Why Surgery Is Higher Risk For Elderly Patients

Understanding the Risks Elderly Surgery Patients Face

Elderly Patients Can Have Great Surgery Outcomes.

The elderly are a unique patient population when it comes to having surgery.  It is also true that not all elderly patients are frail, in fact, some are very healthy and active, so it is important to keep individual differences in mind when discussing surgery and patients  of any age. 

Worldwide, people are living longer lives than ever before, which means that more people need surgery at an advanced age than in the past.

  Surgical skill and extensive medical research is helping make surgery safer for elderly patients, but there will always be risks associated with surgery, regardless of the age of the patient.  

Why are the Elderly at Higher Risk During Surgery?

There are multiple reasons that the elderly are a higher risk patient than other age groups.  First, the elderly are not as resilient as other age groups.  For example, when a child falls down, they may skin their knee or shed a few tears, but they are often as good as new within minutes.  When an elderly person falls down, they have a very high likelihood of breaking a hip or another bone.  The elderly also lose strength, bone mass and muscle mass with age.  

The elderly typically have less “reserve” than younger people, which is most obvious when they are ill.  The concept of reserve is complicated, but one example is that a young patient with pneumonia has a much more efficient respiratory and circulatory system that someone fifty years older.

  If the young person loses 20% of their ability to move oxygen through their body, they are still able to oxygenate their body well enough to survive and recover.  An older person will have lost some of their “reserve” over their lifetime, especially if they have a condition like chronic obstructive pulmonary disease, which makes a loss of 20% much more significant and far more likely to be life threatening when the patient was already living at 80%.


The presence of comorbidities is another cause of higher risk.  That means that an older person is more likely than a young person to have serious health conditions, such as diabetes, high blood pressure, breathing issues, high cholesterol, lack of exercise and coronary artery disease.  These conditions make it harder to recover from surgery.  The healthier an individual is going into surgery, the less risk they face during and after surgery.

Elderly patients are less able to clear the medications used before, during and after surgery.  This means that the patient will take longer to wake up after surgery and will likely be more sensitive to many other medications used during recovery.  The more medications a patient takes, which typically increases over the lifespan, will also increase the change of drug interactions.  Some elderly patients who had excellent mental clarity prior to surgery will have confusion and disorientation in the days or even weeks following surgery until their body is fully able to remove the medications from their body.

Elderly patients faces a longer length of time on the ventilator than a younger patient having the same procedure.  General anesthesia requires that the patient be intubated and a ventilator used to deliver oxygen to the lungs.  Weaning a patient from the ventilator is a very important part of the surgery process, and the quicker a patient can be extubated, the faster the recovery.

Psychologically, some elderly patients are less able to care for themselves before and after surgery.  An individual with dementia, for example, will have a much harder time following instructions and prescription dosage instructions than an individual with excellent mental faculties.  Even minor memories issues can cause great difficulties for the individual trying to recover at home.

Limited support during recovery is also a problem for the elderly, especially those living independently prior to surgery.  While living independently is what most elderly individuals desire, this can limit the amount of help available for day to day health management.  

The elderly are far more likely to need a long term care facility to get the assistance that they need to fully recover from surgery.  Rehabilitation centers provide frequent occupational and physical therapy to assist the patient in their recovery.  For patients who need this type of service, there is often a fear that they will never be able to return to their previous home environment.  While the goal of a temporary placement in a rehabilitation facility is to return a patient to their best possible function and their home, the fear of being permanently moved to a nursing facility is real, and for some, returning home is not possible. 


Perioperative Management of the Geriatric Patient.  Medscape.  Accessed March, 2015.  

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