The Geriatric Patient

An aging population combined with the increasing availability of invasive medical procedures has created a growing number of elderly patients that anesthesiologists care for every day. Geriatric patients present unique challenges that must be taken into consideration when crafting an anesthetic plan. To start with, one must first decide what it means to be elderly. Is it an age cutoff? If so, at what age does a patient become elderly? Is it a physiologic definition? If so, what amount of physiologic derangement must be present and in how many organ systems for someone to be classified as elderly? Although there is no clear consensus, a reasonable definition would combine age with the patient’s physical tolerance towards the stresses of surgery. This chapter attempts to address the myriad challenges faced by the perioperative physician who is planning to anesthetize an elderly patient. There are unique points to be noted in the preoperative physical examination, cognitive evaluation, creation of the anesthetic plan, and risk stratification. There are additional concerns related to a patient’s wishes regarding code status and potential end-of-life care. By addressing all these issues, anesthesiologists can provide safe, successful, and compassionate care to a complex and diverse elderly population. This review contains 5 figures, 3 tables, and 52 references. Key Words: anesthetizing the elderly, code status discussion, delirium, pharmacokinetic changes of aging, postoperative cognitive decline, physiologic changes of aging, regional anesthesia for orthopedic surgery, risk stratification