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Pre-op anaesthetics trigger mental decline in the elderly

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Anaesthetics before surgery has been recognised as another major health hazard for the elderly, increasing the risk of stroke, cognitive decline and delirium.

Around 10 percent of hospital patients who are 65 years and older develop longterm cognitive decline after surgery, while 7 percent suffer stroke, and 65 percent experience delirium.  Delirium isn’t always a short-term problem; it can involve a longer hospital stay and can also lead to functional decline, says anaesthesiologist Susan Vacas from the UCLA Santa Monica Medical Centre.

She monitored the after-effects of anaesthetics given to 1,114 older patients who had non-cardiac surgery, and concluded that the over-65s are more vulnerable to the effects of anaesthesia and surgery.  The procedures could also accelerate undiagnosed neuro-degenerative disorders, such a dementia.

It’s a big problem that has been partly hidden by the way post-operative complications have been classified.  Delirium, which includes an acute state of confusion and inattention, had been considered different from postoperative cognitive dysfunction (POCD), a longterm problem that affects cognitive skills and memory, but Vacas argues they are related, especially in the older patient who may be more vulnerable.

And it’s a problem that will only get worse.  In the past decade, the over-65 population has grown by 34 percent in the US, and the elderly are more likely to need surgery that includes anaesthesia.

(Source: JAMA Insights, August 2, 2021; doi: 10.1001/jama.2021.4773)

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