The Committee on Geriatric Anesthesia has the dual mission of improving the knowledge-base concerning care of the elderly and to disseminate information concerning care of the elderly to ASA members.

There is little question that the elderly make up a large and growing portion of many anesthetic practices. Because anesthetic care has improved greatly, issues associated with elder care have developed an importance that goes beyond simply being a large proportion of our workload — care of the elderly is the new frontier of anesthetic practice.

Last October, ASA President James E. Cottrell, M.D., addressed the issue of postoperative cognitive dysfunction in his inaugural address at the 2002 Annual Meeting. While speaking of the need for anesthesiologists, Dr. Cottrell pointed to one old reason (fear of death) and a new reason. “The new reason is concern about a more subtle outcome. Patients are worried about their minds. They are worried about postoperative cognitive dysfunction, or POCD.”

One of the pre-eminent issues of geriatric anesthesia, POCD was the recent subject of a satellite conference of the Annual Meeting of the Age Anaesthesia Association held last May in Cambridge, England. An international panel addressed recent research and potential future projects. The results from the second International Study of Postoperative Cognitive Dysfunction were presented, including a recent publication indicating no apparent advantage for regional anesthesia in preventing POCD, plus evidence that POCD is really just a disease of elderly patients and data indicating that minor surgery (outpatient and day surgery, i.e., 24-hour stays) are unlikely to cause POCD.

At the ASA 2003 Annual Meeting, it has been announced that Terri G. Monk, M.D., a long-time member of the Committee on Geriatric Anesthesia, will address POCD issues in her Emery A. Rovenstine Memorial Lecture. This represents the first time in recent memory that a named lecture at the ASA Annual Meeting has addressed a clinical problem that primarily affects the elderly!

The Committee on Geriatric Anesthesia maintains relationships with a variety of perioperative specialties via participation in the Section for Surgical and Related Medical Specialties under the auspices of the American Geriatrics Society (AGS). Initially sponsored by the Hartford Foundation, the section is responsible for awarding the Dennis W. Jahnigen Career Development Scholars Awards. The Jahnigen Scholars program offers two-year career development awards to support young faculty in the specialties, including anesthesiology. Each grant will provide two-year salary support of $75,000 per year for salary and fringe benefits, plus $25,000 per year to support research costs. This is an extraordinary opportunity for young faculty with an interest in geriatric anesthesiology. Information relative to the Jahnigen award can be found at <www.americangeriatrics.org/hartford/scholars_award.shtml>.

During this year’s section meeting, a wealth of useful information was presented, including data from an endoscopist suggesting that two liters of oral bowel preparation with oral Dulcolax® provides a clean colon with considerably less periprocedure hemodynamic instability than the standard four-liter preparation.

One particularly brilliant success in the last year is the recent award of two Geriatrics Education for Specialty Residents (GESR) grants to anesthesiologists. AGS, through a program funded by the John A. Hartford Foundation called “Increasing Expertise in Geriatrics for Surgical and Related Medical Specialties,” funds proposals for specialty-specific initiatives from academic training centers to develop, initiate and evaluate programs designed to increase education for residents in the geriatric aspect of their disciplines. This year, Sheila R. Barnett, M.B.B.S., from Beth Israel Deaconess Medical Center in Boston, Massachusetts, and Michael C. Lewis, M.D., from the Miami VAMC and University of Miami School of Medicine, have successfully competed for these grants, and we anxiously await the fruits of their labors.

The Society for the Advancement of Geriatric Anesthesia (SAGA), now in its third year, is a professional organization that works hand in hand with the Committee on Geriatric Anesthesia to improve the perioperative care of geriatric surgical patients through research and education. This year, SAGA will hold its Annual Meeting on October 10, 2003, from 6 p.m. to 10 p.m. in the San Francisco Hilton — Yosemite B. Information about its Annual Meeting and SAGA programs and membership can be located at <www.sagahq.org>.

Remember, there could be a geriatric patient in your operating room today. Take the extra effort to become an expert in their care, and join us in our dedication to the care of all elderly surgical patients.

Jeffrey H. Silverstein, M.D., is Associate Dean for Research, Vice-Chair for the Institutional Review Board, Vice-Chair for Research and Associate Professor of Anesthesiology, Surgery, Geriatrics and Adult Development at Mt. Sinai School of Medicine, New York, New York.