Biology of Aging

Abstract

Principles distilled from geroscience, the scientific study of aging, can facilitate surgical decision making by identifying appropriate surgical candidates, anticipating surgical complications, and predicting functional outcomes. Theories of aging can be divided into program theories that emphasize genetically driven limits on lifespan and stochastic theories that focus on the accumulation of “wear and tear” with age. These changes lead to distinct patterns of dysfunction in intracellular processes and intercellular communication that culminate in organ system-specific alterations, which are reviewed here. The inter-related concepts of frailty and resilience synthesize these diverse changes into a unified conceptual framework that can be used to support surgical decision making. Frailty, which is defined as increased vulnerability to stress, is a risk factor for surgical complications and poor outcomes. Conversely, resilience is the ability to resist functional decline following health stressors. The assessment of frailty and resilience can be integrated into pre-surgical evaluation to gauge risk, support shared decision-making, and improve patient outcomes.