Pre and Post Surgery Management for Older Adults

Enhanced Recovery After Surgery (ERAS)

ERAS is a care plan based on strong research evidence for older patients just before and after surgery. Instead of fasting (not eating) before surgery, ERAS suggests drinking clear liquids and a carbohydrate drink up to two hours before surgery. ERAS also supports minimally invasive surgery (using small cuts) and avoiding too much IV fluid. After surgery, ERAS recommends moving early, eating soon, and managing pain without relying on opioids (strong pain medicines). Following ERAS guidelines can shorten hospital stays and reduce problems after surgery.

Anesthetic Technique

As the body ages, it changes in ways that affect how a person responds to anesthesia (medicine that causes sleep during surgery). These changes can affect how the body handles the medicine. Adjusting doses may be needed to account for these changes.

Nausea and Vomiting After Surgery

Older adults have a higher chance of feeling sick or vomiting after surgery. Treating this is challenging. Many of the common medicines for nausea affect the brain and can cause delirium. Some medicines are available that do not have this side effect.

Caring for Older Adults After Surgery

After surgery, older adults often face problems such as delirium (trouble thinking clearly), pain, constipation, or trouble urinating.

Delirium and Cognitive Impairment

Delirium is one of the most common problems after surgery. Geriatricians are often involved in helping manage this condition.

Causes of delirium can include untreated pain, constipation, trouble urinating, problems with the body's chemical balance, not moving enough, taking certain medicines, and medical emergencies such as a heart attack or blood clot. 

• Treating the cause often treats the delirium.
• Other helpful steps include reducing sleep interruptions, cutting back on medicines, encouraging movement, increasing stimulation (such as using hearing aids or glasses), and staying hydrated.

Medical experts say antipsychotic medicines should not be used as the first treatment for delirium. They should only be used if the patient or staff is at risk of harm. Benzodiazepines (sedative medicines) should also not be used unless the delirium is caused by withdrawal from alcohol or benzodiazepines.

Postoperative cognitive dysfunction (POCD) happens when a person's thinking and memory gets worse after surgery, shown by testing. This can last for days or months, or it can be permanent. It seems to happen most often after heart surgery.

Older patients with POCD have a higher risk of death in the year after surgery. Unfortunately, there is currently no known way to prevent or treat this condition.

Pain Management

Managing pain after surgery can be hard, especially for people with delirium or dementia. These patients are more likely to not get enough pain treatment. They deserve extra attention.

The best way to manage pain is to use more than one approach. Treatments such as ice packs, heating pads, massage, and relaxation techniques can help with pain but are often not used enough. Two other good options are local nerve blocks (numbing a specific area) or scheduled acetaminophen (Tylenol).

When starting a pain medicine after surgery, it is best to start with a low dose and increase it slowly if needed. Some pain medicines have serious side effects.

• NSAIDs (such as ibuprofen) should be avoided. They can cause bleeding, delirium, and heart problems, among other side effects.
• Opioids (strong pain medicines like morphine) can be habit-forming and may cause itching, constipation, breathing problems, nausea, or sleepiness. Patients who use them need close monitoring. A prescription for naloxone (a medicine that reverses opioid overdose) should be given when they go home.
• Muscle relaxants raise the risk of delirium.
• Gabapentin can help reduce nerve pain after surgery. However, it is also linked to a risk of delirium.

Management of Urinary Retention and Constipation

Trouble passing urine (urinary retention) and constipation are common after surgery. Both can lead to delirium or agitation. 

Constipation has many causes, including taking opioids and other medicines, not moving enough, and changes in diet. Constipation can be reduced by:

• Avoiding medicines that cause constipation, if possible.
• Taking a laxative with any opioid medicine.
• Moving around as much as possible.
• Eating foods that help with constipation, such as applesauce, prunes, and bran.

It is important to check for constipation every day. Constipation can cause nausea, loss of appetite, and delirium.

Urinary retention (not being able to pass urine) is also common after surgery. Older adults who often have trouble urinating are more at risk. Men with certain prostate problems are also at higher risk.

Some medicines, such as opioids, can make it harder to urinate. A careful review of all medicines is important when a patient has this problem.

Last Reviewed and Updated: October 2026
By: AGS/HiAF Public Education Committee, HealthinAging.org Content Reviewers