Managing geriatric syndromes in perioperative care - implications for anesthesia practice: A narrative review

Abstract

As the aging population grows, anesthesiologists increasingly care for older surgical patients with geriatric syndromes. This paper reviews key geriatric syndromes, particularly frailty and postoperative delirium, and highlights their implications for anesthesia practice with evidence-based management strategies. Frailty, a predictor of poor surgical outcomes, is often underrecognized preoperatively. Screening tools such as the Fried Frailty Phenotype and Hospital Frailty Risk Score can help identify at-risk patients. Prehabilitation, including exercise, nutritional optimization, and multimodal pain management, may improve surgical recovery. For postoperative delirium, prevention is the most important intervention. Medication reconciliation and multimodal nonpharmacologic approaches, such as restoring sensory aids, optimizing sleep hygiene, and early reorientation, should be prioritized. Other strategies include multimodal analgesia with the minimization of opiates and avoiding deliriogenic medications. Delirium screening using the Confusion Assessment Method or Nurses' Delirium Screening Checklist enables early detection and intervention. Pharmacologic treatment of delirium should be limited to severe agitation, with haloperidol or dexmedetomidine used cautiously. By recognizing frailty and postoperative delirium as geriatric syndromes with potentially modifiable risk factors, anesthesiologists can implement targeted perioperative strategies to improve functional recovery and surgical outcomes in older adults.