Features  |   February 2019
ASA Perioperative Brain Health Initiative: Engaging Others and Closing the Gap
Author Affiliations
  • Carol J. Peden, M.B., Ch.B., M.D., M.P.H.
    Vice Chair for Performance Improvement, Ad Hoc Committee on Brain Health Initiative
  • Lee A. Fleisher, M.D.
    Chair, Ad Hoc Committee on Brain Health Initiative
Article Information
Features
Features   |   February 2019
ASA Perioperative Brain Health Initiative: Engaging Others and Closing the Gap
ASA Monitor 2 2019, Vol.83, 10-12.
ASA Monitor 2 2019, Vol.83, 10-12.
The U.S. population is aging rapidly, and the figures are staggering. Every day, 10,000 people turn 65 in the U.S., and by 2030, one in five Americans will be 65 or older. The numbers of the oldest old, those over 85 years, are also increasing dramatically: by 2050, 18 million Americans will be over 85.1  Many of these older people will have surgery; currently one-third of surgical patients are over 65 years of age, and this is predicted to rise to 50 percent in the near future. The most common postoperative complication for patients over 65 is delirium.2  Despite this, a recent survey of anesthesiologists conducted by the ASA Committee on Geriatric Anesthesia showed that very few anesthesiologists are routinely screening older patients for their brain health, nor taking routine steps to prevent delirium and postoperative delayed neurocognitive recovery. Data suggest that 30-40 percent of delirium is preventable and, for patients who experience an episode of delirium, the incidence of subsequent cognitive decline and dementia is increased.3  It is unclear whether this is a causal relationship or whether surgery and anesthesia reveal a vulnerable brain; however, best practice guidelines now suggest that all patients over 65 years of age should be screened for cognitive impairment, and known perioperative risks such as administration of benzodiazepines and anti-cholinergics should be avoided. A recent consensus statement on best practices for perioperative brain health was published in Anesthesiology.4 
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