Perioperative medication management for older people

Abstract

The average age of surgical candidates is increasing with the ageing population worldwide. Major surgery in older patients is associ-ated with a significant risk of complications due to physiologic changes occurring with ageing and individual patient factors such asfrailty, polypharmacy, and multimorbidity. Periodic medication review should be part of the routine management of all olderpatients, with the perioperative period presenting an opportune time for this review. Regular medications may need short-term mod-ification during the surgical period. Medications implicated in increasing risk of inducing or worsening delirium should be identifiedand withdrawal considered ahead of time. Perioperative commencement of medication aimed at reducing risk of other complica-tions, including cardiovascular events, should be considered on an individual basis, analysing risks and benefits. Comprehensivemedication review and careful planning through the perioperative period may enhance the prospects of recovery and reduce mor-bidity and mortality for older surgical patients.