By the year 2040, persons aged 65 years or older are expected to comprise 24% of the population and account for 50% of health care expenditures. In Europe, persons aged 65 years or older are expected to comprise 30% of the population within the next 40 years. Of these individuals, many will require surgery. The elderly patient typically presents for surgery with multiple chronic medical conditions,
in addition to the acute surgical illness. Age is not a contraindication to anesthesia and surgery; however, perioperative morbidity and mortality are greater in elderly than younger surgical patients.
As with pediatric patients, optimal anesthetic management of geriatric patients depends upon an understanding of the normal changes in physi-ology, anatomy, and response to pharmacological agents that accompany aging. In fact, there are many similarities between elderly and pediatric patients (Table 43–1). Individual genetic polymorphisms and lifestyle choices can modulate the inflammatory response, which contributes to the development of many systemic diseases. Consequently, chronologic age may not fully reflect an individual patient’s true physical condition. The relatively high frequency of serious physiological abnormalities in elderly patients demands a particularly careful preoperative evaluation.
Elderly patients are frequently treated with β-blockers. β-Blockers should be continued peri-operatively, if patients are taking such medications chronically, to avoid the effects of β-blocker with-drawal. A careful review of patients’ often exten-sive medication lists can reveal the routine use of oral hypoglycemic agents, angiotensin-converting enzyme inhibitors or angiotensin receptor block-ers, antiplatelet agents, statins, and anticoagulants. Because elderly patients frequently take multiple drugs for multiple conditions, they often benefit from an evaluation before the day of surgery, even when scheduled for outpatient surgery. Preoperative laboratory studies should be guided by patient con-dition and history. Patients who have cardiac stents requiring antiplatelet therapy present particularly vexing problems. Their management should be closely coordinated between the surgeon, cardi-ologist, and anesthesiologist. At no time should the anesthesia staff discontinue antiplatelet therapy without discussing the plan with the patient’s pri-mary physicians.