health care providers. People are never more alike than they are at birth, nor more different or unique than when they enter the geriatric era. As rich and as varied as the genetic differences between newborn infants appear to be, survival through the young and middle years of adulthood is associated with progressively increasing interindividual variability. In addition, the prevalence of disease in elderly patients who need surgery is even higher than for the elderly population in general, especially for those older patients near the end of their life expectancy. Consequently, evaluation of physical status and identification of age-related disease, rather than aging itself, should be the appropriate focus for preoperative assessment and for planning perioperative care. An important advance allowing a better understanding of the preanesthetic implications of aging has been recognition of the distinction between processes of aging as opposed to age-related disease. How are they differentiated? Those consequences of altered tissue and organ system structure and function that are universally observed in all elderly individuals and increase in severity or magnitude with advancing years reflect aging itself. In contrast, changes in tissue and organ structure or function that are not seen in all members of a geriatric population or those that do not appear to have a direct relationship between severity and chronologic age are probably manifestations of age-related disease.