J Dhesi



This review is based on a presentation given by Dr Dhesi at the RCPE Care of the Elderly Symposium on 15 September 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 agerelated 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.

Keywords Comprehensive geriatric assessment, elderly, elective surgery, older people, pre-operative

Declaration of Interests No conflict of interests declared.