[Preoperative Evaluation and Arrangements: The Elderly Patient].

With a constantly growing portion of elderly within our population and the advances of modern medicine, surgery on aged and very aged patients has become a daily hospital routine. Due to the physical and mental features of ageing these patients face special perioperative risks. They display a higher rate of complications, morbidity and cognitive deficits which might in the end lead to persisting need of care. Even in the healthy elderly, most organ functions are "physiologically" instable or deficient and the homeostasis of health and disease is fragile. The preoperative evaluation of the aged patient has to be extended towards risk factors and pathologic pre-conditions which derive especially from high age and are so far not determined by a mere "fit-for-anaesthesia?" EVALUATION: This includes assessment of frailty and functional status as well as the evaluation of pre-existing cognitive deficits, malnutrition and polypharmacy. Prevention of postoperative cognitive deficits and delirium is an important goal of medical therapy and requires i. a. omission of benzodiazepines, BIS-controlled anaesthesia, focus on patient's comfort and orientation and inclusion of close relatives and confidants in all processes. Considering all this, an elderly patient might require more time than usually given to be well prepared for anaesthesia, surgery and the postoperative course. The altered physiology and the special risk profile of the aged patient demand special attention and time throughout the perioperative phase. With an increasing number of elderly presenting for surgery, it is likely that more age-adapted structures and processes become implemented in our hospitals. Georg Thieme Verlag KG Stuttgart · New York.