Perioperative Care of the Elderly Patient

Book Title: Perioperative Care of the Elderly Patient

Book Author: Sheila Ryan Barnett and Sara E. Neves (Editors)

Publication Information: Cambridge, UK, Cambridge University Press, 2018, 267 pp., $64.99, paperback

Perioperative Care of the Elderly Patient is edited by two Boston-based physicians, both specializing in anesthesia and critical care medicine. It was conceived to help the team of providers taking care an elderly patient to manage care around the time of surgery. The book addresses the unique needs of the elderly population from the vantage points of many different care providers.

This book is a fairly slim volume that breaks topics down by timing related to surgery. The first section covers general health considerations and preoperative assessment of the elderly. It includes chapters on ethical issues of informed consent or refusal, the perioperative management of hypertension in the elderly, heart failure, dementia, postoperative cognitive issues, renal and metabolic aging, and frailty and functional assessment. The next, and largest, section considers intraoperative considerations. Chapters are included on topics like the surgeon’s perspective, geriatric cardiac procedures, geriatric trauma, elective orthopedic procedures, and cataract surgery. There are also several chapters devoted to specific anesthesia concerns like regional and neuraxial anesthesia in the geriatric population, as well as anesthesia for urologic and gynecologic procedures. The final section is devoted to postoperative issues. It covers critical care in the elderly patient, pain management, palliative care, and quality assessment and improvement in the elderly.

Most doctors do not take care of patients in all of these arenas, often not even participating in both outpatient and inpatient care. This book covers both environments on a superficial level, allowing each side to get a reasonable feel for what the other actually does without delving too deeply into the details. In some ways, the book reads like a general workbook intended for ambitious medical students or residents, but there are also pearls for the seasoned primary care physician. It functions as both a quick reference book for those who know what they are looking for, and as an overview for the novice. The layout is clear and bulleted. Each chapter begins with key points summarizing what to expect. Subtopics are headed in bold print. The information is both specific and basic; for example in the chapter addressing consent, there are dictionary definitions of autonomy and competence. The conclusions drawn regarding decision-making capacity are not nuanced, but they are practical and concise. Much of the guidance is obvious, for example: “Type and Screen: These should be drawn prior to surgeries with the potential for significant blood loss. The presence of antibodies may make it difficult and time-consuming to find compatible products.” The section on palliative care and hospice is similarly simplistic, but clearly outlines the concepts and purpose of these services.

For primary care physicians, the preoperative and general health and illness section covers everyday bread-and-butter assessments that are familiar ground and may not need much review. Validated screening tools are referenced and compared, and the surgery types most impacted by impairment are discussed. Data on cardiac risks by procedure type are also oultined. This book may not be the most up-to-date source of this type of information, but it provides a concise comparison of the procedures in relation to one another that might be helpful in guiding a patient with questions. The intraoperative and largest section of the book would be less helpful to the outpatient physician.

In the end, this book largely addresses specific concerns faced by inpatient caregivers—especially those working in the intensive care units and anesthesia—but makes these concerns accessible to the whole team caring for the patient. Consenting a preoperative patient is generally the surgeon’s job, but before that referral is made, or after a surgery has been performed, the primary care doctor has a large role in optimizing health, anticipatory guidance, pain control, maximizing function and mobility, and limiting polypharmacy. This book concisely renders a lot of specific information to assist in this task at your fingertips in an easily accessible resource.