Essential assessment for surgical elders: a geriatric preoperative evaluation tool

Adults today are living longer, many with multiple comorbidities, and having surgeries in numbers unprecedented in history. In 2010, 51.4 million surgeries were done in the United States with 19 million of those on adults ages >65. This increase is due to advances in medical science and surgical technology that coincides with the aging of the baby boomer generation. This phenomenon has resulted in an increase of adverse postoperative outcomes in older adults compared to the general population. A baseline preoperative evaluation is a critical source of information for surgeons and anesthesiologist, as well as for postoperative nurses who care for the anesthetized and recovering older adult patient. The Optimal Preoperative Assessment of the Geriatric Surgical Patient focuses on the evaluation of 13 identified problem domains specific to older patients. While this guideline is a gold standard, the amount of time and resources required to complete it makes it impractical for use in many preoperative clinic settings. An adapted version may still benefit the older surgery patient. The Essential Assessment of Surgical Elders (EASE) guideline presented here evaluates five core domains, using a standard database containing questions that screen for the other eight domains. EASE will allow identification of physiological changes in the elderly often overlooked by a standard assessment and can alert the preoperative registered nurse to conditions requiring further evaluation. The number of geriatric surgeries is projected to grow. Improving geriatric preoperative evaluation can prevent adverse postoperative events and improve quality of life outcomes for the older adult patient population.