People older than 65 years are more likely to need elective and emergent orthopaedic surgery compared with younger persons. They also experience significant benefits. Although age-related changes increase the risk of perioperative complications, understanding those changes allows prevention or at least early recognition and treatment when problems arise. Because of comorbidities, older persons take more medications that need to be managed in the
perioperative period. Care could be simplified if patients were to bring their medications to the preoperative evaluation. Central nervous system sensitivity to certain
pain medications (
meperidine and
propoxyphene) means that these drugs are best avoided as good alternatives exist (
morphine and
oxycodone). Adverse reactions to drugs are an important cause of acute
confusion (
delirium) that often complicates orthopaedic care.
Early mobilization after surgery, avoiding certain drugs, avoiding restraints (including Foley
catheters), attending to hydration, promoting normal sleep, compensating for
sensory disorders, and stimulating daytime activities can prevent
delirium. Patients with
dementia are more likely to have
delirium develop and, like many older people, will present special challenges in communication and decision making. Including family members in discussions may be helpful in ensuring truly informed consent.