The illnesses requiring surgery are among the most strenuous adversities of aging.The decision to operate upon an elderly person must take into account the stress the experience will imposed upon the cardiovascular, metabolic, and other systems which, with less resiliency than in earlier years, will have to adapt to the effects of anesthesia, tissue damage, and the strain of postoperative restoration of somatic function. The surgical experience is also a threat to the integrity of the aging nervous system and to the elderly patient's psychological adaptation. Our research team has had the opportunity of intensive observation of a number of aged people who became ill and were admitted to a surgical service for treatment. We have assembled data that contribute to an understanding of the psychological responses of the aged person to surgery.Concentration upon the psychologically stressful aspects of surgery from a perspective of the therapeutic value of surgery has not led us to conclude that surgery should be discarded as a treatment for an University (Dr. Zwerling). ailing and aging person. Our findings do not provide opposition to surgery, any more than do discoveries of the special problems of electrolyte balance in the pre-and post¬ operative periods of the elderly patient. The stress incident to any therapy poses prob¬ lems for consideration rather than indicat¬ ing that such stress must always be avoided.
Material and MethodsThe study has included 45 patients, all 65 years or over, admitted during 12 months (1953)(1954) to the surgical service of the Cincinnati General Hospital. The means of selection of these patients was as follows : They were included by chance in the random selection of a total of 20 surgical patients chosen for the purpose of a more general and extensive study of the psychological aspects of surgical illness and the representative surgical patient. The larger group, of 200, proved at the end of the year of the study to be statistically representative of the 3656 admissions during the same year with respect to age, race, sex, duration of stay in the hospital, whether or not operation was performed, site of operation, and whether sur¬ gery was elective or emergency. In summary, pa¬ tients were randomly selected from all surgical admissions rather than for special characteristics, and the 200 patients truly represented the year's total surgical admissions.1 The 45 elderly patients from whom were derived the findings of this report include all of the persons of 65 or over who hap¬ pened to be picked by our random selection method. There is reason to believe, therefore, that this subgroup is representative of the patients of 65 and over who enter a municipal hospital for sur¬ gery.