Perioperative medicine for older patients: how do we deliver quality care?

Philip Braude; Judith SL Partridge; David Shipway; Finbarr C Martin; Jugdeep K Dhesi

doi:10.7861/futurehosp.3-1-33

Perioperative medicine for older patients: how do we deliver quality care?

Philip Braude, specialist registrar in geriatric and general medicine^A ⇑,
Judith SL Partridge, consultant physician and geriatrician^B,
David Shipway, consultant physician and geriatrician^C,
Finbarr C Martin, consultant geriatrician/professor of medical gerontology^D and
Jugdeep K Dhesi, consultant physician and geriatrician^E

^ADepartment of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
^BDepartment of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
^CDepartment of Medicine for the Elderly, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
^DDepartment of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; and Division of Health and Social Care Research, Kings College London, UK
^EDepartment of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; and Division of Health and Social Care Research, Kings College London, UK

Address for correspondence: Dr P Braude, POPS, OPAU, Department of Ageing and Health, Guy’s and St Thomas’ Hospital, Great Maze Pond, London SE1 9RT, UK. Email: philip.braude{at}gstt.nhs.uk

Abstract

The demand for surgical intervention in older people is rising due to the growing older population with multimorbidity. Yet older people continue to have reduced access to surgery and have more adverse postoperative outcomes than younger people. Current models of preoperative risk assessment and optimisation are poorly suited to this complex surgical population. Furthermore, there has been little emphasis on perioperative management of older people in national anaesthetic and surgical curriculums. New models of care and training in perioperative medicine for older people are evolving, with national reports calling for collaboration between geriatricians, general physicians, anaesthetists and surgeons. Such collaboration is necessary to impact clinical service development, research agendas and education and training. In this article, we discuss the challenges and potential solutions in the establishment of quality surgical care for older people.

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