Physiology of ageing

Elderly patients are the most challenging group of patients to safely manage during anaesthesia, and this largely relates to changes in their physiology with advancing age. That they are also the largest group of patients presenting for surgery with the poorest outcomes should ensure that their care is delivered only by those who understand the interplay between ageing, disease, surgery and anaesthesia. The aim of this article is to identify some of the aspects of ageing that are relevant to anaesthesia or taking patient examinations related to anaesthesia. The impact of these aspects is often masked by behavioural adaptation, which enables the patient to maintain a degree of function within society, albeit an increasingly limited one. It is only when elderly people can no longer manage that the true extent of their functional decline becomes apparent. Simple biochemical or physiological tests will not identify this process but an awareness of how patients have adapted is essential for their safe care.