Perioperative assessment and care of older patients
Preoperative geriatric assessment (frailty, cognition, function, nutrition, goals), cardiac risk testing under ESC 2022, which medicines to stop or continue including SGLT2 inhibitors and the 2025 GLP-1 receptor agonist advice, postoperative delirium prevention, troponin surveillance for myocardial injury, and geriatric co-management, with a worked example.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Older people have more postoperative complications, mostly geriatric syndromes: delirium, functional decline, falls, pressure injury, urinary retention and loss of independence. These outweigh cardiac events in frequency.
- Chronological age predicts outcomes less well than frailty, cognition and function. Screen everyone 65 or over with the Clinical Frailty Scale (CPOC/BGS 2021) and a cognitive screen (Mini-Cog).
- Shared decision-making: discuss the likely outcomes that matter (survival, function, discharge home or to care) and the non-operative alternative. Assess capacity and involve substitute decision makers early.
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Sources
- PG07 Guideline on pre-anaesthesia consultation and patient preparationAU/NZAustralian and New Zealand College of Anaesthetists, 2024
- ADS-ANZCA Perioperative Diabetes and Hyperglycaemia Guidelines (Adults)AU/NZAustralian Diabetes Society and ANZCA, 2022
- 2025 ADS/ANZCA/GESA/NACOS clinical practice recommendations on the peri-procedural use of GLP-1/GIP receptor agonists (Hocking SL et al. Anaesth Intensive Care 2025;53:300-6)AU/NZAustralian Diabetes Society, ANZCA, GESA and NACOS, 2025
- Optimal preoperative assessment of the geriatric surgical patient: best practices guideline from ACS NSQIP and AGS (Chow WB et al. J Am Coll Surg 2012;215:453-66)American College of Surgeons and American Geriatrics Society, 2012
- Optimal perioperative management of the geriatric patient: best practices guideline from ACS NSQIP and AGS (Mohanty S et al. J Am Coll Surg 2016;222:930-47)American College of Surgeons and American Geriatrics Society, 2016
- Practice advisory for perioperative care of older adults scheduled for inpatient surgery (Sieber F et al. Anesthesiology 2025;142:22-51)American Society of Anesthesiologists, 2025
- Guideline for perioperative care for people living with frailty undergoing elective and emergency surgeryCentre for Perioperative Care and British Geriatrics Society, 2021
- 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery (Halvorsen S et al. Eur Heart J 2022;43:3826-924)European Society of Cardiology, 2022
- Update of the ESAIC evidence-based and consensus-based guideline on postoperative delirium in adult patients (Aldecoa C et al. Eur J Anaesthesiol 2024;41:81-108)European Society of Anaesthesiology and Intensive Care, 2024
- Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery (Evered L et al. Br J Anaesth 2018;121:1005-12)AU/NZBritish Journal of Anaesthesia, 2018
- Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE) (Lancet 2008;371:1839-47)Lancet, 2008
- Association of postoperative high-sensitivity troponin levels with myocardial injury and 30-day mortality (VISION) (Devereaux PJ et al. JAMA 2017;317:1642-51)JAMA, 2017
- Effect of electroencephalography-guided anesthetic administration on postoperative delirium (ENGAGES) (Wildes TS et al. JAMA 2019;321:473-83)JAMA, 2019
- Proactive care of older people undergoing surgery (POPS): designing, embedding, evaluating and funding a comprehensive geriatric assessment service (Harari D et al. Age Ageing 2007;36:190-6)Age and Ageing, 2007
- Last updated
- 14 November 2026
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