Perioperative care of older adults

The perioperative care of older adults requires special considerations to address their unique physiological and psychological needs. As people age, they often develop comorbidities and functional limitations that can complicate surgical procedures and recovery. Understanding the principles of perioperative care for older patients can help ensure better outcomes and reduce the risk of complications. Here to tell us all about it is highly respected consultant physician and geriatrician Dr Dhanupriya Sivapathasuntharam.

What is preoperative assessment?

Effective perioperative care begins with a thorough preoperative assessment. This involves evaluating the patient's medical history, current health status and potential risks associated with surgery. Key components include:

• Comprehensive medical evaluation: Review of medical history, including chronic illnesses (for example: diabetes, hypertension, cardiovascular disease) and current medications.
• Functional status: Assessment of mobility, cognitive function and ability to perform activities of daily living.
• Nutritional status: Evaluation of dietary habits and nutritional deficiencies.
• Medication review: Identification of medications that may affect surgery or recovery, including anticoagulants and antiplatelet agents.

Risk assessment

Risk assessment is crucial to identify patients who may be at higher risk of complications. This involves using geriatric-specific indicators to evaluate surgical risk.

How are comorbidities managed before treatment goes ahead?

Optimising the patient’s medical condition prior to surgery can significantly improve outcomes. This may include:

• Managing chronic diseases: Ensuring conditions such as hypertension, diabetes, and heart disease are well-controlled.
• Medication adjustments: Modifying or temporarily discontinuing medications that may interfere with surgery or anaesthesia.
• Nutritional support: Addressing malnutrition or deficiencies to promote better healing and recovery.

Is it safe for older adults to have anaesthaesia?

Older adults are more sensitive to anaesthesia, and special considerations must be taken:

• Choice of anaesthesia: Deciding between general, regional or local anaesthesia based on the patient's health status and type of surgery.
• Monitoring: Close monitoring of vital signs and physiological responses during surgery.
• Minimising anaesthetic duration: Keeping the duration of anaesthesia as short as possible to reduce the risk of complications.

How are complications prevented during surgery?

During surgery, maintaining stability and preventing complications is paramount:

• Temperature regulation: Older adults are more prone to hypothermia, so maintaining body temperature is crucial.
• Fluid management: Careful monitoring of fluid balance to avoid dehydration or fluid overload.
• Preventing pressure injuries: Using appropriate padding and positioning to prevent pressure sores.

What postoperative care is involved?

Postoperative care focuses on promoting recovery and preventing complications:

• Pain management: Effective pain control using multimodal analgesia to minimise the use of opioids, which can cause side effects like confusion and constipation.
• Early mobilisation: Encouraging movement and physical activity as soon as possible to prevent complications such as deep vein thrombosis and pneumonia.
• Monitoring for complications: Vigilant observation for signs of postoperative complications, including infections, delirium and cardiovascular events.
• Nutritional support: Providing adequate nutrition to support healing and recovery.

What is involved in rehabilitation and recovery?

Recovery and rehabilitation are critical components of postoperative care for older adults:

• Physical therapy: Tailored exercise programs to improve strength, mobility, and functional status.
• Cognitive support: Addressing any cognitive impairments or delirium through appropriate interventions.
• Support systems: Ensuring the patient has access to social and family support during recovery.

Who is involved in perioperative care of older adults?

A multidisciplinary approach is essential for the perioperative care of older adults. This involves collaboration among surgeons, anaesthetists, geriatricians, nurses, physiotherapists, and social workers to provide comprehensive care tailored to the individual needs of the patient.

To arrange a consultation with Dr Sivapathasuntharam, visit her Top Doctors profile.