Geriatric Considerations in Emergency Interventional Radiology: Challenges and Strategies

• Recognize the unique challenges of providing interventional care for a growing geriatric population.


• Awareness of newer terminology and considerations including the ‘super-geriatric’ patient


• Provide a framework for key pre-, intra and post-procedural considerations as it relates to geriatric physiology


• Appreciate the importance of multidisciplinary collaboration in optimizing care

Adapting to a rapidly growing complex, multi-morbid aging population is a monumental challenge facing healthcare systems globally. Declining physiologic and cognitive reserves, multi-organ dysfunction, polypharmacy and an arduous recovery process make geriatric patients some of the most challenging to manage. By the year 2030, 1 in 6 people are estimated to be 60 and over globally. This has resulted in a steep rise in geriatric emergencies. IR is unique in providing a diverse set of minimally invasive solutions for this population. Therefore, understanding and strategizing for the unique challenges in geriatric care is imperative to ensuring optimal care.

Clinical Findings/Procedure Details:

A practical framework for management of the geriatric patient is through evaluating key pre-, intra- and post-procedural considerations.

Pre-procedural evaluation involves developing an understanding of the patient’s cognitive and physiologic baseline. This entails evaluating capacity for consent and developing a thorough understanding of baseline organ function, medications, and bleeding risk for procedural preparation.

Intra-procedurally, the focus shifts to technical adaptations for optimizing procedural success and minimizing acute complications. Examples include adjusting sedative doses and adapting access and navigational techniques based on presence of vascular calcification, stenoses and vessel tortuosity.

Post-procedurally, the goal is to expedite recovery, restore physiologic hemostasis and optimize post-discharge care. This includes strategizing for timely resumption of anticoagulants, optimizing fluid and electrolyte status and ensuring adequate home care supports for drain and tube care, crucial for minimizing complications and re-admissions. This is best achieved through the collaborative contributions of a multidisciplinary network of physicians and allied health professionals.

Conclusion and/or Teaching Points:

In this exhibit, we review the relevant strategies and evidence-based recommendations for tackling these unique challenges and optimizing outcomes for geriatric patients receiving emergency IR treatment.