Stanley Muravchick, MD, PhD
Professor of Anesthesia and Vice
Chair for Clinical Affairs,
Hospital of the University of Pennsylvania,
Philadelphia, PA, USA.
Recent advances in our understanding of the perioperative implications of aging have been due in large part to the establishment of clear distinctions between processes of aging and age-related disease. The implications of disease are clear to physicians caring for surgical patients of any age. However, many gerontologists consider increased susceptibility to stress- and disease-induced organ system decompensation to be a defining characteristic of geriatric medicine.1 Even for healthy and fit older surgical patients, maximal levels of organ function decline rapidly. In fact, the difference between maximal and basal function provides the concept of functional reserve. Therefore, normal aging typically produces a progressive loss of the organ-system functional reserve (Figure 1) that provides the "safety margin" available for the additional demands for cardiac output, carbon dioxide excretion, or protein synthesis imposed upon the patient by trauma, disease, surgery and convalescence.