Send us a text🧠 Clinical ContextPatients over 65 undergoing inpatient surgery face unique risks. Cognitive impairment, frailty, and increased vulnerability to delirium demand a proactive and nuanced approach to anesthesia and postoperative care.🔍 Preoperative PrioritiesAge ≥65 and inpatient status should automatically trigger a frailty and cognitive assessmentEngage a multidisciplinary team early—geriatrics, anesthesia, surgery, and nursing🛌 Postoperative Delirium: A Common PitfallUse dexmedetomidine in the PACU or ICU setting for sedation/delirium preventionAvoid these culprits:BenzodiazepinesAntipsychoticsAnticholinergicsKetamineCorticosteroidsGabapentin💡 Practical StrategyOptimize environment: quiet, well-lit rooms with clocks and calendarsEncourage mobility and family engagementHydrate, monitor electrolytes, and manage pain thoughtfullyAvoid over-sedation and unnecessary polypharmacy🧩 Clinical TakeawayOlder adults need tailored perioperative management. Screening for frailty and cognition is just as important as lab work and EKGs. Avoid high-risk meds, plan for delirium prevention, and build a team around the patient.🎯 When it comes to older surgical patients: less is more, and team-based care is everything.Key Reference: Sieber F et al. 2025 ASA Practice Advisory for Perioperative Care of Older Adults. Anesthesiology. 2025 Jan;142(1):22–51. PMID: 39655991

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