Worldwide, life expectancy is increasing and people are living longer.
Between 2015 and 2050, the proportion of the world’s population over the age of 60
years is expected to double from 12% to 22% [1]. As our elderly population grows,
more elderly patients now require elective, urgent, and emergent surgery. Elderly
patients are complex due to age-related changes and comorbidities. Anesthesia
provides a critical line of defense for these patients, and this begins with a
comprehensive pre-operative evaluation. Assessment begins with a history and
physical exam and is supplemented with laboratory and clinical data. Special attention
must be given to nutritional status, functional capacity, cardiovascular and pulmonary
function, cognitive function, and emotional well-being. Understanding the physiologic
changes of aging and common pathologies in the elderly helps predict the
pharmacokinetics and pharmacodynamics of anesthetic agents. This understanding also
helps plan for the hemodynamic, ventilatory, and cognitive impacts of anesthesia on
the elderly. Perhaps equally important to determine a patient’s physical condition is
establishing the individual’s goals of care, decision-making capacity, and surrogate
decision-making for anesthesia and surgery.
Keywords: Anesthetic planning, Baseline functional status, BEERS criteria, Cardiac preoperative assessment, Cognitive function, Discharge planning, End-oflife care, ETOH.