Geriatric anesthesia
Encyclopedia
Geriatric anesthesia is the branch of medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

 that studies anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...

 approach in elderly.

Origin

The perioperative
Perioperative
The perioperative period, less commonly spelled the peroperative period, is the time period describing the duration of a patient's surgical procedure; this commonly includes ward admission, anesthesia, surgery, and recovery. Perioperative generally refers to the three phases of surgery:...

 care of elderly patients differs from that of younger patients for a number of reasons. Some of these can be attributed to the changes that occur in the process of aging, but many are also caused by diseases that accompany seniority. The distinction between so-called normal aging and pathological changes is critical to the care of elderly people. Anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...

 and surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

 has become more common as the population survives longer. Preoperative management of the geriatric patients requires knowledges about changes associated with aging physiology
Physiology
Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...

 and its relation to surgery and anesthesia. Only experienced anesthetists can evaluate patients effectively and plan for their perioperative care to minimize complications. Comprehensive preoperative evaluation
Evaluation
Evaluation is systematic determination of merit, worth, and significance of something or someone using criteria against a set of standards.Evaluation often is used to characterize and appraise subjects of interest in a wide range of human enterprises, including the arts, criminal justice,...

 of an elderly individual's health status can be a very challenging aspect, especially for the young anesthetist. Sir William Osler
William Osler
Sir William Osler, 1st Baronet was a physician. He was one of the "Big Four" founding professors at Johns Hopkins Hospital as the first Professor of Medicine and founder of the Medical Service there. Sir William Osler, 1st Baronet (July 12, 1849 – December 29, 1919) was a physician. He was...

's aphorism "Listen to the patient, he'll give you the diagnosis" is as true in the elderly patient as it is in the young. But in the elderly several factors makes taking history more difficult and time-consuming.

Many differences can be seen in geriatric anesthesia. First, the preoperative evaluation of the geriatric patient is typically more complex
Complexity
In general usage, complexity tends to be used to characterize something with many parts in intricate arrangement. The study of these complex linkages is the main goal of complex systems theory. In science there are at this time a number of approaches to characterizing complexity, many of which are...

 than that of the younger patient because of the heterogeneity of this patient group and the greater number and complexity of comorbid conditions that usually accumulate with age. Perioperative functional status can be difficult to predict because many elderly patients have reduced preoperative function as a consequence of deconditioning
Deconditioning
Deconditioning is adaptation of an organism to less demanding environment, or, alternatively, the decrease of physiological adaptation to normal conditions...

, age-related disease, or cognitive impairment. This makes it difficult to adequately assess the patient’s ability to respond to the specific stresses associated with surgery. A common example is trying to determine cardiopulmonary reserve in a patient very limited by osteoarthritis
Osteoarthritis
Osteoarthritis also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion...

. Physiologic heterogeneity and decreased functional reserve are also manifested perioperatively. Normal aging results in changes in cardiac, respiratory, and renal physiology, and the response of the elderly patient to surgical stress is often unpredictable. The pharmacokinetics and pharmacodynamics of elderly and younger patients also differ; moreover, the elderly patient’s use of multiple medication
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...

s may alter homeostatic mechanisms.

Training and education programs

A Syllabus
Syllabus
A syllabus , is an outline and summary of topics to be covered in an education or training course. It is descriptive...

 on Geriatric Anesthesiology is available from the American Society of Anesthesiologists
American Society of Anesthesiologists
The American Society of Anesthesiologists is an association of physicians, primarily anesthesiologists, that share a common goal of raising the standard of the medical specialty of anesthesiology and the improvement of patient care by fostering and encouraging education through research and...



Online resources are also available as the Geriatric Anesthesiology Curriculum.

Graduate medical education in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

 is regulated by the Accreditation Council for Graduate Medical Education (ACGME). Each accredited specialty appoints members to an ACGME residency review committee (RRC) that is responsible for establishing and monitoring education requirements. The Anesthesiology RRC includes a requirement for instruction in geriatric care. Each program must provide “appropriate didactic instruction and sufficient clinical experience in managing problems of the geriatric population.” The published joint ASA/American Board of Anesthesiology content outline for in-training examinations also includes a section on “Geriatric Anesthesia/Aging: The Pharmacological Implications, MAC Changes and the Physiological Implications on Major Organ Systems.” These mandates make geriatric education a requirement for any program in anesthesiology. Surprisingly this is not the rule in all graduate medical education programs. A recent survey by the Association of Directors of Geriatric Academic Programs2 reviewed ACGME policies required by 100 nonpediatric RRCs. They found that only 27 of these programs had specific requirements for geriatric training; anesthesiology and pain management were two of these.

Organization and societies

The Society
Society
A society, or a human society, is a group of people related to each other through persistent relations, or a large social grouping sharing the same geographical or virtual territory, subject to the same political authority and dominant cultural expectations...

 for the Advancement of Geriatric Anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...

 (SAGA) is dedicated to improving the care of the older patient coming to surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

. It offers educational programs at its annual meeting as well as at meetings of other anesthesia societies. It also offer educational support for anesthesia training programs. The Age Anaesthesia Society is the UK equivalent of SAGA.

See also

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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