Seniors and Anesthesia

More than 16 percent of the U.S. population is older than 65 – and more than half of those will undergo at least one surgical procedure as senior citizens. In the coming years, the number of retirees, as well as the number of them having surgery, is expected to grow substantially.

Senior citizens face increased risks for complications during and after surgery. These may include 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 as having long-term problems with loss of memory, learning and the ability to concentrate.

Your anesthesiologist can discuss these risks with you and answer any questions you may have about having surgery as a senior citizen. In addition, TSA has many resources in this section to help prepare you for your procedure.

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Important Tips for Seniors and Their Caregivers Prior to Surgery

Get to Know Your Physicians

Before making a decision about surgery, find out whether it’s really necessary and what benefits it will provide. You also should talk to the anesthesiologist prior to surgery. Consider scheduling a consultation with a geriatric anesthesiology specialist, particularly if you are taking multiple medications. A geriatric anesthesiologist has specific experience caring for the elderly both preoperatively and postoperatively.

Please note that if you are depressed, it can be helpful to 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

Having a surgical procedure can bring up a lot of questions. You should bring a list of all your questions to your preoperative appointments, and don’t be afraid to keep asking until you feel you understand the answer. Some questions you may want to ask are:

What are the benefits of this procedure?
Where will the surgery be conducted?
What do I need to do before the procedure?
Can I continue to take my prescribed medication before the procedure?
Is there any medication I should not take?
Are you a geriatric specialist? If not, can you recommend one that I can consult with about my current medications and how they could affect my procedure?
At what point in the procedure will anesthesia be administered?
What type of anesthesia will I receive?
What are the advantages and disadvantages associated with the type of anesthesia I will receive?
How will the anesthesia be administered?
When you administer the anesthesia, will it hurt?
Who will be my anesthesia provider?
When can I speak with my anesthesiologist?
Are there any risks associated with anesthesia?
Will I wake up during the surgery?
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?
Are there risks to mental function with surgery anesthesia?
When will I wake up?
Will the anesthesia make me nauseated after the procedure?
Will I be in pain when I wake up from the procedure?
After the surgery, is it possible for me to be placed in a recovery room with a window?
When will I be discharged from the hospital?
What drugs should I avoid taking in the postoperative period?
How long should I wait before becoming mobile after my procedure?
Will I need someone to drive me home?
What do I do if I don’t feel well after I’m discharged? Who should I call?
When will I be completely healed?
Are any follow-up appointments necessary?

List Your Medications and Other Regularly Used Substances

You must provide your physician with a comprehensive list of all medications you take, including prescriptions, over-the-counter and herbal supplements, as some of these can affect your anesthesia and surgery. Sleeping pills, anxiety medications and alcohol withdrawal have been shown to increase the risk of postoperative complications in the elderly. Download and fill out the ASA’s Checklist of Emergency Contact Information and Current Medications. Be sure to have it with you at all times.

Learn Your Anesthesia Plan

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. He or she is your partner in the operating room, so feel free to ask as many questions as you need to in order to feel comfortable.

Get Your Support System in Place

Surgery can be an overwhelming experience, and family and friends can be an invaluable resource. They are especially important during the recovery period by doing such things as:

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

Stay Vigilant for Complications

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. Some suggestions to minimize this are:

Request that your physician conduct a cognitive exam during your preoperative interview. This will serve as a baseline for your physician to evaluate your mental function after surgery.
Ask your caregiver or support person to monitor your physical and mental activity closely following surgery. He or she should report any troubling behavior to you or your physician. 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.

Surgical Checklist for Seniors

Medication Checklist

Alzheimer's Disease and Anesthesia

Approximately 16 percent of the U.S. population is older than 65 years. Half of these individuals will have some form of surgery in their lifetime. One type of anesthesia commonly used during surgery is inhaled general anesthesia and, until recently, it was assumed to be nontoxic and readily eliminated at the end of surgery.

Recent cell and animal research suggests inhaled anesthesia may cause changes in the brain similar to those seen in individuals with Alzheimer’s disease. While these findings are concerning, it is important to recognize that the animals in these studies were given much higher and frequent doses of inhaled anesthesia than human patients would receive. For example, the animals received anesthesia as much as 25 times over a three-month period.

There is currently no human data to indicate that patients who receive inhaled anesthesia will be at an increased risk for Alzheimer’s disease. If you have any concerns, discuss your anesthetic options and risk factors with your anesthesiologist prior to surgery.