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In the past several decades, there has been a dramatic increase in the percentage of the world's population that is elderly, defined as people 65 years or older. This trend is projected to continue to increase in the future.1 Understanding core principles of perioperative care of the elderly, particularly in the context of clinical pharmacology, will become increasingly more important for clinicians.


As people age, there are important changes in physiology and response to pharmacologic interventions. Aging consists of the deterioration or loss of functional units (eg, neurons, nephrons, or alveoli) at the cellular, tissue, or organ level, as well as disruption of regulatory processes at the molecular level.2 Basal organ function, in the otherwise healthy individual, is relatively preserved with aging,3 but functional reserves and the ability to tolerate stress, such as occurs with anesthesia and surgery, declines significantly with age. However, with regard to organ function, wide intraindividual and interindividual variability does exist.4 That is, biologic age does not linearly correlate with physiologic or medical age. The geriatric population is unique in its physical and medical heterogeneity, which only increases with advancing age. Acute or chronic disease states, genetics, environmental, socioeconomic and likely countless other factors play into the rate or degree of organ function decline. Advanced age, nevertheless, has been shown by many studies to be an independent predictor of perioperative outcome (Table 25–1).

Table 25–1Physiologic changes with age and associated clinical consequences.

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