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  1. The elderly are the fastest-growing segment of the population. By 2030, more than 20% of the population will be more than 65 years old,1 and by 2045, those who are greater than 80 years old will represent the largest proportion of the elderly.2

  2. A healthy elderly patient may have normal organ function but less reserve.

  3. There is a significant difference in defining a patient as elderly versus defining a patient as frail. Newer research has focused on the concept of frailty, not elderly, and its implications on the perioperative period. Frailty has been shown to increase risk of morbidity and mortality even after adjusting for age.

  4. There are normal organ and overall functional changes of aging that do not imply disease but must be considered when planning an anesthetic.

  5. Elderly patients have a high incidence of chronic disease states.

  6. Elderly or frail patients do not require a “special” anesthetic but rather require strict attention to meticulous preoperative assessment, preoperative optimization, detailed management of intraoperative variables and concurrent disease states, choice of drug, and cautious titration of drug administration and dosages.


The elderly population is growing at a remarkable rate, with considerable implications for perioperative health care. In 2012, Medicare had over 42 million Americans enrolled who were over age 65, and by 2040, the Centers for Medicare and Medicaid Services projected that this statistic will almost double to 82 million Americans 65 or older.3 Even though only 13% of the current population is over 65 years old, elderly patients account for almost half of all hospital care days in the United States4 and almost a third of all surgical procedures.5 As the US population is expected to grow, so is the percentage of elderly Americans. By 2030, the US Census Bureau projects that more than 20% of the population will be over 65 years old,1 thus placing an even larger fraction of surgical patients over 65. Virtually every nonpediatric hospital provides a wide range of surgical services for elderly adults; consequently, every anesthesiologist is expected to have expertise in geriatric medicine as it relates to anesthetic practice.6

As they age, adults exhibit an increasingly varied array of physical responses to lifelong exposure to environmental and socioeconomic conditions, prior traumatic injuries, and medical therapies. Prolonged longevity also reveals intrinsic physiologic strengths and weaknesses and full expression of genetic differences that might not be fully apparent over shorter life-span intervals. The terms elderly and geriatric are used synonymously in this chapter to describe patients who are 65 years or older. The term aged is used to describe individuals older than 80 years.


Even though chronological age is important in the perioperative management of a patient, the concept of frailty has become a widely recognized and important concept. Frailty is often described as ...

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