Anesthesiology

Surgery for Older Adults

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A Guide for Patients and Caregivers

Surgery can bring unique challenges as you age. Understanding the risks, preparation and recovery can help you feel more confident and informed. This guide covers key concerns for older adults undergoing surgery and their caregivers.


 

Brain Health and Memory

Older adults may experience brain health issues after surgery. Perioperative means these medical conditions can present before, during or after surgery, beyond the normal changes in memory and thinking that occur with aging. This includes:

Postoperative delirium and "brain fog"

Some patients develop temporary confusion or memory issues after surgery. It may last hours to days.

Will this happen to you? Research shows several factors impact the risk of brain changes after surgery, including:

  • Age
  • Pre-surgery brain health
  • Frailty
  • Medication use
  • Nutrition
  • Other medical conditions

Patients can’t change all their risk factors, including age or past brain health. The World Health Organization recommends taking steps to improve the chances of a smooth recovery:

 

Cognitive Function After Surgery

Should I be worried if I have a pre-existing neurological condition?

There is no proven link between having a pre-existing neurological condition and long-term cognitive problems after surgery. However, these conditions may increase the risk of temporary confusion or memory issues after surgery and may slow your recovery. It’s important to tell your doctor if you have any neurological disorders or if you’ve had memory issues after past surgeries. This helps your medical team prepare if problems come up during surgery. 

What is postoperative cognitive decline?

Postoperative cognitive decline is when a person has trouble thinking, remembering or concentrating after surgery.

Is postoperative cognitive decline reversible?

Postoperative cognitive decline and confusion are often reversible, especially when caught early and treated properly. Studies show that cognitive health is usually most affected in the first six months after surgery, but it improves quickly after that. The recovery time can vary depending on your health and the type of surgery. In most cases, cognitive function fully recovers, but there is a slight risk of long-term issues. 

How long does it take for cognitive function to return to normal after surgery?

Most people see their cognitive function return to normal within a few days to weeks after surgery. Recovery time can vary depending on individual factors and the type of surgery.

Are certain types of anesthesia more likely to cause postoperative cognitive issues than others?

There isn’t much evidence to suggest one type of anesthesia causes more cognitive issues than another. Some studies suggest that certain medications or types of anesthetics, such as chronic benzodiazepines use, may have a higher risk of causing confusion or memory problems after surgery. Talk to your provider about any anesthesia concerns you may have.

Are there any medications that can increase the risk of cognitive issues after surgery?

Certain medications can increase the risk of cognitive issues after surgery. These include antipsychotics, anticholinergics, meperidine, antihistamines, phenothiazines and benzodiazepines. Talk to your doctor if you have any questions or concerns about the medications you take. 

Are there any lifestyle changes I should consider after surgery to reduce my risk developing neurocognitive disorders?

Eating a balanced diet, getting enough sleep, exercising regularly and practicing good hygiene can improve cognitive function after surgery. Staying socially active with family and friends is also important for recovery.

What should I do if I notice any changes in my cognitive function after surgery?

If you or your caregivers notice changes in memory, attention, or awareness after surgery, inform your doctor right away. These may be signs of a perioperative neurocognitive disorder. Perioperative neurocognitive disorder is a temporary or lasting change in memory, thinking, or attention that can happen around the time of surgery, especially in older adults. Your care team will assess your symptoms and recommend the best course of action to help with recovery. 

What are some other things to take note of before, during or after surgery?

Make the hospital room and post anesthesia care unit (PACU) as comfortable as possible to reduce anxiety and help with recovery. Consider bringing items like a sleep mask, headphones or earplugs to help you sleep. Also, make sure to have glasses or hearing aids available to help with cognitive awareness. Let the staff know if you need any of these items during your stay. 

 
 

What to Expect Before Surgery

Doctors may check brain function before surgery to assess risks. Some patients benefit from a "prehabilitation" program, which includes:

  • Brain games or exercises to help with memory
  • Improved nutrition
  • Quitting tobacco
  • Regular exercise, as suggested by your care team

Planning ahead in these areas can improve your surgery experience and recovery:

Prepare your home

  • Remove trip hazards, install grab bars, and set up a comfortable recovery space.
  • Arrange for help with daily tasks, meals and transportation.

Manage medications

  • Review all prescriptions, over-the-counter drugs and supplements with your doctor.
  • Some medications may need to be stopped before surgery.

Prepare emotionally

It’s normal to feel anxious. Relaxation techniques like deep breathing or meditation can help.  Talk to family, friends or a counselor for support.

What to Expect During Surgery

The medical team follows safety measures to reduce risks. Let the doctor know if you have concerns or a history of anesthesia problems.

Understanding the surgical process

Types of surgery include:

  • Elective surgery: Planned in advance, like hip replacement or cataract surgery.
  • Emergency surgery: Needed immediately for conditions like appendicitis or fractures.

Pre-operative procedures

  • Follow fasting instructions and arrive at the hospital or surgical center at the designated time.
  • The medical team will verify the patient’s medical history and medications.
  • You may have last-minute tests, such as bloodwork or imaging.

For the surgery

We will discuss your anesthesia options, including:

  • General anesthesia (fully asleep).
  • Regional anesthesia (numbs a large area, such as a spinal or epidural block).
  • Local anesthesia (numbs only a small part of the body).

The surgical team will explain how long the procedure may take and any important steps you should know.

Postoperative care

Immediate recovery will take place in the post anesthesia care unit (PACU) , where we will closely monitor vital signs. The care team will provide updates on the patient’s condition and discuss the next steps.

What to Expect After Surgery

Recovery

After leaving the PACU, we’ll move you to a hospital room or discharged home, depending on the procedure. You’ll receive postoperative care instructions, including wound care, activity restrictions and medications.

Recovery varies based on the type of surgery, overall health and complications. Most patients feel better within weeks, but some may need longer. Your care team will guide you through rehabilitation, including physical or occupational therapy, if needed.

Healthy habits can improve recovery. Get enough sleep, stay socially engaged and follow all post-surgery instructions.

Pain management

Pain is normal but should be manageable. Your doctor will provide a pain control plan. Non-medication approaches like ice packs, movement and relaxation can also help.

Prevent complications

The best thing you can do to prevent complications is follow all post-surgery care instructions. Watch for signs of infection including redness, swelling or fever.

Remember that all surgeries have risks. Common concerns include:

  • Blood clots: Moving regularly and wearing compression stockings can help.
  • Breathing problems: Deep breathing exercises can reduce the risk of pneumonia.
  • Cognitive changes: Temporary confusion or memory issues may occur but usually improve over time.
  • Infection: Follow wound care instructions and watch for signs of redness or swelling.
  • Your doctor will discuss ways to reduce these risks before surgery.

Impact on existing medical conditions

Surgery may temporarily affect ongoing health conditions such as:

  • Diabetes: Blood sugar levels may fluctuate due to stress and medications.
  • Heart disease: Surgery can put extra strain on the heart, requiring close monitoring.
  • Neurological conditions: Patients with dementia, Parkinson’s disease or stroke history may experience slower recovery or increased confusion.

Let your doctor know about any health conditions before surgery so they can plan accordingly.

Support and Resources

Whether it's help from family, connection with others who’ve had similar experiences, or guidance from hospital support services, there are many resources available for older adults who've had surgery. Here are some key sources of support to help you or your loved one navigate the recovery process with confidence: