With an increase in geriatric population undergoing surgical procedures, research focused on enhancing their perioperative outcomes is of paramount importance. Currently, most of the evidence-based medicine protocols are driven by studies concentrating on adults encompassing all adult age groups. Given the alterations in physiology with aging, geriatric patients respond differently to anesthetics and, therefore, require specific research initiatives to further expound on the same. Large databases and the development of sophisticated analytic tools can provide meaningful insights into this. Here, we discuss a few research opportunities and challenges that data scientists face when focusing on geriatric perioperative research.

With the increase in life expectancy in the United States, octogenarians and nonagenarians are more frequently seen in clinical practice. The older adults patients have multiple preexisting comorbidities and are on multiple medications, which can make pain management complex. Moreover, the older adults population often suffers from chronic pain related to degenerative processes, making medical management challenging. In this review, the authors collated available evidence for best practices for pain management in the older adults.

Although baby boomer generation accounts for a little more than 15% of the US population, the cohort represents a disproportionate percentage of patients undergoing surgery. As this group continues to age, a multitude of challenges have arisen in health care regarding the safest and most effective means of providing anesthesia services to these patients. Many older adults patients may be exquisitely sensitive to the effects of anesthesia and surgery and may experience cognitive and physical decline before, during, or after hospital admission. In this review article, the authors briefly examine the physiologic processes underlying aging and explore steps necessary to deliver safe, empathetic care.

A strong association between frailty and in-hospital delirium in nonsurgical patients has been shown. Physical and cognitive frailties have been associated with decline and dysfunction in the frontal cognitive domains. Risk factors for frailty are similar to risk factors for postoperative delirium (POD). Frailty can be screened and diagnosed by various tools and instruments. Different anesthetic techniques have been studied to decrease the incidence of POD. However, no anesthetic technique has been conclusively proven to decrease the risk of POD. Patients with dementia develop delirium more often, and delirium is associated with accelerated cognitive decline.

Anesthesiologists are increasingly required to care for frail older adults patients. A detailed knowledge of the influence of age on the pharmacokinetics and dynamics of the anesthetic drugs is essential for optimal safety and care. For most of the anesthetic drugs, the older adults need lower doses to achieve the same plasma concentrations, and at any given plasma and effect-site concentration, they will have more profound clinical effects than younger patients. Caution is required, with close monitoring of clinical effects and active titration of dose administration to achieve the desired level of effect, ideally following the "start low, go slow" principle.

As the field of mechanical circulatory support (MCS) continues to advance and resuscitation protocols are being refined, older adults patients previously not considered for MCS are now being supported. MCS devices can broadly be classified based on the duration of support into temporary or durable devices. Although mortality is higher in the older adults, carefully selected patients, MCS support can be valuable and lead to excellent recovery. Age itself should not preclude patients from being candidates for MCS because we must not restrict the progress of science in medicine for any age.

Pioneered by Thomas Starzl in the early 1970s, liver transplant (LT) is nowadays often considered a final intervention and standard of care to cure many forms of acute and chronic end-stage liver diseases. Started in recipients younger than 60 years old, LT indications are now much broader, and at least, one-fifth of the candidates are older than 65 years. Problems associated with ageing and frailty in LT recipients and their impact on the entire perioperative course are discussed according to a modern anesthesiological perspective and the anesthesiologist covering the role of the perioperative (transplant) physician.

The medical complexity of the geriatric patients has been steadily rising. Still, as outcomes of surgical procedures in the older adults are improving, centers are pushing boundaries. There is also a growing appreciation of the importance of perioperative fluid management on postoperative outcomes, especially in the older adults. Optimal fluid management in this cohort is challenging due to the combination of age-related physiological changes in organ function, increased comorbid burden, and larger fluid shifts during more complex surgical procedures. The current state-of-the-art approach to fluid management in the perioperative period is outlined.

With a rapidly aging population and increasing global surgical volumes, managing the elevated risk of perioperative pulmonary complications has become an expanding focus for quality improvement in health care. In this narrative review, we will analyze the evidence-based literature to provide high-quality and actionable management strategies to better detect, stratify risk, optimize, and manage perioperative pulmonary complications in geriatric populations.

Hypertension is among the most common chronic conditions in older adults. Effective treatment exists, yet many older adults do not achieve recommended control of their blood pressure (BP). Self-measured blood pressure (SMBP) monitoring, in which patients check their BP at home, is one underutilized tool for improving hypertension control. Older adults may face unique challenges in using SMBP monitoring and therefore require unique solutions. An individualized approach to guiding older adults to use SMBP monitoring is preferred.

This review explores the extensive evidence linking hypertension with vascular cognitive impairment and dementia, emphasizing its role as a treatable risk factor. Drawing on observational data, it will elucidate how the chronicity of hypertension at different life stages amplifies cognitive decline risk. It explores the mechanisms underlying hypertension's association with dementia, assesses the neuroprotective properties of antihypertensive therapy, and evaluates novel blood pressure metrics and monitoring methods for their diagnostic and therapeutic potential in dementia management.

The focus of antihypertensive therapy in older adults should be on lowering the systolic blood pressure (SBP) to the patient's "optimal" benefit-based target goal. Applying benefit-based therapy to the majority of adults aged 65 years or older who are at high cardiovascular disease or cognitive impairment risk favors an SBP goal of less than 130 mm Hg, and for some, a goal of 120 mm Hg may be considered.

The authors conducted a review of pharmacologic therapy in older adults with hypertension. They reviewed the evidence supporting their use in older adults, understanding the physiologic changes and potential adverse drug effects associated with aging and antihypertensive medication use, exploring guideline recommendations for antihypertensive use in older adults, and evaluating the associated risks and benefits of specific classes of antihypertensive medications.

Hypertension is ubiquitous among older adults and leads to major adverse cardiovascular events. Nonpharmacologic lifestyle interventions represent important preventive and adjunct strategies in the treatment of hypertension and have benefits beyond cardiovascular disease in this population characterized by a high prevalence of frailty and comorbid conditions. In this review, the authors examine nonpharmacologic interventions with the strongest evidence to prevent cardiovascular disease with an emphasis on the older adults.

Resistant hypertension is a complex disorder that requires a comprehensive evaluation of several patient characteristics. Attention should be paid to medication and lifestyle adherence, and investigation into potential secondary causes of resistant hypertension should occur as clinically indicated. Moreover, a shared, multidisciplinary decision-making approach with the patient, specialized care providers, and family members may enhance blood pressure control.

Due to the high prevalence of older individuals with multiple morbidities, polypharmacy, and exposed to unnecessary or inappropriate treatments that can cause potentially serious adverse effects, better medication management should be an objective of all health professionals. This is particularly important in older patients with hypertension. Antihypertensive deprescribing and non-pharmacological strategies have been disseminated as viable and safe alternatives for improving the quality of care for hypertension in the older population.

Hypertension is a major risk factor for cardiovascular disease, cognitive decline, and frailty. Given the increasing burden of hypertension in the aging population, it is imperative to improve hypertension management in that population. Apart from variations in treatment goals, challenges such as polypharmacy, medication side effects, and therapeutic inertia hinder adherence to guideline-directed medical therapies among older people. Effective public health messaging is essential for spreading evidence-based guidelines, raising awareness among clinicians, enhancing patient education and health literacy, and implementing community-based strategies to tackle hypertension. This review examines the current state of public messaging on hypertension in older adults.