Preparing Seniors for Surgery

Research indicates that seniors are at an increased risk for experiencing complications both during and after surgery. In an effort to ensure that senior patients have the best possible outcome, the American Society of Anesthesiologists (ASA) has developed a set of tips to help prepare senior citizens and their caregivers for surgery.

According to the Society for the Advancement of Geriatric Anesthesia (SAGA), “the elderly are more sensitive to drugs, and often in an unpredictable way. It is more difficult to find the right amount of drug to use, and it is easy to have more dramatic undesired effects of a drug. There are many reasons for the increased sensitivity, including the fact that the older brain is more sensitive to some drugs than young people. In other words, the same amount of drug has a bigger effect in the elderly. Some drugs achieve higher concentrations in the blood in elderly patients than in young patients, so more drug gets to the brain and heart and so the effects are greater. Lastly, most drugs are eliminated from the body more slowly in the elderly so the drug effects last longer in older people.”

“Two complications that may occur in elderly patients following surgery are postoperative delirium, a condition that causes some patients to become confused and disoriented for up to a week after surgery, and postoperative cognitive dysfunction (POCD), which is defined for patients as having long-term problems with memory loss, learning and the ability to concentrate,” said Dr. Monk. “In an effort to help minimize the likelihood of cognitive problems after surgery, seniors are encouraged to undergo a cognitive exam before surgery and avoid taking certain drugs.”

Additional information and resources are available at at the ASA’s Website dedicated to educating and empowering the public about anesthesiology.

Tips to Help Seniors and Caregivers Prepare for Surgery

Get to know your physicians. When considering whether or not to have surgery, find out if the surgery is really necessary and what benefits it will provide. You should also talk to the anesthesiologist prior to surgery and consider scheduling a consultation with a geriatric specialist, particularly if you are taking multiple medications. A geriatric anesthesiologist specializes in treating the geriatric patient, and he or she has specific experience caring for the elderly both preoperatively and postoperatively.

Lastly, if you may be depressed, please see a psychiatrist and seek treatment prior to surgery. This is extremely important because depression has been tied to higher mortality rates in surgical patients. The psychiatrist, in consultation with other members of the surgical team, may also recommend minimizing the use of sedatives, especially long-acting drugs such as benzodiazepines.

Don’t be afraid to ask questions about the procedure. Having a surgical procedure can bring up a lot of questions, and it is important to bring that list of questions to your preoperative appointments in order to ensure you are as educated and confident as possible. Important questions to ask include:

Can you tell me more about the procedure?
Where will the surgery be conducted?
What do I need to do before the procedure?
At what point in the procedure will anesthesia be administered? What type of anesthesia will I receive?
Who will be my anesthesia provider?
When can I speak with my anesthesiologist?
As a senior citizen, are there any specific complications associated with anesthesia and this procedure that I should be aware of?
How long will the entire surgery take?
Will the anesthesia make me nauseous after the procedure?
Will I be in pain when I wake up from the procedure?
When will I be discharged from the hospital?
When will I be completely healed?

Make sure to prepare for your preoperative conversation with your physician. Once you’ve made the decision to undergo a surgical procedure, your physician will schedule a preoperative meeting to make sure the entire procedure is both as safe and as comfortable for you as possible. You will likely discuss the following with your physician at that time:

Medical history, including past experiences with depression
Any known allergies
Dietary restrictions you will need to be aware of leading up to the procedure
Lab tests and diagnostic studies you will undergo in preparation for surgery
Type of anesthesia that will be administered during the procedure
Potential complications associated with the procedure – both physical and mental
Status of family and friend support network leading up to, during and after surgery
Any concerns or anxieties you might have about the procedure

Provide your physician with a comprehensive list of medications and substances you take regularly. To help identify those substances that may affect your anesthesia and surgery, it is very important that you provide your physician with a complete list of all medications, including prescription, over-the-counter or natural. Specifically, sleeping pills, anxiety medications and alcohol withdrawal have been shown to increase the risk of postoperative complications in the elderly, such as delirium. In order to be prepared, fill out, print and carry a medication record with you when you visit your physician. The form will help you keep track of your personal medical history, prescriptions, allergies, emergency contacts and the information of your primary and secondary physicians.
Inform yourself about the type of anesthetic that will be used during surgery and its potential physical and mental effects. Ask your anesthesiologist about the type of anesthesia that will be used during your procedure – general, regional or local, as well as potential effects of the medication.
Reach out to family and friends for support and remember that caregivers can help you deal with surgical complications. Surgery can be an overwhelming experience, and family and friends can be surprisingly helpful. You may also need help during the recovery period, and your support network will be essential during that time. Caregivers can help make you feel as comfortable as possible following surgery by:

Ensuring your eyeglasses, hearing aid, etc. will be made available as soon as possible following the procedure
Placing a calendar in your room so you know what day of the week it is
Putting photos of your family in your room
Requesting a recovery room with a window, if possible, so you know if it is day or night

Your caregivers should help you watch for cognitive problems after surgery. After a successful surgical outcome, it is easy to fall back into a daily routine and forget to watch out for post-surgical complications, which may include cognitive problems, or issues with mental function. To help prevent cognitive problems, caregivers are encouraged to do the following:

Request that your physician conducts a cognitive exam during your preoperative interview
This will serve as a baseline for your physician to evaluate your mental function after surgery
Monitor your physical and mental activity closely following surgery to prevent complications
Ensure you avoid taking drugs with long-acting central nervous system effects, such as benzodiazepines, which are frequently used to treat insomnia, anxiety, seizures and muscle spasms

The American Society of Anesthesiologists

Anesthesiologists: Physicians providing the lifeline of modern medicine. Founded in 1905, the American Society of Anesthesiologists is an educational, research and scientific association with 43,000 members organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient. For more information on the field of anesthesiology, visit the American Society of Anesthesiologists.