Therapeutic Advances in the Perioperative Period for Older Adults : American Journal of Therapeutics

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Systematic Review and Clinical Guidelines

Therapeutic Advances in the Perioperative Period for Older Adults

Solomon, Philip MD; Calabrese, Brooke MD; LaVine, Sean MD*

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American Journal of Therapeutics 25(1):p e81-e91, January/February 2018. | DOI: 10.1097/MJT.0000000000000668



As the population of the United States continues to increase, particularly older than 65 years, the number of adults older than 65 years undergoing surgeries should increase as well.

Areas of Uncertainty: 

The inpatient perioperative care of the segment of the population older than 65 years has unique challenges that are not currently well studied or outlined.

Therapeutic Advances: 

There have been encouraging data on preoperative risk assessments and screening for geriatric patients in recent years. Although younger patients may not have improved outcomes from a full preoperative evaluation, there are potential benefits for elderly population. However, this must be weighed against the risks of overscreening, unnecessary testing, and potentially dangerous delays in time to surgery. The American College of Cardiology/American Heart Association perioperative guidelines should continue to be used in preoperative evaluation of older adults, as it decreases unnecessary testing. Frailty screening should be done in all geriatric patients to help predict postoperative complications and quality of life. In regards to perioperative medication management, some recommendations are strong and based on high-quality evidence (ie, continuation of beta-blockers) and should be followed in the geriatric population. However, high-quality evidence is lacking for many medication classes, particularly in the geriatric patient population.


Older adults pose a unique set of challenges during the perioperative period. Therapeutic advances continue to rapidly evolve in the field and should be used in conjunction with a robust individualized risk assessment to help optimize geriatric patients' postoperative outcomes.

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