Anesthesia and psychology in the elderly patient

Summary aging of population is increasing everywhere in the world, the elderly frequently becomes surgical patient. The anesthetist must always face both the psychological and physiological status of the elderly patient. The concerns about impending surgery depend on some stressfull sensations, such as the separation from family, the impact of a new environment, the possibility of loss of independence, the possibility of death. The elderly people employ two types of coping when facing surgery: the “vigilance” and the “avoidance”; these seem to produce different postoperative effects. The vigilant patient has a longer hospitalization and a more negative psychological reaction after surgery. The avoidant patient has a better recovery. The anesthetist has a great choice among different anesthetic techniques. Actually we know that no significant difference in outcome can be attributed to the use of any specific anesthetic agent. A recent study of us indicates that the combined anesthesia (narcosis with peridural analgesia), allows a better recovery of psychophysical functions in the earlier postoperative phases. Postoperatively the elderly often presents disorientation and acute brain syndrome that may persist for a long time, apart from anesthetic technique. The problem is that many factors influence the mental status of the elderly. It appears that the biological age of the brain rather than its chronological age may be correlated with the vulnerability by anesthesia.