Postoperative Delirium in the Older Patient

Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Journal of the American College of Surgeons (Impact Factor: 5.12). 06/2005; 200(5):767-73. DOI: 10.1016/j.jamcollsurg.2004.08.031
Source: PubMed
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    • "When prevalence was examined by type of unit, the highest rate was found among medical units, which is consistent with other studies.(35) However, inexplicably, the prevalence of delirium on surgical wards was lower than that reported in other studies.(34,36) Patients with pre-existing delirium (prevalent delirium) are often excluded from admission to rehabilitation units, which may explain the lower rates found in these units. "
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    ABSTRACT: Research indicates that 40% of hospital-acquired delirium cases may be preventable. However, despite its clinical significance, delirium often goes unrecognized or is misdiagnosed. The purpose of this study was to assess the need for delirium education in acute care hospitals in Hamilton, Ontario. Approximately 100 health professionals were trained as delirium screeners. On 'Delirium Day', all patients ≥ 65 years of age in non-critical care areas in all acute care sites in Hamilton were identified. Those willing to take part in the prevalence study were assessed for delirium using the Standardized Mini-Mental State Examination and the Confusion Assessment Method. The Research Ethics Boards at Hamilton Health Sciences and St. Joseph's Healthcare Hamilton approved this quality assurance project. Of the 562 patients eligible for screening, eight were excluded and six did not have sufficient data collected to assess for delirium. Of the 548 individuals screened for delirium, 10.6% screened positive. Prevalence estimates ranged by site from 0% to 21% and type of unit from 3.8% to 16%. Recognition of delirium by nursing staff was fair; but, documentation was usually absent. While the prevalence rates were somewhat lower than in other studies, the results support the need for education among health-care providers in the prevention, identification, and management of delirium.
    03/2012; 15(1):2-7. DOI:10.5770/cgj.15.15
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    • "Older age is characterized by aging of tissues and organs, a greater occurrence of cognitive decline and functional impairment and an increasing number of frail subjects (Fried et al., 2001; Blaum et al., 2002). These frail elderly are more prone to several complications including delirium, which affects approximately one fourth of the hospitalized older patients and a wide range of post-surgical elderly (Amador and Goodwin, 2005). The elderly are a large group of patients undergoing urological surgery, both for endoscopic and for open surgery and POD is an important issue in the daily clinical practice. "
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    ABSTRACT: The aim of this observational study was to investigate the occurrence of postoperative delirium (POD) in elderly patients undergoing urological surgery and to identify those factors associated with delirium. Ninety consecutive patients (81 males and 9 females; average age of 74.3 ± 0.40 years), undergoing urological surgery in University-Hospital Urological Clinic were selected. Personal, medical, cognitive and functional data, biochemical parameters, preoperative medications, conduct of surgery and anesthesia and details of hemodynamic control were collected as predictors of delirium. After surgery, the subjects were divided on the basis of delirium onset within a week observation period. Delirium was diagnosed by the Confusion Assessment Method. Delirium started the first post-operative day (2F; 6 M) and lasted 3.0 ± 0.8 days. Subjects with POD were significantly older, had a previous history of delirium, were more impaired in the instrumental activities of daily living and had poorer clock drawing test (CDT) score. Interestingly, a significantly greater number of hypotensive events were recorded during anesthesia. Age, cognitive and functional status, previous history of delirium and hypotensive episodes intrasurgery are the best predictor of POD in this setting. Our findings have implications in preventing delirium in elderly by an early and targeted evaluation.
    Archives of gerontology and geriatrics 11/2010; 52(3):e166-9. DOI:10.1016/j.archger.2010.10.021 · 1.85 Impact Factor
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    ABSTRACT: BACKGROUND: Delirium or acute confusion is a temporary mental disorder, which occurs frequently among hospitalized elderly patients. Patients who undergo cardiac surgery have an increased risk of developing delirium. Delirium is associated with many negative consequences. Therefore, prevention or early recognition of delirium is essential. - MAIN AIMS:  measure incidence delirium and duration of delirium episode after cardiac surgery  examine the predictive validity of the Delirium Observation Screening (DOS) scale  develop and validate the predictive validity of a risk model for delirium  study the consequences of delirium 6 and 12-18 months after cardiac surgery METHODS: In two studies we first developed and then validated a risk model delrium to see wich risk factors are independently associated with a postoperative delirium after cardiac surgery. The diagnosis delirium was based on the DOS scale and the diagnosis was confirmed or refuted by a psychaitrist. To study the consequences of delrium two questionnaire studies were performed in a first cohort with 112 patients and a second cohort with 300 patients. - RESULTS: The incidence delirium after cardiac surgery was 21% and 17% in the two studies. After multivariate analysis a risk model delirium in cardiac surgery patients was constructed with the following risk factors: Euroscore, older age (> 70 years), cognitive impairment, the number of co-morbidities, history of delirium, alcohol use, and type of surgery. The DOS scale is a very good instrument to facilitate early recognition of delirium by nurses’ observation of patients who undergo cardiac surgery. A delirium after cardiac surgery is associated with important consequences: increased mortality, more re-admissions to the hospital, reduced quality of life, and reduced functional and cognitive function. - CONCLUSIONS: With the risk model delirium, including seven risk factors, patients with an increased risk of developing delirium following cardiac surgery can be identified. Next, with the DOS scale early recogniton of delirium can be realized. In further research in patients at risk for delirium, interventions to reduce the number, severity or duration of episodes of delirium, should be investigated.
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