Perioperative Assessment of and Care for the Elderly and Frail

Older adults should undergo the standard risk stratification based on the history, physical examination, and diagnostic tests, but the assessment should be supplemented with geriatric-specific evaluations including frailty, cognitive status, nutrition, functional status, and risk of delirium. Management of frail older adults provides many challenges to the surgical team. A multidisciplinary patient-centered approach implementing evidence-based interventions and hands-on rather than consultative care with follow-up may improve postoperative outcomes. These pathways should include geriatric assessment early in the course of the surgery planning to ensure sufficient time for optimization. Preoperative assessment should identify elderly patients at high risk for adverse outcomes.