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This innovative, comprehensive book covers the key elements of perioperative management of older patients. The book's chapter structure coincides with the clinical path patients tread during their treatment, from preoperative evaluation to post-hospital care. Epidemiological aspects and aging processes are illustrated, providing keys to understanding the quick expansion of geriatric surgery and defining the clinical profile of older surgical patients in a cybernetic perspective. Preoperative evaluation and preparation for surgery, including medication reconciliation and pre-habilitation, are developed in the light of supporting decision-making about surgery in an evidence-based and patient-focused way. Intra- and postoperative management are discussed, aiming to tailor anesthetic, surgical and nursing approaches to specific patients' needs, in order to prevent both general and age-related complications. This volume also addresses issues relevant to geriatric surgery, from different organizational models to clinical risk management and systems engineering applied to hospital organization.
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Older patients carry some of the highest risks of suffering an adverse event or death following anesthesia and surgery. They are inherently vulnerable, presenting with numerous comorbidities and reduced physiological reserve, requiring 'gero-centric' perioperative care for everything from routine eye surgery to major cardiac surgeries. Dementia, frailty, and the need for palliative care and pain management for the orthopedic patient are important areas requiring special consideration in this group. This book provides a general overview of these topics for those healthcare providers who may not have extensive knowledge of this patient population, while at the same time offering practical tips for the more experienced clinician. Chapters cover the spectrum of perioperative care including preoperative management of comorbid conditions, intraoperative anesthetic management, postoperative pain control, and a primer on advanced directive discussions. This book is appropriate not only for anesthesiologists but for any perioperative physician caring for the older patient.
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