Mind Your Elders: Perioperative Management of the Geriatric Patient-Slides

Slides
Pdf Summary
This presentation by Dr. Heather E. Nye focuses on the perioperative care of older adults, highlighting the unique challenges and best practices for optimizing surgical outcomes in this population. Adults aged 65 and older constitute a growing proportion of surgical patients, with increased risks due to age-related physiological decline, frailty, and comorbidities. Frailty—an age-related syndrome of decreased physiological reserves—is distinct from age alone and strongly predicts poorer postoperative outcomes including complications, delirium, functional decline, institutionalization, readmission, and mortality.<br /><br />Older adults commonly experience postoperative complications beyond typical concerns, such as a high incidence of delirium and long-term cognitive dysfunction, with substantial impacts on quality of life and independence. Functional decline post-surgery is prevalent, making assessment of activities of daily living (ADLs), instrumental ADLs (IADLs), mobility, cognition, and social support critical prior to surgery.<br /><br />The evaluation phase employs validated tools (Clinical Frailty Scale, Risk Analysis Index) and screens cognitive function (Mini-COG), delirium risk factors, medication review for polypharmacy, and physical function tests (Timed Up and Go). The 4Ms framework—Mentation, Mobility, Medications, and What Matters (patient goals)—guides assessments.<br /><br />Interventions focus on understanding patient goals emphasizing quality of life and valued activities, which often prioritize functional independence over survival extension. Advance care planning, medication optimization, prehabilitation (exercise, nutrition, cognitive training), and interdisciplinary communication are key. Delirium prevention bundles include minimizing opioids, benzodiazepines, anticholinergics, promoting early mobilization, ensuring sensory aids, hydration, and family engagement.<br /><br />Hospitalists play a pivotal role in stabilizing comorbidities, assessing decision-making capacity, facilitating shared decision-making, interpreting surgical plans, and coordinating care.<br /><br />Key takeaways stress that older adults require specialized, multidisciplinary perioperative care tailored to frailty and patient-centered goals using systematic screening and evidence-based interventions (ABCDE: Ask, Build resilience, Communicate, Delirium risk reduction, Educate). This approach improves surgical safety while aligning care with what matters most to older patients.
Keywords
perioperative care
older adults
frailty
postoperative complications
delirium prevention
functional decline
4Ms framework
prehabilitation
advance care planning
multidisciplinary approach