Can someone be too old for surgery? What older adults need to know.

4-minute read

When it comes to surgery, age is an important consideration. Older adults can have higher risks of surgery-related complications and side effects, depending on many different factors. However, your age isn't the only factor to consider when thinking about the risks and benefits of surgery. Talking with your provider about what to expect during and after the procedure can help you make the right healthcare choices. Your personal risk factors, the type of surgery, anesthesia, and planning ahead for what to expect afterwards can make a huge impact on your recovery.

There are several steps you can take to lower your risk of complications or poor outcomes. Learning your risk factors, taking care of your health, and choosing a provider experienced in the surgical care of older adults can increase your chances of having a successful procedure and recovery at any age.

Surgical outcomes and quality of life

Major surgery carries risks for patients of all ages. However, people 65 and older are at a higher risk than younger adults for certain complications or side effects, according to the American Society of Anesthesiologists.

Older adults are also more sensitive to the effects of anesthesia and have an increased risk of the following:

• Postoperative cognitive dysfunction (POCD). This condition causes long-term issues with concentration, problem-solving, and remembering. Risk factors of having dementia, heart disease, lung disease, Parkinson's disease, or having a stroke can further increase your risk of developing POCD.
• Postoperative delirium. This temporary condition causes short-term confusion, disorientation, and issues with concentration and memory.

A perioperative specialist can discuss your individual risk for this and what measures to take to lower your chances of these happening. As people age, recovery from major surgery can also pose challenges. Because of these risks, older adults need to think about what their quality of life may look like after surgery by having important conversations with your care team.

To make informed choices about surgical options, it's essential to learn about:

• Possible complications and side effects
• How these complications or side effects could affect day-to-day life
• What you can do to lower your risks
• Setting up your goals for care

Your provider or perioperative surgical team can discuss the benefits, potential complications, and side effects of surgery. They can help you consider how these challenges might impact your overall quality of life, and help you make decisions that are right for you.

Elective versus emergency surgery

As an older adult, your risk of complications after a major operation is affected by whether you have elective or non-elective surgery.

Elective surgeries are planned and scheduled in advance, such as knee replacements. Non-elective, or emergency, surgery is unplanned. An example may be to remove the appendix or surgery after a fracture.

According to research, older adults who have a non-elective procedure are at higher risk for major complications than those who have elective surgery. This is because there is no time to prepare the body for the surgery and reduce the risks of complications. Delaying the surgery can be harmful and sometimes even life threatening. People who have non-elective surgeries are also more likely to experience the following:

Dehydration
Delirium
Failure to thrive
Falls and fractures due to falls
Need for skilled nursing home care
Pressure ulcers

Your overall health and wellness also significantly affect your health during and after surgery.

Cognition and mental health

Like physical health, mental health plays a role in surgical outcomes and risks. Declining cognition or long-standing mental health conditions may increase surgical complications and challenges during recovery.

Cognition refers to the ability to learn, pay attention, remember, and solve problems. Dementia or other health conditions may impair cognition in some older adults. Having dementia or probable dementia puts a person at risk for complications and increased disability after surgery.

If you have been diagnosed with anxiety, depression, or another mental health condition, you may be at high risk for surgical complications or being readmitted to the hospital post-surgery. Symptoms of mental health conditions may worsen after the procedure. This can make recovery more challenging. Talking with your provider about managing your mental health condition before and after surgery can help reduce the risks.

Frailty and surgery

Frailty is a medical condition that affects the whole body. People with this condition have a higher risk for falls, surgical complications, and post-surgical disability. A perioperative specialist can determine if you are medically frail and provide ways to improve before surgery.

You might have frailty if you have three or more of these criteria:

• Can only walk slowly
• Fatigue, or unexplained exhaustion
• Inactivity
• Weight loss without trying to lose weight
• Weakness of hand grip strength

Physical therapy beforehand can decrease frailty. Presurgical occupational therapy can also help you determine what support or equipment you need to remain independent and prevent post surgical injuries.

Reduce the risk of complications

If you're having an elective procedure, there are several things you can do before and after surgery to reduce the risk of complications.

Being as healthy as possible before surgery can decrease your risk of complications. Taking steps to improve your overall health can aid in healing down the line. Managing chronic physical and mental health conditions is also vital.

Before the procedure, talk with your perioperative provider about the common side effects or risk factors for the type of surgery you're having and your particular health needs. They can help you prepare for all steps of the process, from preoperative to postoperative care. Preparing for your recovery beforehand can lower your chances of complications.

During your recovery

Being proactive about your health after surgery can support healing and prevent illness and injury. Doing so can also help you get back to your usual life. Sometimes "prehabilitation" or therapy before surgery can help you gain the strength you need to recover easier.

Physical therapy after surgery can increase balance, endurance, flexibility, and strength. Occupational therapy can teach you how to conserve energy, preserve or improve your independence, and prevent injury.

Ensuring you have the right hearing aids or glasses, if needed, before surgery can improve your chances of a successful recovery too. If you are hard of hearing, wearing hearing aids can decrease your risk of postsurgical delirium, especially in the first month after the procedure.

You can also support your recovery by:

• Avoiding smoking and other tobacco products
• Continuing to manage chronic conditions
• Drinking enough water to stay hydrated
• Eating a balanced diet
• Good bowel health
• Following a regular sleep schedule
• Spending time with family or friends
• Staying active
• Taking care of your mental health
• Having a plan to control your pain
• Involving a loved one to help you recover and sharing your care plan

Want to learn more about staying healthy following surgery? Make an appointment with an expert at Reid Health Perioperative Clinic.