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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

Advances in Healthcare & Technology

  • 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

Challenges in providing anaesthesia to the older patient

  • 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
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Introduction to Using Total Intravenous Anaesthesia (TIVA)

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