4 - Anaesthesia for the elderly

Summary

The care of the elderly patient during anaesthesia is one of the most common tasks we perform. It has the highest rate of serious complications and long-term effects and yet it is also the least researched and taught element of anaesthetic practice. The absolute number of the elderly and their relative proportion in our population are increasing and will do so until the latter part of the century. This has an impact not only on the challenges to our anaesthetic practice, but also, because of the reduction in the proportion of people paying taxes, in the country's ability to pay for healthcare. Increased disability and dependence on other carers greatly add to this burden. The figure of a 25% incidence of cognitive dysfunction following major surgery would cause political intervention in any other group of patients. There have been some advances in our understanding of the elderly, in the availability of newer drugs and techniques for instance, that make a review worthwhile.

The basics of getting old

The research into aging and the cellular process underlying these are advancing rapidly in many areas. Integrating these into the responses we observe is more difficult, largely because getting older is a combination of aging at a cellular, organ and systems level with the residual impact of acute and chronic disease states, and finally the adaptation of life-style the patient uses to cope as long as possible. It is this behavioural adaptation that masks many of the underlying processes of importance to us.