Physiological changes affect reaction to surgery

No one enjoys undergoing surgery or approaches surgery without some anxiety, but older patients have physiological reasons that may increase their apprehension and confusion about surgery, according to Patricia Stein, RN, MAOL, CNOR, nurse education specialist for perioperative services at Palomar Pomerado Health System in Escondido, CA.

Impaired senses.

Not only are vision and hearing affected by age, but also by medications, anxiety, and the noises and activity in strange surroundings. "These impaired senses will affect the ability of the older patient to grasp what is being said or to read through of all of the papers that he or she is required to sign," says Stein. "The patient is taking in as much as possible so don't push the patient to hurry or quickly sign papers."

One way to make it simpler for older patients to comprehend is to make all preprinted material easy to read, says Stein. "Consider large-print font for preoperative consents," she suggests.

Body temperature.

"Thermoregulation is impaired so the older patient will not shiver until their temperature drops lower than a younger patient who has better temperature regulating ability," Stein says. Expect that the older patient will get colder sooner and take longer to bring their temperature back up, she says. "This alone will slow the metabolism of the medications that the patient is receiving preoperatively and intraoperatively."

Nurses should keep the patient warm, even if they have not complained about cold, says Stein. "Consider preoperative warming systems that pre-warm the patient prior to the move into surgery," she suggests.

Musculoskeletal changes.

Changes in the older patient's musculoskeletal system that decrease the range of motion for patient limbs and proprioception affect balance, especially if preoperative medications are administered, says Stein.

Vascular and cardiac functions.

"A decrease in elasticity of both the arteries, and the muscles and nerves that surround them, affect vascular and cardiac functions," Stein says. "Contractility and irritability will be affected, medications given will take longer to take effect, and impaired kidney and renal function will affect drug clearance, especially of lipid-soluble medications like propofol," she says.

Risk of infection.

"The elderly patient has a weaker immune system because of fewer T-cell production and maturation," explains Stein. "For this reason, exquisite attention to strict principles of asepsis must be followed," she states.