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

25 March 2021
18 min read
Volume 30 · Issue 6


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).

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