The combination of low birth rate and greater life expectancy has created an ageing population exposed to orthopaedic trauma and surgeries. This remains a tremendous challenge for anaesthetists because many geriatric patients have multiple comorbidities and age-related pathophysiological changes which complicate their perioperative anaesthetic management.

The perioperative care plan should be tailored for individual patients according to their past medical history, demographic and type of surgery. Orthogeriatric patients are at risk of higher morbidity and mortality and, hence, many centres have developed guidelines for their perioperative management. However, the process of formulating a perioperative plan for orthogeriatric patients is complex due to their pre-existing medical illnesses and the difficulties in assessing functional capacity, a major marker of frailty.

Cardiovascular diseases are particularly common in the elderly. Unfortunately, anaesthetists may experience difficulty in determining cardiac function in these patients as they often present with cognitive impairment, frailty and impaired exercise tolerance or inability to exercise because of orthopaedic pathology. Therefore, the use of perioperative transthoracic echocardiography (TTE) has become more popular because it offers a non-invasive method to assess cardiac function and screen for life-threatening conditions.