In recent decades advances in surgery and anaesthesia have greatly optimized surgical treatments and outcomes, even for frail elderly people. Further methods of optimization resulting from innovation, guided by research and development, are emerging. Surgery represents a major stressor for patients, causing temporary deconditioning. Age-related psychophysiological changes and co-morbidities affect older people’s tolerance to surgery, making this a major life event with the risk of more permanent and definitive consequences. Optimization of the continuity of care might be of paramount importance for elderly patients. Preoperative assessment and detailed systematic screening of common geriatric syndromes are required, besides the usual physical evaluation. Cognitive, gait and balance, nutritional and functional impairments all flag up patients at high risk of perioperative and postoperative complications.
Preoperative assessment can help to detect high-risk patients at an early stage and employ interventions (prehabilitation), including physiotherapy, nutritional, pharmacological and cognitive support, to reduce the risk of postoperative mortality, morbidity and adverse functional outcomes.