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The altered physiology of the older patient in combination with the increased number of disease processes increases the potential risk of perioperative complications. The usual diagnostic procedures often fail to uncover the multiple problems these patients have. They need a comprehensive preoperative assessment, which includes a thorough history, physical examination and laboratory testing. Special considerations include an evaluation of the nutritional status, the functional capabilities and an assessment of the patients' cognitive and emotional status. This type of comprehensive assessment helps the physician to minimize the perioperative risks for older patients and is an excellent tool for improving the postoperative care and rehabilitation procedures.

In regard to everyday problems with older patients on the emergency wards of our hospitals the usual diagnostic procedures are obviously not very helpful in uncovering the multiple problems these patients have. They need a comprehensive assessment which includes evaluation of the patient in several domains, namely physical, mental, socioeconomic, functional and environmental status. The multidisciplinary character of the comprehensive geriatric assessment and its problems and goals are discussed.

A pharmacokinetic investigation was carried out on a group of 13 elderly patients (2 males, 11 females, mean age 79 years) who were either mildly hypertensive or had a history of hypertension. The aim of the study was to determine and compare the plasma concentrations, urinary excretion and pharmacokinetic parameters of pindolol (Visken) after a single oral dose and in steady-state. Each patient received 10 mg (two 5 mg tablets in one dose) of pindolol daily for 7 days. Blood plasma and urine samples were obtained for up to 24 h after administration on days 1 and 7, blood pressure and pulse rate were also taken on the same days. The pharmacokinetic parameters and the effects on blood pressure and pulse rate of pindolol after 7 days of treatment showed no statistical difference to those recorded after a single dose. Kinetic data in this group did not differ from findings recorded in previous studies conducted on younger subjects. Results of this study indicate that pindolol does not accumulate on repeated administration to older patients. Therefore no adjustment of the usual dosage is necessary when prescribing for this age group. Finally the problems concerning pharmacokinetic investigations in elderly patients are discussed.