Anesthesia for elderly patients with cancer: What caregivers should know
Tayab Andrabi, M.D.
You may have heard the phrase “age is just a number,” and while that may be true, certain factors make age an important part of your medical history. In the U.S., any patient over age 65 is considered elderly even if they’re in good health.
As we age, our cells don’t recover from injury as quickly as they did when we were younger. Having comorbidities like high blood pressure, heart disease or memory problems can also increase a patient’s risk of complications during cancer treatment or surgery.
How age affects patients undergoing anesthesia
Patients are living longer now than when I first started my career, meaning they may be receiving treatment well into their 80s, 90s or even 100s. While the technical term for these patients is “elderly,” we also consider their physical wellness in relation to the treatment they’ll receive.
A patient who is active at age 70 may be healthier overall than a patient in their 50s or 60s, for example. We consider how frail a patient is and whether they have any other conditions that may affect their overall health.
Every patient is different, so we work to create a personalized plan that will offer them the best outcome. We assess each patient before treatment to get a feel for how fit they are for a certain procedure, and we cater our approach to ensure the most successful treatment options for even the frailest patients.
We provide a range of services, from local anesthesia, where just one area of the body is numbed to limit or prevent pain, to general anesthesia, when a patient is given medication to make them unconscious so they can endure longer procedures like surgery.
When patients undergo general anesthesia, we breathe for them through a breathing tube – a process called intubation – while monitoring their vital signs. The effects of anesthesia and surgery itself can be quite stressful on the body. Elderly patients often breathe more shallowly than younger patients, so the anesthesiology team must take that into account while intubating patients. Older lungs and chests are often heavier than younger ones, too, so we’re constantly measuring our approach to match the patient’s natural breathing patterns.
Confusion is common after anesthesia
One of the most common side effects for patients undergoing
anesthesia is confusion after waking up from anesthetics. This can be
especially troubling for patients who may already be experiencing cognitive decline, dementia or memory problems.
Patients may experience delirium at any point between the first few hours or even up to five days after treatment.
At MD Anderson, we screen all our elderly patients for cognitive function before they receive anesthesia so we can have a good baseline understanding of their needs before, during and after treatment. Caregivers can also let us know if a patient is experiencing memory challenges before treatment.
Keeping other health issues in mind
By the time patients reach old age, it’s normal for them to have certain underlying conditions like high blood pressure, heart disease or diabetes. As anesthesiologists, we need to know what your full health history is, as well as any medications you’re taking, to help make the best choices for your care.
These are all conditions your care team should know about before your loved one undergoes anesthesia so we can adjust medications accordingly to avoid any negative side effects.
Patients may experience blood pressure changes during a procedure, which we monitor throughout to make sure they’re not reaching dangerous levels.
The same can be said of diabetes. If we notice any dramatic changes in blood sugar levels, we can adjust them to maintain the patient's safety during a procedure.
Even when we’re as gentle as possible, intubating patients for general anesthesia can cause some discomfort or pain in the throat. This is especially true for patients who have head and neck cancers or a history of radiation to the head and neck.
The older we get, the longer it may take to recover from things, so we try to prep patients ahead of time.
Easing back into life after anesthesia
Older patients often wear glasses or use hearing aids to help them through their day-to-day activities. We make sure to have those items close by as a patient wakes up from anesthesia to help them feel as comfortable and secure as possible.
For patients with neurological conditions like Parkinson’s disease, dementia or Alzheimer’s disease, or a history of strokes, we prep their care team and family members on how to keep them calm and composed after anesthesia. Our brains don’t necessarily understand that we’ve been put under, so our sleep/wake cycle can be affected when we wake up.
We try to keep clocks visible and leave window blinds open during the day and closed at night to help patients get oriented to time and place.
Care teams should also make sure that hearing aids, and eyeglasses are put back on as soon as a patient’s condition allows.
Patients who need help with a walker or wheelchair should also keep those nearby to help aid in their recovery.
Prehabilitation and enhanced recovery efforts can help
There are things patients can do before and after treatment to help them have the best possible outcome. It’s never too late to make healthy choices, especially when it comes to eating a balanced diet, staying well hydrated and getting frequent physical activity. Walking even a few minutes each day can help improve your overall health.
MD Anderson patients can request assistance from our nutrition team. We also offer programs for pre-habilitation and enhanced recovery after surgery to help patients avoid negative side effects and get them back to their normal activities as soon as possible.