How to define an elderly and frail patient?

Elderly is conventionally defined as a person 65 years old or older, but some studies have addressed the issue of biological age-based descriptions of "elderly. " The latter differs from chronological age because it takes into consideration a number of factors other than just the date of birth. Since aging would occur gradually accumulating damage to various cells and tissues in the body, the concept of "biological age" may be used as a trait d'union between elderly and frail. Globally, the population is aging, and the life expectancy is increasing worldwide. As a result of the increasing number of elderlies worldwide, the conditions that require surgery are also increasing. This demographic transition has changed the surgeons' definition of older patients; indeed, nowadays a growing number of complex operations are being successfully performed to patients over 80 years. No evidence supports a single standard pre-surgical assessment for the elderly and frail patients. Preoperative screening should be guided by the type of surgery and the underlying comorbidities rather than a routine list of tests. There are many risk predictions models available to the emergency clinician, for example, ASA, P-POSSUM, and APACHE-2. None of these risk scores makes any adjustment for frailty. Comorbidity and frailty often coexist with polypharmacy. Polypharmacy itself has been used as a surrogate for frailty. Postoperative care of the elderly patient is extremely important for both decreasing the short-and long-term mortality of the patients and improving the quality of life. There are no standard guidelines for postoperative care of the elderly patient. The followings are worth mentioning when working with elderly patients: hypothermia, pain control, mobilization, rehabilitation, fall prevention, prevention of postoperative delirium and cognitive dysfunction, and intolerance to complications. In conclusion, the surgeon must, therefore, be familiar with the physiological, pathological, and clinical changes of this group of people.