Pre-op Geriatric Evaluation Guidelines

13 Key Assessment Areas

The guidelines highlight 13 important areas requiring preoperative assessment in geriatric patients: cognitive impairment and dementia; decision-making ability; postoperative delirium; alcohol and substance abuse; cardiac assessment; pulmonary assessment; functional status, mobility, and fall risk; frailty; nutritional status; medication regimen; counseling; preoperative testing; and patient-family and social support system.

Checklist

The guidelines strongly recommend the following preoperative assessments for every geriatric patient:

• Performing complete history and physical examination;
• Conducting cognitive assessment, including the patient's ability to understand the purpose and likely outcomes of the planned surgical procedure;
• Screening for depression;
• Determining risk factors for postoperative delirium;
• Screening for substance abuse/dependence, including alcohol;
• Performing cardiac evaluation following the American College of Cardiology/American Heart Association algorithm for patients undergoing noncardiac surgery;
• Assessing risk factors for postoperative pulmonary complications and implementing suitable preventive strategies;
• Documenting functional status and fall history;
• Calculating frailty score at baseline;
• Assessing nutritional status and considering implementation of preoperative interventions for high-risk patients;
• Taking a complete medication history, making needed perioperative adjustments, and monitoring for polypharmacy;
• Identifying the patient's treatment goals and expectations in light of anticipated and unexpected treatment outcomes;
• Assessing the family and social support system; and
• Performing suitable diagnostic tests as needed for elderly patients.