Preoperative assessment of older adults.

Caring for older patients who need surgery presents challenging medical situations. The clinical paradigm involves identifying coexisting disease, defining the urgency of the intervention, and predicting postoperative complications based on the type of surgery planned. The prime function of the medical consultant is searching for correctable medical conditions. The consultant must carefully identify coexisting and comorbid conditions. Emergency surgery should be avoided, if possible, by elective planning. The risk of surgery varies with the procedure. Non-body cavity surgery, with the exception of hip fracture repair, is usually tolerated well. Age is a risk factor for surgery, but coexisting disease is more important than age alone. The net effect of improvements in surgical outcome advances the age at which surgical risk becomes prohibitive.