Lesson 1

Geriatric Classification

• Patients aged 65 years or older are categorized as geriatric or elderly.

Perioperative Risk Assessment

• A bedside tool is needed to measure functional reserve for perioperative risk.
• Metabolic equivalents (METs) are used:
  • 1 MET = 3.5 mL O2/kg/min.
  • Inability to achieve 4 METs correlates with higher perioperative risk.
  • Activities meeting 4 METs: climbing stairs, raking leaves.
• Subjectivity of METs limits predictive value; alternatives like the Duke Activity Status Index (DASI) may be better indicators.

Frailty Definition

• Frailty is marked by decreased reserve and stress resistance (physiologic, physical, psychosocial).
• Frail patients face worse outcomes during perioperative stress.
• Interest in developing tools to quantify frailty and enhance preoperative rehabilitation for improved outcomes.

Demographics and Aging Trends

• By 2050, individuals over 60 will surpass younger adults in number.
• Physiologic function declines post-age 30; health management impacts this.
• Aging is a major risk factor for cancer development.

Life Expectancy Trends in the U.S.

• 1960: Males 66.8, Females 73.5
• 1980: Males 71.5, Females 78.4
• 2000: Males 75.8, Females 80.6
• 2010: Males 77.7, Females 84.3
• 2030: Males 79.5, Females 85.8
• 2050: Males 80.8, Females 82.4

METs and Functional Capacity

• MET classifications:
  • 1 MET = Poor functional capacity
  • 4 METs = Good functional capacity
  • 10 METs or more = Outstanding functional capacity
• Activities categorized by MET levels include self-care, walking, climbing stairs, and strenuous sports.

Conclusion

• Understanding and evaluating both frailty and functional capacity are crucial for optimizing care in elderly patients undergoing surgery.