Perioperative medication management for older people

The average age of surgical candidates is increasing with the ageing population worldwide. Major surgery in older patients is associated with a significant risk of complications due to physiologic changes occurring with ageing and individual patient factors such as frailty, polypharmacy, and multimorbidity. Periodic medication review should be part of the routine management of all older patients, with the perioperative period presenting an opportune time for this review. Regular medications may need short-term modification during the surgical period. Medications implicated in increasing risk of inducing or worsening delirium should be identified and withdrawal considered ahead of time. Perioperative commencement of medication aimed at reducing risk of other complications, including cardiovascular events, should be considered on an individual basis, analysing risks and benefits. Comprehensive medication review and careful planning through the perioperative period may enhance the prospects of recovery and reduce morbidity and mortality for older surgical patients.