Geriatric anesthesia (or geriatric anaesthesia) is the branch of

medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...

that studies

anesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), ...

approach in

elderly Old age refers to ages nearing or surpassing the life expectancy of human beings, and is thus the end of the human life cycle. Terms and euphemisms for people at this age include old people, the elderly (worldwide usage), OAPs (British usage ...

Origin

The

perioperative The perioperative period is the time period of a patient's surgical procedure. It commonly includes ward admission, anesthesia, surgery, and recovery. Perioperative may refer to the three phases of surgery: preoperative, intraoperative, and posto ...

care of

patients differs from that of younger patients for a number of reasons. Some of these can be attributed to the changes that occur in the process of

aging Ageing ( BE) or aging ( AE) is the process of becoming older. The term refers mainly to humans, many other animals, and fungi, whereas for example, bacteria, perennial plants and some simple animals are potentially biologically immortal. In ...

, but many are also caused by

diseases A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that ar ...

that accompany seniority. The distinction between so-called normal aging and pathological changes is critical to the care of elderly people.

Anesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), ...

and

surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

has become more common as the population survives longer.

Perioperative The perioperative period is the time period of a patient's surgical procedure. It commonly includes ward admission, anesthesia, surgery, and recovery. Perioperative may refer to the three phases of surgery: preoperative, intraoperative, and posto ...

management of the geriatric patients requires knowledges about changes associated with aging

physiology Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...

and its relation to surgery and anesthesia. Only experienced anesthetists can evaluate patients effectively and plan for their perioperative care to minimize complications. Comprehensive preoperative

evaluation Evaluation is a systematic determination and assessment of a subject's merit, worth and significance, using criteria governed by a set of standards. It can assist an organization, program, design, project or any other intervention or initiative ...

of an elderly individual's health status can be a very challenging aspect, especially for the young anesthetist. Sir

William Osler Sir William Osler, 1st Baronet, (; July 12, 1849 – December 29, 1919) was a Canadian physician and one of the "Big Four" founding professors of Johns Hopkins Hospital. Osler created the first Residency (medicine), residency program for spec ...

's aphorism "Listen to the patient, he'll give you the diagnosis" is as true in the elderly patient as it is in the young. But in the elderly several factors makes taking history more difficult and time-consuming. Many differences can be seen in geriatric anesthesia. First, the preoperative evaluation of the geriatric patient is typically more

complex Complex commonly refers to: * Complexity, the behaviour of a system whose components interact in multiple ways so possible interactions are difficult to describe ** Complex system, a system composed of many components which may interact with each ...

than that of the younger patient because of the

heterogeneity Homogeneity and heterogeneity are concepts often used in the sciences and statistics relating to the uniformity of a substance or organism. A material or image that is homogeneous is uniform in composition or character (i.e. color, shape, siz ...

of this patient group and the greater number and complexity of

comorbid In medicine, comorbidity - from Latin morbus ("sickness"), co ("together"), -ity (as if - several sicknesses together) - is the presence of one or more additional conditions often co-occurring (that is, concomitant or concurrent) with a primary c ...

conditions that usually accumulate with age. Perioperative

functional status Functional may refer to: * Movements in architecture: ** Functionalism (architecture) ** Form follows function * Functional group, combination of atoms within molecules * Medical conditions without currently visible organic basis: ** Functional sy ...

can be difficult to

predict A prediction (Latin ''præ-'', "before," and ''dicere'', "to say"), or forecast, is a statement about a future event or data. They are often, but not always, based upon experience or knowledge. There is no universal agreement about the exact ...

because many elderly patients have reduced preoperative function as a consequence of

deconditioning Deconditioning is adaptation of an organism to less demanding environment, or, alternatively, the decrease of physiological adaptation to normal conditions. Decondition may result from decreased physical activity, prescribed bed rest, orthopedic cas ...

, age-related disease, or

cognitive impairment Cognitive deficit is an inclusive term to describe any characteristic that acts as a barrier to the cognition process. The term may describe * deficits in overall intelligence (as with intellectual disabilities), * specific and restricted defici ...

. This makes it difficult to adequately assess the patient’s ability to respond to the specific

stress Stress may refer to: Science and medicine * Stress (biology), an organism's response to a stressor such as an environmental condition * Stress (linguistics), relative emphasis or prominence given to a syllable in a word, or to a word in a phrase ...

es associated with surgery. A common example is trying to determine cardiopulmonary reserve in a patient very limited by

osteoarthritis Osteoarthritis (OA) is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone which affects 1 in 7 adults in the United States. It is believed to be the fourth leading cause of disability in the w ...

. Physiologic heterogeneity and decreased functional reserve are also manifested perioperatively. Normal aging results in changes in cardiac, respiratory, and renal physiology, and the response of the elderly patient to surgical stress is often unpredictable. The pharmacokinetics and

pharmacodynamic Pharmacodynamics (PD) is the study of the biochemical and physiologic effects of drugs (especially pharmaceutical drugs). The effects can include those manifested within animals (including humans), microorganisms, or combinations of organisms (for ...

s of elderly and younger patients also differ; moreover, the elderly patient’s use of multiple

medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and re ...

s may alter homeostatic mechanisms.

Training and education programs

Syllabus A syllabus (; plural ''syllabuses'' or ''syllabi'') or specification is a document that communicates information about an academic course or class and defines expectations and responsibilities. It is generally an overview or summary of the curric ...

on Geriatric Anesthesiology is available from the

American Society of Anesthesiologists The American Society of Anesthesiologists (ASA) is an educational, research and scientific association of physicians organized to raise the standards of the medical practice of anesthesiology and to improve patient care. As of 2021, the organizat ...

. Online resources are also available as the Geriatric Anesthesiology Curriculum. Graduate medical education in the

United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...

is regulated by the Accreditation Council for Graduate Medical Education (ACGME) and the

American Osteopathic Association Bureau of Osteopathic Specialists Established in 1939, the American Osteopathic Association Bureau of Osteopathic Specialists (AOABOS) is a non-profit umbrella organization for 18 medical specialty boards in the United States. Along with the American Board of Medical Specialties (A ...

(AOABOS). Each program must provide “appropriate didactic instruction and sufficient clinical experience in managing problems of the geriatric population.” The published joint ASA/American Board of Anesthesiology content outline for in-training examinations also includes a section on “Geriatric Anesthesia/Aging: The Pharmacological Implications, MAC Changes and the Physiological Implications on Major Organ Systems.” These mandates make geriatric education a requirement for any program in anesthesiology. This is not the rule in all graduate medical education programs. A recent survey by the Association of Directors of Geriatric Academic Programs reviewed ACGME policies required by 100 nonpediatric programs. They found that only 27 of these programs had specific requirements for geriatric training; anesthesiology and pain management were two of these.

Organization and societies

The

Society A society is a group of individuals involved in persistent social interaction, or a large social group sharing the same spatial or social territory, typically subject to the same political authority and dominant cultural expectations. Socie ...

for the Advancement of

Geriatric Geriatrics, or geriatric medicine, is a medical specialty focused on providing care for the unique health needs of older adults. The term ''geriatrics'' originates from the Greek language, Greek γέρων ''geron'' meaning "old man", and ιατ ...

(SAGA) is dedicated to improving the care of the older patient coming to

. It offers educational programs at its annual meeting as well as at meetings of other anesthesia societies. It also offer educational support for anesthesia training programs. The Age Anaesthesia Society is the UK equivalent of SAGA.Age Anaesthesia Society in the UK
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References

External links

GERIATRIC ANESTHESIA by David J Cook

The Society for the Advancement of Geriatric Anesthesia (SAGA)

Age Anaesthesia Society in the UK

Geriatric Anesthesiology Curriculum

Useful Geriatric Anesthesiology Resources

* ttps://web.archive.org/web/20080515205758/http://www.asahq.org/Newsletters/2004/05_04/barnett05_04.html Geriatric Education: ‘Start Low, Go Slow’, ASA NEWSLETTER {{DEFAULTSORT:Geriatric Anesthesia Anesthesia Geriatrics