ANESTHESIA AND PSYCHOLOGY IN THE ELDERLY PATIENT

As the aging of population is increasing everywhere in the world, the elderly frequently becomes surgical patient. The anesthetist must alwa ys face both the psychological and physiological status of the elderly patient. The concerns about impending surgery depend on some stressfu ll sensations, such as the separation from family, the impact of a new environment, the possibility of loss of independence, the possibility of death. The elderly people employ two types of coping when facing s urgery: the ''vigilance'' and the ''avoidance''; these seem to produce different postoperative effects. The vigilant patient has a longer ho spitalization and a more negative psychological reaction after surgery . The avoidant patient has a better recovery. The anesthetist has a gr eat choice among different anesthetic techniques. Actually we know tha t no significant difference in outcome can be attributed to the use of any specific anesthetic agent. A recent study of us indicates that th e combined anesthesia (narcosis with peridural analgesia), allows a be tter recovery of psychophysical functions in the earlier postoperative phases. Postoperatively the elderly often presents disorientation and acute brain syndrome that may persist for a long time, apart from ane sthetic technique. The problem is that many factors influence the ment al status of the elderly. It appears that the biological age of the br ain rather than its chronological age may be correlated with the vulne rability by anesthesia.