Incorporating shared decision making into perioperative care of older adults

Purpose of review Older patients represent a growing and significant portion of the surgical population. Due to age-related changes in physiology and the presence of multiple comorbidities, older patients are more likely to experience complications, functional decline, increased care needs, and decreased independence following surgery. Identification of risk factors preoperatively permits early use of prevention strategies to mitigate risk, which translates into optimal postoperative outcomes. Recent findings Preexisting cognitive impairment is identified in 30% of patients undergoing elective surgery, and is associated with long-term postoperative cognitive dys-function. Assessment for the presence of comorbidities, medication history, nutritional status, and frailty is critical. Patient preference, treatment goals, and advanced direc-tives should be discussed and documented preoperatively. Post-hospital disposition requires significant planning, with emphasis on efficient transition of care and early post-op-erative follow-up. Summary Multidisciplinary perioperative assessment and appropriate management of the elderly surgical population are of paramount importance.

Duke Scholars

Author Shelley R McDonald Medicine, Geriatrics and Palliative Care

Author Mitchell Tod Heflin Medicine, Geriatrics and Palliative Care

Author Sandhya Anand Lagoo-Deenadayalan Surgery, Minimally Invasive Surgery