What examinations and assessments should a nurse practitioner perform on an elderly patient prior to facelift surgery?

Preoperative Nurse Practitioner Examination for Elderly Facelift Patient

A nurse practitioner must perform a validated multidimensional frailty assessment and comprehensive geriatric assessment (CGA) on all elderly patients aged 65 and older prior to elective facelift surgery, focusing on six mandatory domains: cognitive function, functional status, nutritional status, polypharmacy, comorbidity burden, and social support. 1, 2

Mandatory Assessment Domains

Cognitive Function Evaluation

• Screen for pre-existing cognitive deficits and baseline mental status to establish risk for postoperative delirium and cognitive decline 1, 3
• Document decision-making capacity and ability to provide informed consent, as mental capacity laws require assessment of whether the patient understands how the intervention affects their remaining quality of life 1
• Obtain collateral history from family members if cognitive concerns exist 2

Frailty Screening (Critical Priority)

• Use a validated multidimensional frailty instrument on all patients ≥65 years, as frailty provides unique prognostic information beyond traditional risk scores and shows dose-dependent effects on postoperative complications, reoperation, and mortality 1, 2
• The American College of Surgeons and British Journal of Anaesthesia emphasize that frailty assessment is feasible in clinical practice and mandatory for geriatric surgical patients 1
• Do not rely solely on ASA Physical Status classification, as it does not predict 6-month mortality in older adults 1

Functional Status Assessment

• Evaluate the patient's ability to perform activities of daily living independently, partially dependently, or with total dependence, as functional capacity is one of five key elements predicting 30-day cardiac complications 2
• Assess mobility, strength, and balance using validated tools 4
• Screen for sarcopenia (loss of muscle mass, strength, and function), which represents declining musculoskeletal reserve that precedes frailty 1

Nutritional Status

• Screen for malnutrition using validated assessment tools, as malnutrition increases risk of postoperative complications and poor wound healing 1, 3, 4
• Document baseline nutritional parameters to guide preoperative optimization 1

Polypharmacy Review

• Conduct comprehensive medication reconciliation and apply START/STOPP criteria for medication optimization 1
• The British Journal of Anaesthesia specifically recommends avoiding extending polypharmacy unnecessarily and identifying medications that increase perioperative risk 1
• Document all medications including over-the-counter supplements 2

Comorbidity Burden Assessment

• Evaluate all concurrent medical conditions beyond the surgical indication, recognizing that elderly patients present with age-related physiological decline and multimorbidity that independently increase perioperative risk 1, 5
• Remember that physiological reserve decreases approximately 1% per year after age 40, making patients vulnerable to surgical stress 1, 2
• Document cardiac, pulmonary, renal, hepatic, and endocrine function 2

Social Support Evaluation

• Assess availability of caregivers and home support for postoperative recovery, as this is a mandatory CGA domain 1, 2
• Document next-of-kin and emergency contacts 2

Physical Examination Specifics

Cardiovascular Assessment

• Establish baseline blood pressure to guide intraoperative management, as mean arterial pressure should be maintained within 20% of preoperative baseline 1
• Screen for cardiac risk factors using validated tools beyond simple cardiac risk indices 2, 4

Thermoregulation Considerations

• Note baseline temperature and assess thermoregulatory capacity, as perioperative hypothermia is common in elderly patients and associated with postoperative delirium, cardiac dysfunction, prolonged hospital stay, and poor wound healing 1

Functional Aids Documentation

• Document use of glasses, hearing aids, and dentures, as these should remain in place until just before anesthesia induction to maintain patient orientation and comfort 1

Critical Pitfalls to Avoid

• Never ration surgical care based solely on chronological age—biological age and frailty status matter more than the number of years lived 2
• Do not perform high-risk surgery without a preoperative commitment to adequate postoperative care, as this violates ethical standards 1
• Avoid relying on traditional risk scores alone (like ASA classification or cardiac indices), as they miss geriatric-specific vulnerabilities that better predict outcomes 1, 4
• Balance preoperative optimization against surgical delay, though for elective facelift surgery, adequate time for optimization is appropriate 1, 2

Multidisciplinary Consultation Requirements

Higher-risk elderly patients require preoperative assessment by both a senior geriatrician and senior anesthetist with geriatric subspecialty training 1, 2. For an elective cosmetic procedure like facelift, if the patient screens positive for frailty or has significant comorbidities, early multidisciplinary team involvement is mandatory throughout the perioperative period 1.