SURGICAL INTERVENTIONS IN ELDERLY PATIENTS: CHALLENGES AND ETHICAL CONSIDERATIONS

Abstract

Population aging has increased the demand for surgical interventions in elderly patients, who have specific characteristics, such as multiple comorbidities and physiological changes, which directly impact surgical management. This study aimed to conduct an integrative review of the challenges and ethical considerations in the surgical treatment of geriatric patients. The review followed the steps proposed by Mendes, Silveira, and Galvão (2008) and analyzed articles published between 2015 and 2023, in the SciELO, PubMed, and LILACS databases. The results indicated that comprehensive geriatric assessment (CGA) is essential to identify frailties and comorbidities that may influence surgical prognosis. CGA allows personalized perioperative planning, which contributes to risk reduction and improvement in postoperative outcomes. Perioperative planning should be carefully adapted to the particularities of elderly patients, considering physiological limitations and appropriate anesthesia and intra- and postoperative management strategies. Ethical considerations, such as respect for autonomy, beneficence, nonmaleficence, and justice, are essential to guide clinical decisions, especially regarding the choice of surgical interventions and equitable access to health care. This study highlights the importance of a multidisciplinary and patient-centered approach, as well as the need for ongoing training of health professionals in technical and ethical aspects. The research also points to the need for further studies on the perception of older adults and their families in surgical decisions and preoperative rehabilitation programs.