Perioperative geriatric medicine and specialty liaison
The increasing numbers of older people attending hospital for all aspects of care has led to a growth in work for geriatricians. Traditional ad-hoc reviews in response to complications occurring in older people are being replaced by commissioned and planned services, eg in general surgery, surgical specialties such as vascular, neurosurgery and cardiology, and oncology. Established structures within orthogeriatrics are often used as guidance.
Services are often divided into elective and emergency, and ideally input should be available across both. For example, proactive preoperative assessment of older people undergoing planned surgery results in fewer complications and a shorter length of stay. Geriatricians work with anaesthetic colleagues to prepare patients prior to surgery. They also provide input into shared decision making around surgical and other options, and provide expertise where complex medical conditions coexist or where there are cognitive impairments.
In the emergency setting, older patients who present with acute surgical or other conditions can have prompt medical input, and the responsible teams can access advice on varied issues such as anticoagulation, delirium, poor mobility and discharge planning.
- Guy’s and St Thomas’s POPS resources (proactive care of older people undergoing surgery)
- Age Anaesthesia Association