Preoperative Assessment

Patient Goals and Expectations for Surgery

Before surgery (also called the preoperative or perioperative period), the doctor talks with the older adult about their overall goals and what they hope surgery will do for them. This talk gives the older adult a chance to learn about what may happen. It also helps the doctor understand how the older adult makes health decisions.

Evaluation of Medical Comorbidities (other health conditions)

Before surgery, the doctor checks the older adult's overall health. This includes looking at how their heart and lungs are working. The doctor also looks at other health conditions the older adult may have, such as diabetes.

Cardiovascular Risk

Up to 30 percent of health problems after surgery are related to heart health. This risk gets higher with age. Because of this, checking heart health is one of the most important steps before surgery.

The doctor will review the older adult's medical history and do a physical exam. The goal is to find any major heart risk factors. Other tests may be needed in some cases, including tests of how the heart is working.

The risk check looks at the older adult's overall health and the type of surgery. Some of the riskiest surgeries are those that involve the blood vessels or the belly area.

Some older adults need extra attention because of their conditions or medications. For example:

• Warfarin is a medicine that prevents blood clots. It can cause heavy bleeding during surgery. Older adults who take warfarin may need to stop taking it before surgery.
• Some older adults take beta blockers. Most need to keep taking these medicines before surgery.
• Older adults with recent coronary stents need special care. Problems can happen if surgery takes place soon after a stent is placed.

Pulmonary Risk

Older adults are most at risk of lung problems after surgery. The most common problems are a collapsed lung, pneumonia (a lung infection), or needing a machine to help with breathing for a long time. Older adults who have these problems after surgery are at higher risk of death, even over the long term.

Other things that raise the risk of lung problems after surgery include:

• Chronic obstructive pulmonary disease (COPD), a lung disease that makes it hard to breathe
• Smoking
• Congestive heart failure, a condition where the heart does not pump blood well

Some things that can help prevent lung problems include:

• Breathing exercises to strengthen the lungs. This may lower the risk of lung problems after certain surgeries.
• Quitting smoking at least 4 weeks before surgery.

Cognition and Depression Evaluation

Many older adults need to have their thinking and memory checked before surgery. Doctors also check for depression. These checks are important for several reasons.

• Older adults are more likely to have thinking and memory problems than younger people. These problems are not always easy to spot.
• The check helps find out if the older adult can make their own health decisions. If not, a family member or trusted person may need to make decisions for them.
• Older adults with dementia (a disease that causes memory loss and confusion) have a higher risk of problems after surgery, including kidney failure, pneumonia, stroke, and delirium.
• Depression is linked to death within a year of surgery. Treating depression may lead to better outcomes.

Health care professionals also need to watch for delirium. Delirium affects up to half of older adults who have surgery. Delirium is a sudden change in a person's thinking, attention, and awareness. Symptoms often come on fast and can change from hour to hour. Delirium is linked to higher death rates, longer hospital stays, and loss of ability to function.

Malnutrition Screening

Poor nutrition before surgery raises the risk of serious problems afterward. These problems can include death, a longer hospital stay, and being readmitted to the hospital. It is very important to check older adults for malnutrition (not getting enough nutrients) and to address any problems found.

Evaluation of Functional Status, Frailty, and Social Support

Older adults need a thorough check of what they can do on their own and what support they have. Older adults who need help with daily activities tend to have worse outcomes after surgery, including death, delirium, and having to move into a care facility.

• Before surgery, the doctor needs to check whether the older adult can do their usual daily activities. This helps the doctor spot the risk of poor outcomes, talk about realistic recovery options, and suggest any needed support.
• Older adults who are frail (physically weak and less able to handle stress) are more at risk of losing function, having a longer hospital stay, or needing to move into a care facility after surgery.

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