Approximately one‐third of elective surgical procedures are performed on adults aged 65 and older, and this population has a high burden of postsurgical morbidity and mortality. As the population ages, an increasing number of surgeries will be performed on these higher‐risk older adults. Traditional preoperative risk assessment tools, such as the American Society of Anesthesiologists (ASA) Physical Classification System, focus on medical factors associated with risk of adverse postoperative outcomes, but such tools do not account for risk factors unique to older adults such as malnourishment, impaired mobility, cognitive impairment, and frailty. Geriatric‐specific risk stratification models are better able to predict outcomes in older adults. A growing literature supports incorporation of tools used for geriatric assessment as part of the preoperative evaluation of older adults undergoing elective surgery. The Perioperative Optimization of Senior Health (POSH) program is an innovative care model developed at Duke University that aims not only to assess surgical risk in older adults accurately, but also to improve clinical outcomes through early multidisciplinary risk assessment and targeted interventions throughout the perioperative period.Cognitive ability is one of the most important perioperative risk indicators, and the prevalence of mild cognitive impairment (MCI) and dementia are expected to rise.
Journal of American Geriatrics Society – Wiley
Published: Jan 1, 2018
Keywords: ; ; ;
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