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To promote quality improvement in geriatric surgical care, extensive best practice guidelines have been issued by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) and the American Geriatrics Society (AGS). These guidelines provide a systematic approach to perioperative geriatric care. In particular, they require the care team to confirm that the patient’s wishes regarding treatment preferences and advanced directives are understood and documented. A checklist to ensure optimal preoperative assessment in the geriatric surgical patient is suggested (Table 31–1).

Table 31–1.Checklist for the Optimal Preoperative Assessment of the Geriatric Surgical Patient

A cognitive assessment such as the Mini-Cog examination is recommended for patients who do not have a history of dementia or cognitive impairment. Depression screening should also be conducted. Frailty, reflecting a decrease in functional reserve capacity and an inability to respond to the physiological challenges presented by the stress of surgery, can be assessed using one of several scoring systems.



Distinguishing between changes in physiology that accompany normal aging and changes in physiology from diseases common in the geriatric population is important (Table 31–2). Changes in the cardiovascular system that accompany aging include decreased vascular and myocardial compliance and autonomic responsiveness. In addition to myocardial fibrosis, calcification of the valves can occur. Older adult patients with systolic murmurs should be suspected of having aortic stenosis. However, in the ...

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