Older adults represent a growing patient population with unique care needs. As perioperative physicians, our goal is to optimize our patients' physical, psychological, social, and cognitive health. In a holistic model of care, all the above domains are interconnected, and accordingly our care should be highly integrated across all the domains with specific interventions targeted to areas of risk. High-yield targets for preoperative evaluation include functional status and mobility, nutrition, cognitive screening, and communication and shared decision-making (asamonitor.pub/3nQFLGv). As an example, a high percentage of older adults have probable cognitive impairment when screened preoperatively. These patients are at risk for perioperative neurocognitive disorders, which often impacts physical and psychological health – and, ultimately, outcomes.
The aging process is associated with physiological changes that increase perioperative risk, including a decline in respiratory mechanics, impaired temperature regulation, decreased heart rate variability, and reductions in esophageal muscle tone, renal function, and...
