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Preoperative assessment and optimization of the older surgical patient 

Preoperative assessment and optimization of the older surgical patient
Chapter:
Preoperative assessment and optimization of the older surgical patient
Author(s):

Jugdeep Dhesi

DOI:
10.1093/med/9780199604999.003.0015
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date: 20 August 2019

This chapter focuses on the preoperative assessment of the elderly and then the importance of using this assessment to optimize the patient for surgery. Key points in the assessment process are underlined, such as difficulties in eliciting a clear history, appropriate clinical examination, choosing which investigations will provide useful information to guide optimization as well as surgical and anaesthetic procedural decisions. The reasons for a more comprehensive assessment in the elderly are reviewed against the background of their increased risk of complications, including death. Comprehensive geriatric assessment (CGA) is discussed with the variety of risk assessment tools available. Optimization then follows and this chapter reviews the common cognitive comorbidities as well as malnutrition and frailty. Models of care including integrated schemes with geriatric involvement and physiotherapy and occupational assessment preoperatively are discussed.

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