الفهرس 
Frailty and Aging; Physiology and PathophysiologyOnly 14 pages are availabe for public view
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Abstract
In the last 50 years, the number of people over 65 years of age has tripled in the world. In Europe, they are expected to represent 30% of the population within 40 years. As a consequence, the demand for surgery by older patients is increasing.
Anaesthesia for the elderly has to take into account the specific physiology of the aged that develops naturally during the course of life. Therefore, not all physiological changes of ageing should be looked at as pathological entities because they may be completely compensated for in normal life and their potentially pathological character is revealed only in extreme conditions. To adjust anaesthetic management for the elderly with regard to individual pathophysiological changes related to ageing, it is necessary to examine patients with regard to the specific organ systems that are of special relevance for the anaesthetist and may directly change the individual anaesthetic approach to care safely for the old.
The elderly population may present conditions that have long been known as factors of increased surgical risk, such as polypathology, polymedication and disorders at the cellular level. Moreover, progress in technology and medicine in recent years has allowed a large number of elderly patients to survive illnesses. These improvements have consistently increased the number of vulnerable and frail patients presenting for surgery and have caused debates about surgical decisions in many cases. Although many surgical procedures can enhance the quality and duration of life, even in the very elderly, the balance between the expected benefits and the risks of adverse events (such as cognitive disorders, infection or cardiac complications) determining unfavorable outcomes remains a key issue.
Preoperative consultation should occur several days before surgery to allow further investigation if needed. A full history and meticulous clinical assessment is required, especially for older and more compromised patients. Clear medical information about the surgical plan is essential. The collection of clinical history may be challenging due to patient sensorial impairment or cognitive deterioration. The presence of a relative or caregiver may be helpful in these cases. Laboratory testing is indicated by associated conditions and the surgical procedure involved; age itself does not justify extensive testing.
Frailty assessment enables clinicians to inform patients more accurately of their perioperative risk, allowing more informed decisions about healthcare options. Assessing frailty may allow optimisation of a patient’s condition if time permits prior to surgery and it helps doctors anticipate and plan for potential problems. The overall goal of stratifying a patient’s perioperative risk is to reduce the incidence and severity of perioperative complications and their consequences (such as increasing dependency, reduced quality of life, mortality and healthcare costs).
Generally, elderly patients are more sensitive to anaesthetic agents. Less medication is usually required to achieve a desired clinical effect, and drug effect is often prolonged. Most evidence suggests little, if any, difference in outcome between regional and general anaesthesia in elderly patients .These results have been reported in many types of surgery, including major vascular and orthopedic procedures. Use of regional anaesthesia does not seem to decrease the incidence of postoperative cognitive dysfunction compared with general anaesthesia.
Elderly patients have a higher rate of postoperative complications. In contrast, younger patients had complication rates approximately half of that in the elderly patients. Elderly patients are similar to other patients in terms of the “typical” postoperative complications that can occur with an operation such as bleeding, infection, or technical errors. However, elderly patients are at risk for a group of unique complications owing to the physiologic changes of aging and the stress of the perioperative period.