What perioperative considerations are especially important in elderly patients?

• A. Decreased physiologic reserve, polypharmacy, altered drug metabolism, delirium risk, slower wound healing; adjust dosing and monitor closely
• B. Increased physiologic reserve, polypharmacy is not an issue
• C. Elderly patients recover faster and require no dose adjustments
• D. They do not have delirium risk

Answer: (A)

In older adults, aging brings reduced physiologic reserve and changes in how the body handles drugs, which raises the risk of complications during and after surgery. Because of this, perioperative management focuses on adjusting medication dosing and monitoring closely. Polypharmacy increases the chance of drug–drug interactions and adverse effects, while altered pharmacokinetics and pharmacodynamics mean drugs can act more strongly or linger longer. Delirium risk is higher in this group, and wound healing tends to be slower, so plans often emphasize safer drug choices, careful dosing, and vigilant observation for confusion, sedation, respiratory or hemodynamic changes, and signs of infection or poor healing. Practical implications include thorough preop medication review, renal and hepatic function assessment, potential use of regional or multimodal analgesia to minimize systemic drugs, and proactive delirium prevention strategies.

Statements about increased physiologic reserve, no need for dose adjustments, faster recovery, or no delirium risk do not fit elderly perioperative reality, as they overlook these age-related changes and associated risks.