| Popis: |
The elderly, above 65 years, is the fastest growing segment of the population in the United States and European Union as a result of advances in health care. A large percentage of this population will require anesthesia for surgical, diagnostic and interventional procedures either in elective or emergency settings. Although anesthesia and surgical techniques have improved significantly, anesthesia related morbidity and mortality is still high in this vulnerable population. This is more likely due to age related disease and not the age itself. The functional reserve of each organ system begins to decline with age, and may not be clinically apparent until the organ system is subjected to increased demand, in terms of peri-operative stress, disease, polymedications including anticoagulants or surgical interventions. Aging limits the physiological reserve of the cardiovascular, neurologic, respiratory, endocrine, hepatic and renal systems and may influence the pharmacokinetics and pharmacodynamics of anesthetic agents, resulting in prolonged action and increased risk of post-operative complications. The co-morbidities may co-exist with malnutrition, communication difficulties, psycho-social alterations, disability, dementia and frailty. The traditional pre-anesthetic assessment captures limited information hence paving way for the more informative comprehensive geriatric assessment (CGA) which assesses the functional status and frailty. CGA is an established evaluation methodology for evaluating and optimizing physical, psychological, functional and social issues in older patients so as to improve long term outcomes. The most devastating post-operative complications following surgery is that due to changes in cognition as the elderly may suffer from delirium, dementia or post-operative cognitive dysfunction which impact memory, planning, organisation, attention and may result in loss of independence and quality of life. |
