Abstract / Summary
This review summarizes current evidence and practical recommendations for the perioperative management of very old (defined as ≥80 years old) surgical patients. Where evidence specific to this age group was unavailable, relevant findings from broader populations of older adults were considered. Geriatric-specific problems (frailty, cognitive decline, malnutrition, sarcopenia, comorbidities) should be assessed and addressed in preoperative assessment. Perioperative care should take into consideration comorbidities and delirium risk. Rehabilitation and post-discharge care are pivotal due to high risk of functional decline. Older adults require special consideration regarding geriatric syndromes. In many cases, individualized approach and involvement of an interdisciplinary team should be considered. The perioperative care of older patients is challenging due to clinical complexity. In this narrative review, we summarized the most important aspects of perioperative care of very old adults. We performed a non-systematic narrative review of available studies to summarize evidence to support best clinical practice in perioperative care of very old patients. When appropriate, evidence was supplemented with data from broader population of older adults. The preoperative assessment should take into consideration comorbidities and cardiac risk as well as geriatric syndromes, including cognitive decline, sarcopenia, frailty, and malnutrition. Identification of geriatric syndromes should prompt intervention or involvement of an interdisciplinary team. In the perioperative period, caution regarding medication is advised due to frequent polypharmacy and altered pharmacodynamics of drugs. Perioperative delirium should be prevented and adequately managed. Due to a significant risk of postoperative functional decline, rehabilitation and coordinated post-discharge care play a pivotal role in the postoperative period. Our review briefly summarizes the most important clinical problems in the perioperative care of very old adults, drawing where necessary on evidence from broader older populations. Despite increase of high-quality evidence in the field, an individualized approach and involvement of an interdisciplinary team are frequently required in this group of patients.