Geriatric surgery is a specialized approach to surgical care for older adults, typically defined as those over 65 years of age. This field recognizes that age alone does not determine surgical risk; rather, it is the patient’s overall physiological state. The focus shifts from merely treating the disease to optimizing the entire care process, aligning treatment with the unique needs and goals of the patient. This multidisciplinary model involves surgeons, anesthesiologists, geriatricians, and nurses working together to tailor the experience.
Why Older Adults Need Specialized Surgical Care
Specialized surgical care is necessary due to the distinct physiological changes that occur with age, which are often overlooked in standard surgical models. Older patients possess a reduced capacity to recover from the physical stress of an operation, known as diminished physiological reserve. This means their body systems have less ability to recover from injury, anesthesia, and inflammation.
A major concern is frailty, a measurable state of vulnerability that increases the risk of complications independent of chronological age. Frailty is a geriatric syndrome characterized by a decline in physical and cognitive reserves. Frail patients are at a significantly higher risk for adverse outcomes, including major complications, longer hospital stays, and a reduced chance of returning home.
Surgical risk is further complicated by the high burden of comorbidities in this population, such as heart disease, diabetes, and kidney issues. These multiple chronic conditions complicate anesthesia delivery and slow the healing process. The presence of multiple health problems means that a surgical stressor tolerated easily by a younger patient can trigger a cascade of organ system failures in an older adult.
Comprehensive Pre-Operative Evaluation
The core difference in geriatric surgical care is the comprehensive assessment performed before the operation, which transforms risk prediction and management. This evaluation moves the focus from the single disease requiring surgery to the patient’s overall functional status and long-term quality of life. The aim is to identify and modify vulnerabilities before surgery begins.
A Comprehensive Geriatric Assessment (CGA) is the central tool, involving a multidisciplinary team to evaluate several key domains.
- Cognition
- Functional status (ability to perform daily activities)
- Nutritional status
- Psychological state
A review of polypharmacy, the use of multiple medications, is also performed to identify and discontinue drugs that may increase surgical risk.
The results of the CGA directly inform prehabilitation, an optimization program in the weeks leading up to the procedure. This multi-component intervention includes tailored physical therapy to improve strength and endurance, nutritional counseling with protein supplementation, and psychological support to manage anxiety. Studies show that even modest improvements in physical metrics can translate to better post-operative results.
Specialized Post-Surgical Recovery
Recovery in geriatric surgery is managed through specialized protocols that prevent common, age-specific complications. A primary focus is preventing postoperative delirium, a sudden state of confusion that affects many older surgical patients and is linked to functional decline. Prevention plans are multifaceted, including non-pharmacological strategies like ensuring the patient has their glasses and hearing aids to maintain orientation.
Early mobilization is another cornerstone of recovery, as avoiding bed rest is paramount to preventing functional decline (the loss of ability to perform daily tasks). Nurses and physical therapists encourage patients to walk multiple times daily to maintain muscle strength and endurance. Pain management is also carefully controlled, often utilizing non-opioid medications to minimize the risk of confusion and other side effects.
Discharge planning for older adults begins on the day of admission, aiming for a safe and successful transition back to the community. This coordinated process involves a discharge planner who assesses the patient’s needs for rehabilitation services or home health support. By identifying potential deficits early, the team ensures resources are in place to maintain the patient’s independence and reduce the likelihood of readmission.