3. Introduction
The geriatric population is growing and will approach
20% by 2025
Age is not the only factor, and comorbidities play a major
role
Healthy geriatric population have outcome similar to
healthy younger patients
4. Definition
Aging is the progressive intrinsic universally prevalent
physiological process producing measurable changes in
the structure and function of tissue and organ
6. Chrono vs biological age
chronological age –poor discrimination of individual
surgical risk
‘old’ 60yrs vs young 80yrs
Heterogenicity is the most consistent feature in the
elderly
7.
8. Metabolism
-there is decrease ability to handle glucose load
-Type II NIDD is common 4%
-Hypothyroidism 3%
-intraoperative and post operative core temperature
are lower in eldery
9.
10.
11.
12. Body Composition
-By age 25 there is decrease of 25% and 28% in TBW
in both male and female respectively
- there is increase in lipid fracture and loss of skeletal
mass
-osteoporosis in 30% of women
13. -osteomalacia in 30% of population
-85% with radiological OA
-Anemia of all types in 12%
14. Pharmacokinetics
-Regular medication consumed by 75%
-30% takes 4 or more drugs
-noncompliance est. 60% with adverse reaction
increases from 20% in middle age to 30% in the age
-drug absorbtion is little affected with only little
increase in fat soluble drugs
15. - drugs accumulate if given in young adult dose
-increase adverse drug effects
16.
17. General Principles
Principle I- Clinical presentation
may be subtle or different leading to delay in
diagnosis
Age related illness affecting cognition
18. Principle II- Lack of reserve
handle stress satisfactorily but handle severe stress
poorly due to lack of organ system reserves
19. Principle III- Preoperative preparation
Should be optimal because of lack of reserve
When Suboptimal increases perioperative risk
20. Principle IV- Emergency surgeries
emergency surgeries have poor outcomes compare to
elective though but are better than non-operative
Risk of surgical complications due to II and III
21. Principles V – Attention to details
Scrupulous attention yields great benefits
Poor tolerance to complication due to lack of reserve
Careful surgical technique
Perioperative monitoring
22. Principle VI- Age is a scientific fact
should not be treated with prejudice
No contraindication to chronological age due to IV
Great biological variability exist
Some medical condition more important than age
23. Preoperative geriatric
assessment checklist
Cognition screening
Decision making capacity
Screening for depression
Functional status, fall risk
Frailty
Nutritional assessment
Medical assessment
Medication review
Advance directives
24. Intraoperative Management
checklist
Anasthetic Approach consideration
-Regional technique
-multi modal analgesic/opoid sparing
-post op nausea risk stratification and prevention
• Patient safety strategies
• Post op pulmonary complication and hypothermia
• Fluid management and physiologic management
25.
26.
27.
28. Postoperative care
Pain management
Delirium monitoring
Early ambulation
Bowel management
Falls prevention
Pressure ulcer prevention
Prevention of pulmonary complication
Transition of care following the perioperative period
30. Conclusion
Surgical problems abounds in the age therefore surgeons
must become students of physiological changes that
occur with aging.
The patient age should be considered but should not be
feared
31. Reference
Principles and practice of geriatric surgery; 3rd ed.
Ronnie A et al Pp 25-42
Physiological principles in surgery of elderly by Frank
Glenn M.D
Dept of surgery, New York Hospital
Principles of geriatric surgery, Mark.r.Kathie ; chapt.6,
2011
