Surgery in Elderly People

Another controversial and ethically challenging area of geriatric medicine involves patient care in an intensive care setting. Frail, debilitated patients who undergo major surgery typically require prolonged ventilation on a mechanical breathing machine.

Traditionally, age is associated with a greater incidence of negative outcomes and a poorer quality of life for surgery patients who have a prolonged postoperative ICU stay. An examination of this issue was performed by Udekwu et al., using perceived quality of life and activities of daily living survey scores as an indication of value of care, in surgical ICU survivors over seventy years of age. The investigators found that age, by itself, did not increase the level of death experienced in a surgical intensive care unit, and therefore age should not restrict access to critical care. The investigators concluded that while overall functional levels fell for these patients, perceived quality of life was high. Additionally, full dependency (e.g., full-time nursing care) rose only slightly from a baseline level. The status of the whole patient needs to be considered when evaluating the appropriateness of utilization of critical care resources by the older adult.