Acute Postoperative Pain Management in the Older Patient

Thor Hallingbye; Jacob Martin; Christopher Viscomi


Aging Health. 2011;7(6):813-828. 

In This Article

Physiologic Changes of Aging

With age, progressive physiologic changes occur that ultimately lead to a decrease in the function of various organ systems.[29] In fact, aging has been defined as "processes in an organism that increase the mortality risk as a function of time".[37] Aging is typified by changes in the cardiovascular system including a decrease in cardiac output and increase in vascular resistance. The heart becomes more dependent on blood volume (preload). There is a decrease in autonomic nervous system responsiveness, such that following spinal or epidural anesthesia there is an increased risk of profound hypotension. Decreases in cardiac output lead to decreased hepatic blood flow. Because most analgesics are metabolized by the liver, decreased blood flow may result in decreased metabolism and prolonged excretion of medications.

Renal function declines progressively with age. This varies between individuals, with some experiencing very little decline in glomerular filtration rate. Although primary renal aging occurs, diabetes, hypertension and vascular disease play a significant role in worsening renal function. Decreased glomerular filtration rate may be balanced by an age-related decrease in muscle mass, and therefore, creatinine may not be a reliable indicator of glomerular filtration rate in the elderly.[38] On average, glomerular filtration rate decreases less than 1 ml/min/year after middle age.[7] Decreased renal function can lead to toxic accumulation of drugs and metabolites if dosing is not adjusted according to renal clearance. Table 2 summarizes physiologic changes in older people compared with younger people.[7,30,39,40]


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