Challenges of providing anaesthesia to the older patient

In this article, we discuss the challenges that face the anaesthetist when providing care for older patients

Global life expectancy has increased by 6.1 years to 73.2 in the last decade (2010 – 2020)
The World Health Organisation define an elderly person as one aged 65 years or above.
- Over 65 years is the fastest-growing age segment
- This is the first time in history that people > 65 years outnumber those < 5 years old
- A significant proportion of these can be defined as the ‘oldest old’ (> 85 years)
Societies expectations have increased alongside surgical advances
Anaesthetists are tasked with providing care for an increasing number of elderly patients in both elective and emergency surgery

Cognitive Impairment
- Pre-operative cognitive assessment (ascertain baseline)
- Patients have neuronal changes which decrease cognitive reserve
- ↑ susceptibility to the stresses of surgery and adverse effects of anaesthesia
- ↑ risk of postoperative neurocognitive disorders (PNDs), hypoperfusion and stroke
Frailty (very important)
- ↑ Morbidity and mortality
- Associated with poor postoperative outcomes and functional status
- ↑ Length of hospital stay, complications and readmission rate
- ↓ Independence
Age
- ↑ Morbidity and mortality
- Age-related physiological decline affects all organs
- Biological age and incidence of co-morbidity is a superior index for disease-related mortality than chronological age
Acute medical conditions
- Active disease process
- Rapid but potentially reversible decline
Chronic medical conditions
- Polypharmacy
- Multi morbidity
- ↓ Functional reserve
- ↓ Life expectancy
- ↑ Length of hospital stay