ABSTRACT
Advances in nutrition, public health, education, and social services during the twentieth century produced extraordinary increases in human longevity. In all industrialized societies, increased life expectancy and reduced mortality from chronic age-related disease continue to enlarge that fraction of the surgical patient population considered elderly. Although they represent only 10-15% of all Americans, individuals 65 years of age or older undergo almost one-third of the 25 million surgical procedures performed annually in the USA. Overall, older Americans also consume about one-third of all health expenditures and fully onehalf of the $140 billion annual US federal healthcare budget. The surgical demographics are very similar in Europe and in Japan. Therefore, these apparently beneficial changes have further amplified the fiscal impact of the increasing per capitahealthcare costs that already represented a formidable burden for modern societies. Consequently, unless intentionally limited to pediatrics or obstetrics, every anesthesiologist in contemporary practice eventually becomes a subspecialist in geriatric medicine with a special responsibility for delivering cost-effective healthcare to older adults. The sections that follow define the current concepts of aging that are relevant to anesthetic practice and discuss the distinction between aging and age-related disease, perioperative assessment of the elderly patient, and practical aspects of anesthetic management and outcome in geriatric surgical patients.
