Complications particular to the elderly

Life expectancy continues to increase as does the age of those patients undergoing surgery. These patients have more health problems and are at higher risk for perioperative complications when compared to younger patients, particularly, deep vein thrombosis, immobility, functional loss, delirium, postoperative cognitive dysfunction (POCD), urinary tract infection, falls, and frailty. Prevention of complications is of principal importance as this population has greater morbidity and mortality from these complications. However, the complications that do occur must be diagnosed and treated expeditiously to prevent further harm in this population with decreased functional reserve. Elderly patients are at increased risk for deep vein thrombosis secondary decreased mobility, poor cardiovascular health, and less fibrinolytic activity. The prevention of pulmonary embolus is of paramount importance as the elderly are six times more likely to die from this complication. Functional loss and immobility are prevalent in the elderly secondary to arthritis, musculoskeletal problems, and quicker debilitation which leads to pressure ulcers, osteoporosis, DVT, pneumonia, aspiration, dehydration, depression, delirium, and atelectasis. The incidence of delirium can be as high as 20 %, costs four billion dollars per year, and can be precipitated by decreased oxygen delivery to cerebral tissue, infection, alterations in electrolytes, anesthetic metabolism variations, and is best treated by prevention. Once delirium is diagnosed a cause must be identified, treated, and the patient should be protected from harm such as falls and pulling out tubes or lines. POCD, manifested as thought impairment, trouble finding words, short-term memory issues, difficulty with daily activities, but no alteration in sensorium, may be seen in half of postoperative elderly patients and may persist well beyond the initial hospital stay. Urinary tract infection may be difficult to diagnose as the presentation in the elderly is different as confusion or delirium may be the only symptom and, if not recognized, can be a significant source of morbidity. Frailty, a syndrome characterized by decreased health and vast impairments, increases mortality by four times when compared to patients without this syndrome. In the following chapter, each of these complications will be discussed in depth including complication presentation, diagnosis, treatment, and prevention.