KEY POINTS

1. Two important principles must be kept in mind when discussing the physiology of aging. First, aging is associated with a progressive loss of functional reserve in all organ systems. Second, the extent and onset of these changes are highly variable from person to person.
2. In general, the elderly are more sensitive to anesthetic agents. Less medication is usually required to achieve a desired clinical effect, and drug effect is often prolonged.
3. The greatest concern of the elderly patient is to maintain independence. Therefore, the most important outcome and overall objective of perioperative care of the geriatric population is to speed recovery and avoid functional decline.
4. Surgical risk and outcome in patients aged 65 and older depend primarily on four factors: (1) age, (2) the patient's physiologic status and coexisting disease (ASA class), (3) whether the surgery is elective or urgent, and (4) the type of procedure.
5. Two principles should be kept in mind when performing preoperative evaluation of a geriatric patient. First, one should have a high index of suspicion for disease processes commonly associated with aging. Second, one should assess the degree of functional reserve of specific, pertinent organ systems, as well as the patient as a whole, before surgery.
6. Important issues of special concern in caring for the elderly patient are cognitive dysfunction and perioperative delirium.
7. Current data suggest that routine testing on the basis of age alone is not indicated. Instead, selective testing should be performed on the basis of the history and physical examination and the specific surgical procedure.
8. Data suggest that preoperative comorbid disease is a greater determinant of postoperative complications than anesthetic management is. Thus, perioperative care should be tailored to comorbid disease and requirements of the surgical procedure.
9. Preoperative and postoperative management of pulmonary problems in the elderly is of particular importance in the prevention of morbidity and mortality.