Affects of Anesthesia on an Elderly Patient

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Sally Smith: Welcome to Age to Age. I'm Sally Smith. Let's talk. Today we have with us Dr. Jerry Reves, past Chairman of Anesthesiology. And I would like to talk to him today about the effects of general anesthesiology on the elderly. Thank you Jerry for being with us. I read recently that in an emerging field of baby boomers, one in six Americans are going to be over the age of 65 by 2020. This means if there's one in six, we're going to be doing a lot of surgery on older people. What is different with the elderly?

Dr. Jerry Reves: You're absolutely right Sally. The problem with getting older is you do in fact have more surgery. That's because as you age, you develop more problems whether it's joints, heart, you name it. So it's very common as you age to look to the future to expect to have an operation.

The things that are different about being old and having an operation are that the drugs that are used - the anesthesiologist has to use lower doses because strong, young people require more anesthesia than young. And that's the main difference between the elderly and the young in terms of anesthesia.

Sally Smith: Well I've heard it's said sometimes when someone has a heart by-pass or something that they never were quite the same again. I don't know whether that's a figment of their imagination or whether there's any basis in fact. Is it hard to come up with a full recovery in an aging surgery patient?

Dr. Jerry Reves: Let me put it this way, Sally. The incidence of complications after any surgical procedure - particularly the brain and cardiacs or the issue you just raised. The incidence of complications goes up as you age. Whether this is cause and effect of what the particular causes is still not known. But absolutely you can expect to have more of the complications as you age than if you were younger.

Sally Smith: Are more of these complications in the sort of field, you might say, slight loss of memory, a little cognitive weakness. Is this the way it mostly presents?

Dr. Jerry Reves: It often does. And of course a human is who they are because how their brain functions. And so we are concerned about that. And there must be something about the aged brain that makes it more susceptible to whatever's going on. And therefore you can lose some short-term memory after some of the operations. Or you become confused or a number of central nervous system brain functions tend to be a little bit impaired more in the elderly than in the young after the same operation.

Sally Smith: I recently talked to a doctor who had operated on several people that were over 90. We got into a discussion about then what if not only is the patient older but if they are in that category we've discussed before. High-risk, they're smokers, they're obese. Does sometimes a patient have to wait on a surgery until they get themselves a little bit better shaped? In their older age, are they a little more susceptible?

Dr. Jerry Reves: If you talked to surgeons and anesthesiologists, they will tell you that the number of risks factors for anything, the more risk factors the more likely you are to have a bad outcome. So absolutely, if you've got something that's known to be adding a risk to an operation such as a severe cold or bronchitis or something in your lungs. You need to clear that up before you have the operation and particularly if you're elderly.

Sometimes it is very good advice to put something up until you're in as optimal condition as possible. Because the more things that you combine risk factors and don't forget age is a risk factor itself that you can't do anything about. So the more you add up, the more likely you are to have a problem. And so if you can eliminate any of those risk factors you should do so.

Sally Smith: Can and do doctors that are talking to their patients, can they say you're an older person? You're obese, you smoke, you got these other things, I don't think the surgery is going to work for you. I don't recommend this surgery. Can you say that and then not do the surgery? Or is it still the patient's prerogative to say, "I don't care if I'm 2% chance out 100%. I want the surgery."

Dr. Jerry Reves: Very interesting question. And one that each individual patient and surgeon tend to have to deal with on an individual basis. There are some surgeons who are pretty strict and will tell their patients, "I won't do this operation on you until you have done your share." And then there are other surgeons who will say, "Well if I'd go ahead and do it as you wish, it will increase the risk.

And you need to understand that you're in increased risk." So I think there is no single answer to what you said but it is incumbent on both to understand that there are risks that can be minimized and it is in the best interest of both the surgeon and the patient to minimize those risk.

Sally Smith: One final question. With the numbers that we started out our talk with today, where it is expected that in the year 2020, one in six Americans will be over the age of 65. I think now it's one in eight. So that's quite a leap in 13 years. Are enough people going into the care of the elderly. That's a huge amount of people. But you don't hear is often in numbers, the numbers of people taking care of an aging population.

Dr. Jerry Reves: It's a good point. We do have specialties in Geriatric Medicine. And we do have each field, each of the sub-specialty has a segment of people that become experts. They study the geriatrics.

But in general, I would say that the medical workforce is out there for adult medicine understands that a larger and larger percentage of their patients will be elderly. And there's enough good information out there for the routine average practitioner to be acquainted with the special needs of the elderly patients. So that you don't need someone who is a specialist in just geriatrics.

But we absolutely must have are people who are studying the elderly population and passing that information on to the adult doctors, no matter what their specialty surgery, medicine, anesthesia, you name it. Getting the information out. And that is happening.

Sally Smith: So in the medical schools, this is evolving as more of a focused area as it is just from the logistics of what their world is going to be.

Dr. Jerry Reves: Right it's an area of intense investigation, clinical investigation in each specialty. Thanks to the American Geriatrics Society. Each specialty is now putting-in in their training programs a curriculum that deals with the elderly and is preparing doctors to deal with this burden of elderly that you and I, others are becoming part of. And that will be even larger in the future.

Sally Smith: That's good news. I like hearing that. Thank you so much Jerry for talking with us today. I also want to thank my producer, Betsy Reeves and web administrator, Sujit Kara. Thank all of our listeners too, for joining us. We welcome your suggestions. Please give us your comments on our website. This is Sally Smith, Age to Age saying goodbye and wishing you courage and joy on your journey. We are all connected.

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