Geriatric Emergency Surgery

Due to the progress in health and safety of living, elderly population is increasing worldwide. Associated with this change in demography comes also increased health care costs, added complexity in care, and higher morbidity and mortality. With increasing age comes also an increased risk or susceptibility for certain diseases, including those that follow with added comorbidity, use of medications, and lifestyle risk factors. In most of the emergency general surgery conditions, mortality also increases severalfold with each decade of age. Frailty, the lack of physiological resilience to an insult, is difficult to objectively assess, but comes with added morbidity and mortality for the elderly. The approach with multidisciplinary geriatric care units has been implemented with convincing results in some emergency areas. Futility in the very old and sick patient may sometimes be clearly defined, but most often becomes a borderline decision between ethics, clinical predictions, and patient communication, for which no solid evidence currently exists.