Surgery in Elderly People

Surgery on elderly people was once uncommon, but as the population has aged it has become much more frequent. There has also been a change in who is thought of as old, and studies based on someone sixty-five years old provide incomplete insight into the issues surrounding appropriate therapies for the ‘‘new’’ geriatric patient.

The traditional view of risk for surgical procedures has focused more on chronological than biological age. Advanced age has generally been considered to carry a higher risk of illness and complications (morbidity), and of death (mortality). In consequence, life-saving procedures such as cardiac, vascular, or oncology procedures can be delayed or withheld. However, relying on age alone to determine a patient’s response to surgery can be inappropriate.

Chronological age can, of course, serve as a marker for increased physiological frailty. Frail older adults (the ‘‘new’’ geriatric patient) frequently suffer from multisystem disease, several comorbidities, and polypharmaceutic regimens (an excessive number of medications). Frailty implies not just lower reserve capacity, but also an interaction of social and medical problems. In consequence, the decision to perform surgery should be multidisciplinary in nature, encompassing not only the suitability to withstand the stress of surgery, but also the rehabilitation and social supports required for hospital discharge.

Dentist Dr. Barney Clark, 61, became the first man to receive an artificial heart when he had open heart surgery to implant the Jarvik-7 device at the University of Utah hospital in 1982. Clark, who is being monitored by therapist John Durkin while working out, lived for 112 days with the help of the mechanical device. (Photo by Corbis/Bettmann.)