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In many developed countries, the proportion of the population that is older is growing. The oldest old (80 years or older) are the fastest growing segment of the older population. Currently, this group accounts for 11% of those 60 years of age and older. By the year 2030, 17% of the population in the United States will be older than 65 years.1 Improvements in surgical techniques, anesthesia, and intensive care units make surgical interventions in older and sicker patients possible. It is estimated that over half of the population older than 65 years will require surgical intervention at least once during the remainder of their lives2 (Figure 56–1). Consequently, elderly patients are becoming an even larger part of anesthetic practice. Regional anesthesia is frequently used in elderly patients, especially during orthopedic surgery, genitourologic and gynecologic procedures, and hernia repair. Although age can no longer be considered as a contraindication to anesthesia and surgery, anesthesia-related morbidity and mortality remain higher among elderly than among young adult surgical patients.

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Fig. 56-1
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Annual rate of anesthesia per 100 population within the different age groups from 1980 to 1996 in France (Reprinted, with permission, from Clerque F, Auroy Y, Pequinot F, et al: French survey of anesthesia in 1996. Anesthesiology 1999;91:1509).

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To effectively treat elderly patients, clinicians must have an understanding of aging, how it occurs, how it affects specific organ systems, and how it influences clinical care when a patient is subjected to surgery. Aging is a normal phenomenon, although the basic mechanisms that cause aging are still poorly understood. Aging per se is represented by those manifestations of irreversibly altered organ function that are common in all elderly persons and are usually progressive. The physiologic process of aging varies considerably from person to person; hence variation in organ capabilities increases with age. Different organs in the same individual may age at different rates; each system has its own temporal pattern of age change. The organ reserves, which are so essential to ensure homeostasis, gradually decrease, resulting in an increased sensitivity to internal and external environmental stressful stimuli3 (Figure 56–2).

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Fig. 56-2
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Effects of aging on organ function (Reprinted, with permission, from Williams ME: Clinical implications of aging physiology. Am J Med 1984;76:1049).

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Age alone is not a major factor in predicting the risks to a patient undergoing anesthesia and operation. The overall physical status or disease state or both are better predictors of outcome. Risk is directly related to the number and extent of coexisting preoperative diseases. Ischemic heart disease, diabetes mellitus, and hypertension are the preoperative conditions most indicative of a higher risk of peri- and postoperative morbidity and mortality.4 The type of operation appears to be important; upper abdominal surgery ...

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