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August 29, 2018

Surgery Risks for Older Adults: What to Know

Surgeries range from elective ones to those needed to save a life. And, no matter which type of surgery is taking place, older adults face more risks during the procedure.

Reasons why include, according to the American Society of Anesthesiologists, because older adults may have:

  • increased blood pressure
  • clogged arteries
  • heart disease
  • lung disease

These conditions can make it more likely for you to experience side effects during or after surgery, and can cause more potential complications during surgery, as well as afterwards. Plus, aging brains are more vulnerable to a couple of conditions related to anesthesia: postoperative delirium and postoperative cognitive dysfunction (POCD).

The first condition temporarily causes the patient to experience confusion, as he or she becomes disoriented. Memory and focus problems occur, as well, with symptoms often occurring a few days after the surgery itself. All is usually resolved within a week or so. The second condition is more serious, though, sometimes leading to long-term memory loss. This condition is more common in people with heart or lung disease, Alzheimer’s disease, Parkinson’s disease, and those who have already experienced a stroke.

And, in general, recovery from surgery can take longer than with younger patients.

Surgery for Older Adults: Is it Always Riskier?

The short answer? No. It isn’t.

So, if you’re an older adult who needs surgery (or a loved one does), what should you do? First, don’t panic. As an article in USNews.com points out, patients in their “late 60s, 70s and beyond can do just as well postoperatively as much younger patients. To determine surgical risk, it's important to look at the whole person beyond his or her birthdate.”

That’s because age, per se, doesn’t necessarily equal potential complications during surgery, or afterwards. What does matter includes:

  • possible frailty
  • chronic conditions
  • current medications
  • mental health status
  • where people live
  • how they function

Numerous studies examining surgery risks for older adults have been done. One large review of 44 studies of more than 12,000 people aged 80 and up found that risks for complications included:

  • frailty
  • smoking
  • mental impairment
  • depression

Related: These 6 Healthy Habits Could Prolong Your Life

How to Predict Increased Risk

Doctors can quickly, even precisely, determine levels of frailty using a hand-grip dynamometer, a device typically used to test the strength of athletes. The older adults facing surgery would simply squeeze the device and the doctor could estimate frailty and, therefore, “someone’s reserve for recovering from stress.” If a patient is clearly frail, it often makes sense to wait and watch if a proposed surgery is elective, especially if doing the surgery would not prolong life.

Methods used to decide if surgery for older adults is wise has changed over the years, now incorporating more of a patient’s personal values and goals for health. USNews.com shares two different sets of values and goals to demonstrate how they can play a role in doctors’ decisions:

Differing values and goals, then, may lead to different decisions about surgery.

Making Good Lifestyle Choices

Finally, as the Cleveland Clinic points out, making quality lifestyle choices can significantly reduce risk factors. These choices can “influence nutritional status and physical well-being” and they “also influence the concept of frailty, its relationship to surgical risk and the ability to tolerate surgery later in life.”

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