Age may bring wisdom but it also brings a greater chance of health problems. While some health issues are minor and can be treated with medications, other problems aren’t so forgiving and may require surgery. The thought of having surgery can be rather intimidating, but for older adults who have been repeatedly told that they are ‘high risk’ for surgery, the thought can be downright scary.
When it comes to elderly care, there are many questions with regard to surgeries – senior caregivers want to know whether surgical procedures pose risks for seniors, how can one tell if a surgery can be avoided, the impact of anaesthesia on elderly patients, etc. While it is true that an elderly person has a higher risk of complications during and after surgery, that does not mean that a person should expect the worst during or soon after surgery just because they are no longer in their youth.
Studies have found that patients in their 80s undergoing major surgery for lung, oesophageal and pancreatic cancer have substantially higher mortality rates than those aged 65 to 69, and they’re also more likely to go to nursing homes afterward. This is because older patients often have chronic health problems, aside from whatever the surgery is supposed to fix, and take long lists of drugs. The hospital itself, where they risk acquiring infections or losing mobility after days in bed, can endanger them.
Anaesthesia can take a greater toll on their bodies and minds. Recovery may take longer. In many cases, however, patients in their late 60s, 70s and beyond can do just as well post-operatively as much younger patients. To determine surgical risk, it’s important to look at the whole person beyond his or her birthdate.
Old age alone is not to blame for increased surgical complications – there are other aspects that need to be checked before opting for an elderly patient’s surgery. Let’s take a look.
1. Frailty
A simple hand-squeeze test at the doctor’s office is one way to tell whether a patient might be too frail for surgery. As per a study, using a device called a hand-grip dynamometer – typically used to test hand and forearm strength in athletes – in conjunction with a patient’s body mass index, clinicians can quickly and precisely measure frailty.
2. Mental Status
Delirium – sudden confusion, hallucinations and other mental disturbances like hallucinations – is a distressing surgical side effect. Older patients are more likely to experience post-operative delirium. Those with mild cognitive impairment or dementia are particularly vulnerable. Ideally, mental status assessment is part of a comprehensive evaluation performed by a geriatrician or nurse practitioner who specializes in the care of older patients. However, other health professionals can assess cognition fairly quickly using standardized tools whenever surgery might be needed.
3. Functional Status
Assessment of pre-operative functional status can be a valuable predictor of post-operative outcomes in elderly patients. The degree of pre-operative functional status may have implications on a variety of factors including infection, pulmonary complications, and discharge disposition. With this knowledge, surgeons can counsel patients on ways to recover or surpass preoperative functional levels in the post-operative period.
4. Cognitive Ability
Elderly adults have a greater frequency of pre-operative complications and poor postoperative outcomes, including cognitive decline. A decline in cognition and memory in elderly patients usually results in a loss of independent function that affects families, caregivers, and the healthcare system in general. Furthermore, several studies have demonstrated that individuals with mild cognitive impairment have a greater risk of developing dementia, which is known to increase the risk of morbidity and mortality within the geriatric population.
Reducing Anaesthesia Risks in Elderly Patients
The most important thing elderly caregivers can do to reduce risks of anaesthesia is talk to their loved ones’ physician or surgeon to be sure their anaesthesia care is led by a good physician anaesthesiologist. Caregivers can also ask if there’s a physician anaesthesiologist who specializes in geriatric patients, or has more experience with older patients, who can manage their care. Steps can be taken before, during and after surgery to help reduce seniors’ risks of developing age-related problems from anaesthesia.
Make sure to talk about any health problems your senior loved one might have, list down all the medications they take – including nutritional or herbal supplements and any concerns or fears you might have about their surgery. Surgeons also need to know about any surgery the patient might have had in the past and problems related to anaesthesia if any.
Doing this is important in order to help surgeons develop the best anaesthesia care and post-operative care plan for the elderly patient, to reduce their risk of complications, and then closely monitor them during the surgery.
These risks and health issues is the reason why elderly care is given so much emphasis in today’s times. It is true that the elderly often have more health problems than younger patients, and they may have a greater need for surgery, but they also face age-related bias when being evaluated for their medical and surgical needs. Age is only one aspect of evaluating a patient’s risk for a procedure, and should not be the only factor that determines whether surgery is performed or not.
