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Specialist nurses key to reducing post-surgical delirium

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Care from specially-trained nurses can substantially reduce the chances of older patients experiencing delirium after surgery, according to German researchers.

They assessed the impact of “delirium liaison nurses” with training in geriatric psychiatry.

The nurses supported patients aged over 70 to achieve early self-feeding, improved cognitive activity, and restorative sleep. Specifically, the nurses implemented the component measures of the Hospital Elder Life Program (HELP).

“The acute confusional state known as delirium can often be prevented by specialist nursing care after the operation”

Torsten Kratz

The study involved patients with an average age of 77 treated on two surgical wards at a hospital in Berlin, of which 53 received routine care and 61 the specialist nursing care.

In every patient, the risk of post-operative delirium was reduced compared to patients who received routine care, said the study authors, led by Professor Torsten Kratz.

Post-operative delirium arose in 20.8% of the patients on the ward with no specific interventions, but in only 4.9% of those on the ward where the intervention was carried out.

This translated as one patient in five receiving routine care experiencing post-operative delirium, compared with fewer than one in 20 in the group receiving support from delirium liaison nurses.

“The difference was presumably due to the measures initiated by the specially-trained nurse, including validation, improvement of sleep, cognitive activation, early mobilization, improved sensory stimulation, and improved nutritional and fluid intake,” said the authors in the journal Deutsches Ärzteblatt International.

“The frequency of post-operative delirium in elderly patients with cognitive deficits can be lowered with nursing measures carried out by a specially-trained nurse, close postoperative supervision, and cognitive activation,” they stated.

However, the authors acknowledged their study was unable to identify the specific measures that reduced the risk for delirium, which they said would require more studies in larger numbers of patients.

 

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