Challenges of providing anaesthesia to the older patient

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