The answer is not known with certainty, but there are several likely reasons. Age-related decline in liver and kidney function results in a decreased ability to metabolize and eliminate drugs, which results in significantly slower elimination and clearance of these drugs from the bloodstream with increased effects—and side effects. The elderly brain is more susceptible to injury and metabolic derangement than the younger brain and less tolerant of it. Alcohol and sedative abuse is common in the elderly, and withdrawal syndrome with delirium may result from sudden cessation of these substances in the hospital. Prevalent psychological factors in the elderly, like depression, dementia, and anxiety, often are associated with postoperative mental decompensation.
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