As we progress through life we are met with different challenges at different ages. The first time we rode a bike, when we learned to swim, going for the job interview, and now getting surgery. Does your age at the time of surgery add risks? With surgery and the elderly does age matter?
Does Age Matter – Not to this 100 Year Old Yoga Instructor?
Does someone’s age determine how well surgery will go? The answer is yes and no. The term elderly has been known to pertain to those individuals 65 years of age and older. However, within that demographic, there is a wide range of physical, mental and physiological health. We have all heard of someone in their 70s doing what a 30-year old wouldn’t be able to do. Harriette Thompson participated in marathons into her 90s – something I could say, with some certainty, I couldn’t do at my age.
Another example is Tao Porchon-Lynch who teaches yoga at 100 years of age. And though most of us won’t achieve this type of fitness, it does bring to light that someone in their 70s might be a better candidate for surgery than someone in their 30s. A patient’s age should be treated as a fact, not with unfair judgment, and no particular chronological age in itself is a contraindication to surgery. More than the age of the patient their health prior to surgery may be more a concern than age itself.
Risk Factors for This Age Group
Diseases such as hypertension (high blood pressure), diabetes and coronary heart disease are more likely to be present in the elderly than younger patients. Heath issues such as these are the real culprits of the increased risk of surgery more than age itself. Any chronic illness or disease, as well as, any other health issues should be addressed with the surgeon, primary care physician, as well as, any specialty doctors before surgery.
Hypertension is a disease that brings with it inherent risks in surgery. Some of these risks are a heart attack, when the flow of blood to an area of the heart is blocked, kidney problems, stroke, and congestive heart failure when the heart’s pumping power is weaker than normal. During surgery your blood pressure will be monitored by the anesthesiologist and if needed medication will be administered. There are times prior to surgery you are told to stop medication – sometimes you will be told to continue so it’s important to find out your doctor’s wishes before your surgery date.
The increased risks from surgery for people with diabetes include infection including urinary tract infection, sepsis, and infection of the incision site. There is also increase risk of having slow healing of the incision and also pneumonia. If you have diabetes, it’s important that you have your blood glucose level under control before surgery.
Patients with coronary heart disease are at particular risk for perioperative (the time around surgery) myocardial ischemia which is when there is a reduced blood flow to the heart muscle reducing the amount of oxygen the heart receives. Also, tachycardia disorder, a common type of heart rhythm disorder (arrhythmia) is when the heart beats faster than normal while at rest and hypertension during the operation may increase cardiac work and decrease coronary blood flow, causing ischemia or a restriction of blood supply to tissues. Your surgeon might have you get clearance from your heart specialist before surgery.
Complications from Anesthesia
Cognitive issues, including delirium, confusion and postoperative cognitive dysfunction (POCD), are seen at a greater frequency after surgery in those who are elderly. Patients suffering from delirium may be agitated, withdrawn, confused, disoriented and unaware of surroundings. There also may be problems with memory and paying attention. This complication usually displays itself anywhere from upon awakening from anesthesia up to 3 days post-surgery.
POCD, or postoperative cognitive dysfunction, manifests itself with a decrease in mental performance. This can lead to long-term memory loss and make it difficult to learn, concentrate and think. However, in most patients, this complication usually resolves itself in 3 months and by 2 years post-op, the percentage of patients still experiencing POCD is only 1%.
Steps to Take Prior to Surgery
As for all surgery, including those for the elderly, there should be steps taken before surgery. In another article I wrote entitled, Preparing for Surgery Checklist I go over what you should do before surgery. The list is similar for the elderly.
- Consult with your surgeon and any doctors that you may be seeing for health issues.
- Know the ins and outs of your medical insurance.
- Have important documents completed or updated?
- Get yourself ready.
- Purchase or borrow those post-surgery supplies you will need.
- Hire a health aid or nurse if needed.
In addition to the steps above, prepare your home to ensure safety. If your home has stairs, you may want to make a recovery area downstairs. Declutter the home so the risk of tripping or falling is reduced. Be sure electrical cords are not in pathways. Have a few nightlights in hallways, bedrooms, and bathrooms so you’ll be able to see better at night. Once you get to a light switch turn it on, again to avoid tripping. Keep items that are needed nearby including, phone, water, walker, cane, grabber, watch, glasses, books, hearing aid and a bell to summon for needs also comes in handy.
So, Is Age a Risk to Surgery?
Age, in itself, is not a risk factor to surgery, however, some of the health issues seen more commonly in the elderly can be. Diabetes, hypertension, coronary heart disease are risk factors and communication with your physician is essential. Most patients come through surgery just fine but there is an increased risk of delirium and POCD seen in elderly patients but most times this is temporary and will resolve itself as one moves through recovery. Whether surgery should be delayed because of these added risk factors should be a discussion you have with your physician. Being prepared before surgery is recommended and will help relieve some of the stress associated with surgery thus making the recovery process more comfortable.