References

Postoperative delirium in older adults: best practice statement from the American Geriatrics Society. J Am Coll Surg. 2015; 220:(2)136-148.e1 https://doi.org/10.1016/j.jamcollsurg.2014.10.019

Bettelli G, Neuner B Postoperative delirium: A preventable complication in the elderly surgical patient. Monaldi Arch Chest Dis. 2017; 87:(2) https://doi.org/10.4081/monaldi.2017.842

Björkelund KB, Hommel A, Thorngren KG, Gustafson L, Larsson S, Lundberg D Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study. Acta Anaesthesiol Scand. 2010; 54:(6)678-688 https://doi.org/10.1111/j.1399-6576.2010.02232.x

Brooks P, Spillane JJ, Dick K, Stuart-Shor E Developing a strategy to identify and treat older patients with postoperative delirium. AORN J. 2014; 99:(2)256-276 https://doi.org/10.1016/j.aorn.2013.12.009

Bruce AJ, Ritchie CW, Blizard R, Lai R, Raven P The incidence of delirium associated with orthopedic surgery: a meta-analytic review. Int Psychogeriatr. 2007; 19:(02)197-214 https://doi.org/10.1017/S104161020600425X

Chen CCH, Li HC, Liang JT, Lai IR Effect of a modified Hospital Elder Life Program on delirium and length of hospital stay in patients undergoing abdominal surgery. JAMA Surg. 2017; 152:(9)827-834

Chevillon C, Hellyar M, Madani C, Kerr K, Kim SC Preoperative education on postoperative delirium, anxiety, and knowledge in pulmonary thromboendarterectomy patients. Am J Crit Care. 2015; 24:(2)164-171 https://doi.org/10.4037/ajcc2015658

Clarke V, Braun V Thematic analysis.(ed). New York (NY): Springer; 2014

Coughlan M, Cronin P, Ryan F, 1st edn. London: Sage Publications; 2013

Culley DJ, Flaherty D, Fahey MC Poor performance on a preoperative cognitive screening test predicts postoperative complications in older orthopaedic surgical patients. Anesthesiology. 2017; 127:(5)765-774 https://doi.org/10.1097/ALN.0000000000001859

Denny DL, Lindseth G Preoperative risk factors for subsyndromal delirium in older adults who undergo joint replacement surgery. Orthop Nurs. 2017; 36:(6)402-411 https://doi.org/10.1097/NOR.0000000000000401

Denny DL, Such TL Exploration of relationships between postoperative pain and subsyndromal delirium in older adults. Nurs Res. 2018; 67:(6)421-429 https://doi.org/10.1097/NNR.0000000000000305

Flynn Makic MB Preventing delirium in postoperative patients. J Perianesth Nurs. 2013; 28:(6)404-408 https://doi.org/10.1016/j.jopan.2013.09.002

Fok MC, Sepehry AA, Frisch L Do antipsychotics prevent postoperative delirium? A systematic review and meta-analysis. Int J Geriatr Psychiatry. 2015; 30:(4)333-344 https://doi.org/10.1002/gps.4240

Freter SH, Dunbar MJ, MacLeod H, Morrison M, MacKnight C, Rockwood K Predicting post-operative delirium in elective orthopaedic patients: the Delirium Elderly At-Risk (DEAR) instrument. Age Ageing. 2005; 34:(2)169-171 https://doi.org/10.1093/ageing/afh245

Freter S, Dunbar M, Koller K, MacKnight C, Rockwood K Risk of pre- and post-operative delirium and the Delirium Elderly At Risk (DEAR) tool in hip fracture patients. Can Geriatr J. 2015; 18:(4)212-216 https://doi.org/10.5770/cgj.18.185

Freter S, Koller K, Dunbar M, MacKnight C, Rockwood K Translating delirium prevention strategies for elderly adults with hip fracture into routine clinical care: A pragmatic clinical trial. J Am Geriatr Soc. 2017; 65:(3)567-573 https://doi.org/10.1111/jgs.14568

Gherghina V, Nicolae G, Balcan A, Cindea I, Costea D, Popescu R Incidence and risk factors of acute postoperative delirium in elderly patients after elective and emergency surgery. European Journal of Anaesthesiology. 2011; 28

Glynn L, Corry M Intensive care nurses’ opinions and current practice in relation to delirium in the intensive care setting. Intensive Crit Care Nurs. 2015; 31:(5)269-275 https://doi.org/10.1016/j.iccn.2015.05.001

Guo Y, Fan Y A Preoperative, Nurse-led intervention program reduces acute postoperative delirium. J Neurosci Nurs. 2016; 48:(4)229-235 https://doi.org/10.1097/JNN.0000000000000220

Hattori H, Kamiya J, Shimada H Assessment of the risk of postoperative delirium in elderly patients using E-PASS and the NEECHAM Confusion Scale. Int J Geriatr Psychiatry. 2009; 24:(11)1304-1310 https://doi.org/10.1002/gps.2262

Inouye SK, Charpentier PA Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA. 1996; 275:(11)852-857 https://doi.org/10.1001/jama.1996.03530350034031

Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990; 113:(12)941-948 https://doi.org/10.7326/0003-4819-113-12-941

Inouye SK, Westendorp RGJ, Saczynski JS Delirium in elderly people. Lancet. 2014; 383:(9920)911-922 https://doi.org/10.1016/S0140-6736(13)60688-1

Inouye SK Delirium in older persons. N Engl J Med. 2006; 354:(11)1157-1165 https://doi.org/10.1056/NEJMra052321

Khan BA, Perkins AJ, Campbell NL Preventing postoperative delirium after major noncardiac thoracic surgery—a randomized clinical trial. J Am Geriatr Soc. 2018; 66:(12)2289-2297 https://doi.org/10.1111/jgs.15640

Kratz T, Heinrich M, Schlauß E, Diefenbacher A Preventing postoperative delirium. Dtsch Arztebl Int. 2015; 112:(17)289-296 https://doi.org/10.3238/arztebl.2015.0289

Lee J, Jung J, Noh JS, Yoo S, Hong YS Perioperative psycho-educational intervention can reduce postoperative delirium in patients after cardiac surgery: a pilot study. Int J Psychiatry Med. 2013; 45:(2)143-158 https://doi.org/10.2190/PM.45.2.d

Leung JM, Sands LP, Lim E, Tsai TL, Kinjo S Does preoperative risk for delirium moderate the effects of postoperative pain and opiate use on postoperative delirium?. Am J Geriatr Psychiatry. 2013; 21:(10)946-956 https://doi.org/10.1016/j.jagp.2013.01.069

Lynch E, Lazor M, Gellis JE The impact of postoperative pain on the development of postoperative delirium. Anesth Anal. 1998; 86:(4)781-785 https://doi.org/10.1097/00000539-199804000-00019

Marcantonio ER, Flacker JM, Wright RJ, Resnick NM Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001; 49:(5)516-522 https://doi.org/10.1046/j.1532-5415.2001.49108.x

Mazzola P, Ward L, Zazzetta S Association between preoperative malnutrition and postoperative delirium after hip fracture surgery in older adults. J Am Geriatr Soc. 2017; 65:(6)1222-1228 https://doi.org/10.1111/jgs.14764

Moyce Z, Rodseth RN, Biccard BM The efficacy of peri-operative interventions to decrease postoperative delirium in non-cardiac surgery: a systematic review and meta-analysis. Anaesthesia. 2014; 69:(3)259-269 https://doi.org/10.1111/anae.12539

Delirium: prevention, diagnosis and management. Clinical guideline CG103. 2010; https://www.nice.org.uk/guidance/cg103

Neufeld KJ, Leoutsakos JS, Sieber FE Evaluation of two delirium screening tools for detecting post-operative delirium in the elderly. Br J Anaesth. 2013; 111:(4)612-618 https://doi.org/10.1093/bja/aet167

O'Neal JB, Shaw AD Predicting, preventing, and identifying delirium after cardiac surgery. Perioper Med (Lond). 2016; 5:(1) https://doi.org/10.1186/s13741-016-0032-5

Pasina L, Colzani L, Cortesi L Relation between delirium and anticholinergic drug burden in a cohort of hospitalized older patients: an observational study. Drugs Aging. 2019; 36:(1)85-91 https://doi.org/10.1007/s40266-018-0612-9

Polit DF, Beck C Essentials of nursing research, 8th edn. London: Lippincott Williams & Wilkins; 2014

Radtke FM, Franck M, MacGuill M Duration of fluid fasting and choice of analgesic are modifiable factors for early postoperative delirium. Eur J Anaesthesiol. 2010; 27:(5)411-416 https://doi.org/10.1097/EJA.0b013e3283335cee

Teslyar P, Stock VM, Wilk CM, Camsari U, Ehrenreich MJ, Himelhoch S Prophylaxis with antipsychotic medication reduces the risk of post-operative delirium in elderly patients: a meta-analysis. Psychosomatics. 2013; 54:(2)124-131 https://doi.org/10.1016/j.psym.2012.12.004

Vaurio LE, Sands LP, Wang Y, Mullen EA, Leung JM Postoperative delirium: the importance of pain and pain management. Anesth Analg. 2006; 102:(4)1267-1273 https://doi.org/10.1213/01.ane.0000199156.59226.af

Vlisides P, Avidan M Recent advances in preventing and managing postoperative delirium. F1000Res. 2019; 1:(8) https://doi.org/10.12688/f1000research.16780.1

Wang C, Qin Y, Wan X, Song L, Li Z, Li H Incidence and risk factors of postoperative delirium in the elderly patients with hip fracture. J Orthop Surg Res. 2018; 13:(1) https://doi.org/10.1186/s13018-018-0897-8

Wass S, Webster PJ, Nair BR Delirium in the elderly: a review. Oman Med J. 2008; 23:(3)150-157

Weng CF, Lin KP, Lu FP Effects of depression, dementia and delirium on activities of daily living in elderly patients after discharge. BMC Geriatr. 2019; 19:(1) https://doi.org/10.1186/s12877-019-1294-9

Whitlock EL, Vannucci A, Avidan MS Postoperative delirium. Minerva Anestesiol. 2011; 77:(4)448-456

Zanobini F, Nitti M, Giubbolini G, Giubbolini F, Fagiolini A Early recognition and treatment of delirium using the confusion assessment method for the intensive care unit in cardiac surgical intensive care unit. European Neuropsychopharmacol. 2017; 27 https://doi.org/10.1016/S0924-977X(17)31356-1

Zhang H, Lu Y, Liu M Strategies for prevention of postoperative delirium: a systematic review and meta-analysis of randomized trials. Crit Care. 2013; 17:(2) https://doi.org/10.1186/cc12566

A narrative review of preventive measures for postoperative delirium in older adults

25 March 2021
18 min read
Volume 30 · Issue 6

Abstract

Postoperative delirium (POD) is an acute neurological condition associated with changes in cognition and attention and disorganised thinking. Although delirium can affect patients from any age group, it is common in older patients and could lead to a longer hospital stay and a higher risks of mortality. This article presents findings from a literature review that identifies various strategies used by health professionals globally to prevent POD. A database search resulted in 25 articles that met the inclusion criteria. Thematic analysis and coding were used to combine recurrent ideas that emerged from the literature. Three themes were identified: early identification and screening, modifiable risk factors, and preventive interventions. Further research focusing on education and improving awareness about POD among nurses is essential.

Postoperative delirium (POD) is an acute neurological condition that develops as an adverse complication following surgery or use of anaesthesia. It usually lasts for some hours postoperatively but, if left untreated, it can manifest for several days (Bettelli and Neuner, 2017). Delirium can be characterised as hyperactive, hypoactive and mixed. Patients with hyperactive delirium will have symptoms of agitation, acute disorientation or restlessness. Hypoactive delirium commonly goes unrecognised because patients usually present as lethargic and quiet, but still disoriented (Flynn Makic, 2013).

Delirium has been well documented as one of the leading complications of major surgery, affecting 15–53% of patients; however, the incidence of POD varies and depends on age, risk factors and type of surgery (Gherghina et al, 2011; Inouye et al, 2014; Wang et al, 2018). It is a serious complication for older adults because an episode of delirium can start a cascade of adverse events, for example a prolonged length of stay in hospital but also increase the risk of mortality due to complications such as hospital-acquired infection, pressure ulcers, incontinence and falls (Wass et al, 2008; O'Neal and Shaw, 2016).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content