Journal Mobile

J Dhesi
Journal Issue: 
Volume 40: Issue 4: 2010




Older people have much to gain from surgery, but pose a significant challenge  not  only  in  emergency  surgery  but  also  in  elective  surgery.  Despite significant progress in the care of older surgical patients, they remain more likely to ‘fail’  pre-assessment  and  have  higher  rates  of  post-operative  complications than  younger  people. The  evidence  suggests  that  this  is  a  consequence  of  age-related  increases  in  co-morbidities  and  reduction  in  physiological  reserve. Numerous studies have demonstrated improvements in outcome when individual co-morbidities  are  appropriately  assessed  and  optimised.  However,  current models  of  care  do  not  allow  for  the  translation  of  this  evidence  into  routine clinical practice, particularly in those with complex co-morbidities and functional dependence. This article explores the reasons for poor outcome in older people and describes an alternative model of care for the older elective surgical patient.