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Frail older adults ‘more likely to experience delirium after surgery’

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Older adults who are also frail are twice as likely to experience delirium following elective surgery than others of an older age, a new review by Canadian researchers suggests.

Researchers found that a history of delirium, frailty and cognitive impairment were the risk factors most strongly associated with developing post-operative delirium.

“Post-operative delirium is a common, yet preventable, complication”

Jennifer Watt

Other risk factors that were associated with developing post-operative delirium included smoking and the use of psychotropic medications, according to the study authors.

The results of their systematic review were published today in the Journal of General Internal Medicine. It involved 41 existing studies including more than 9,000 patients 60 years and older.

The researchers, from St Michael’s Hospital in Toronto, found that 18.6% – around one in six – of the older adults in the study experienced delirium following elective surgery.

The researchers also highlighted that patients who developed delirium were at an increased risk of developing other adverse post-surgical outcomes and were more likely to be discharged to another hospital, a long-term care facility, or die following surgery.

Although older adults were assessed for cardiovascular and respiratory risk before an elective surgery, often not enough consideration was given to risk factors that were more common in older adults, including delirium, the authors said.

They stated: “Though caution must be used in interpreting meta-analyses of non-randomised studies due to the potential influence of unmeasured confounding, we identified potentially modifiable prognostic factors including frailty and psychotropic medication use that should be targeted to optimise care.”

“This study highlights how common delirium is among older adults undergoing elective surgery”

Jennifer Watt

Lead author Dr Jennifer Watt said: “Post-operative delirium is a common, yet preventable, complication experienced by older adults undergoing elective surgery.

“Understanding delirium risk factors may help clinicians, patients, and caregivers to target interventions aimed at lessening its burden,” noted Dr Watt.

She added: “This study highlights how common delirium is among older adults undergoing elective surgery, and the importance of geriatric syndromes, including frailty, in identifying older adults who may be at risk.”

As well as the risk factors, the researchers also found that patients who had carer support are also 30% less likely to experience delirium following elective surgery than those who did not.

Carer support was defined in the studies as the patient being married or having a higher number of visitors than average, according to the review.

The studies included in the review did not specify whether carer support came before surgery, after surgery, or both, noted the study authors.

Dr Watt said earlier research had shown that when families delivered interventions, such as helping to mobilise or orient the patient, they were less likely to experience delirium following hip surgery.

“What we’re seeing in this review may be a result of the fact that they’re doing some of these things for their loved ones already,” she noted.

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Readers' comments (3)

  • After almost 40 years working in orthopaedics I could have told you that for free. How much was spent on this research! Infection, Dehydration, Shock, Analgesia Compounded by strange environment. Asking some families to help is counter productive and can alienate the relatives who cannot comprehend the behaviours of a prim and proper mother acting out like a fish wife using language unheard before. The skills honed by years of experience are being lost.

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  • And so simply avoidable through regular observations, close monitoring and hydration. Fewer trained on the wards will only see this problem get worse.

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  • Agree Anonymous. I think we older nurses have noted this for years. Many of the patients coming in have not been eating or drinking properly at home, they need good hydration and nutrition before the onslaught of elective surgery but we have to accept we know nothing!!!!

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