Peri‐operative optimisation of elderly and frail patients: a narrative review

Abstract

With increasing life expectancy and technological advancement, provision of anaesthesia for elderly patients has become a significant part of the overall case‐load. These patients are unique, not only because they are older with more propensity for comorbidity but a decline in physiological reserve and cognitive function invariably accompanies ageing; this can substantially impact peri‐operative outcome and quality of recovery. Furthermore, it is not only morbidity and mortality that matters; quality of life is also especially relevant in this vulnerable population. Comprehensive geriatric assessment is a patient‐centred and multidisciplinary approach to peri‐operative care. The assessment of frailty has a central role in the pre‐operative evaluation of the elderly. Other essential domains include optimisation of nutritional status, assessment of baseline cognitive function and proper approach to patient counselling and the decision‐making process. Anaesthetists should be proactive in multidisciplinary care to achieve better outcomes; they are integral to the process.