Abstract
Advancing age is characterized by functional impair ment of the many regulatory processes that provide integration between organs and therefore, may lead failure to maintain homeostasis under conditions of physiological stress. There are two main factors he lping to identify the high risk for surgery. The fi rst relates to the type of surgery and the second to th e scope of cardiopulmonary functional capacity of t he patient. There are major cardiovascular, respirator y, renal and musculoskeletal changes in elderly pat ients. Preoperative assessment of risk in elderly patients must consider patient factors, the surgical proble m and the treatment options. Medical co-morbid conditions are common with age and may markedly increase the risks associated with surgical intervention. Postop erative care of elderly includes respiratory Care, renal function and fluid and electrolyte management, card iovascular Care, management of pain and maintenance of function. In conclusion, health providers should pay attention to the quality of care in elderly pa tients because they are vulnerable surgical and anaestheti c stress. Minimizing perioperative risk in those pa tients requires thoughtful preoperative assessment of orga n function and reserve, meticulous intraoperative management and postoperative care. Management of surgical elderly patients is both complex and different from younger patients. Assessment of the surgical proble ms and physiologic status of elderly persons must t ake into account the changes associated with advancing age, changes in the incidence, prevalence and natural hi story of certain disease processes; and the increased likeli hood of multiple medical diagnoses and polypharmacy.
Highlights
Aging is generally characrized by gradual decline in both physiological function and the ability to respond to stress and homeostatic imbalance leading to increasing susceptibility to disease (Lui et al, 2010)
Among the currently available risk assessment tools, American Society of Anesthesiologists (ASA) scoring system despite does not measure operative risk, rather it assesses the degree of sickness or physical state prior to anesthesia and surgery
The assessment of cardiac risk is addressed by the Cardiac Risk Index (CRI) in noncardiac surgery and the risks of postoperative respiratory complications are age over 70; perioperative bronchodilator use; abnormal chest x-ray and high ASA grade (Saber, 2011; Girbes, 2000)
Summary
Aging is generally characrized by gradual decline in both physiological function and the ability to respond to stress and homeostatic imbalance leading to increasing susceptibility to disease (Lui et al, 2010). The Acute Physiological and Chronic Health Evaluation (APACHE) is the best known physiological scoring system It is based on twelve physiological variables and is currently being used in general and surgical intensive care patients. Aly Saber / American Medical Journal 4 (1): 63-77, 2013 above mentioned risk prediction tools; ASA, Cardiac Risk Index (CRI) an APACHE. Such as adverse drug effects, drug-drug interactions, or drug toxicities. The second item is the functional capacity of the patient that determines his ability to support the postoperative demand of increased oxygen consumption and of cardiac output. Myocardial ischemia only becomes part of this equation if the ischemia limits ventricular function and cardiac output (Saber, 2011; Girbes, 2000)
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