The Geriatrician: From Patient-Centered Perioperative Care to Geriatric Syndromes Management

In the last two decades an increasing proportion of older patients is undergoing surgery worldwide. Although more prone to geriatrics perioperative complications, older patients may equally benefit from surgical intervention compared to younger people. Indeed, is not chronological age per sè which confers a poor prognostic profile, but the impact of age-related pathophysiological changes combined with the burden of multimorbidity on patient’s health and functional status. Fundamental objectives for clinical decision making and optimization of perioperative care are early recognition of frail and vulnerable patients; assessment of patients’ and caregivers’ goals and preferences; prevention of perioperative geriatrics complications including but not limited to postoperative delirium, malnutrition, acute sarcopenia, prolonged bed rest and physical disability; timely and appropriate discharge planning ensuring continuity of care after hospital discharge. To achieve these key goals a multidisciplinary teamwork, guided by the results of comprehensive geriatric assessment, is highly recommended. Before planned surgery, and possibly also in urgent conditions, a preliminary team consultation, including surgeon, anesthesiologist, geriatrician, patient, and caregiver should be performed. This chapter summarize fundamental steps in perioperative assessment and care of older patients candidate to general surgery.