A Nurse‐Led Interdisciplinary Intervention Program for Delirium in Elderly Hip‐Fracture Patients

Milisen, Koen; Foreman, Marquis D.; Abraham, Ivo; Geest, Sabina De; Godderis, Jan; Vandermeulen, Erik; Fischler, Benjamin; Delooz, Herman; Spiessens, Bart; Broos, Paul

doi:10.1046/j.1532-5415.2001.49109.x

Cited by 325 publications

(361 citation statements)

References 64 publications

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“…Seven studies [18][19][20][21][22][23][24] were done in critically ill patients, 5 in geriatric general medicine patients, 9-13 3 in postoperative patients, [14][15][16] and 2 in patients who had a hip fracture. 7,8 A total of 13 of the studies were prospective investigations, [7][8][9][10][11]13,15,16,18,[21][22][23][24] and 4 were randomized control trials. [14][15][16]24 The Confusion Assessment Method or the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was the most frequently used tool and was used in 10 studies.…”

Section: All Studiesmentioning

confidence: 99%

“…Unfortunately, most of the literature is on nonpharmacological interventions used in either general medicine, geriatric, or perioperative patients. [7][8][9][10][11][12][13][14][15][16] Although critically ill patients certainly differ from most of the populations of patients studied, one can reasonably assume that critically ill patients, who are at the highest risk for delirium, would also benefit from nonpharmacological interventions. Large randomized controlled trials with a multi-interventional approach that includes pharmacological and nonpharmacological approaches to prevent delirium are needed.…”

mentioning

confidence: 99%

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Nonpharmacological Interventions to Prevent Delirium: An Evidence-Based Systematic Review

Rivosecchi

Smithburger

Svec

et al. 2015

Critical Care Nurse

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Development of delirium in critical care patients is associated with increased length of stay, hospital costs, and mortality. Delirium occurs across all inpatient settings, although critically ill patients who require mechanical ventilation are at the highest risk. Overall, evidence to support the use of antipsychotics to either prevent or treat delirium is lacking, and these medications can have adverse effects. The pain, agitation, and delirium guidelines of the American College of Critical Care Medicine provide the strongest level of recommendation for the use of nonpharmacological approaches to prevent delirium, but questions remain about which nonpharmacological interventions are beneficial.

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Section: All Studiesmentioning

confidence: 99%

mentioning

confidence: 99%

Nonpharmacological Interventions to Prevent Delirium: An Evidence-Based Systematic Review

Rivosecchi

Smithburger

Svec

et al. 2015

Critical Care Nurse

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“…Numerous studies have demonstrated that perioperative geriatric consultation, early surgery, effective pain management, and staff education can successfully decrease the incidence and severity of postoperative delirium in hip-fracture patients [10][11][12][13][14][15]. In the majority of these studies, many of the patients had preoperative cognitive impairment.…”

Section: Current Research On Postoperative Deliriummentioning

confidence: 99%

Postoperative Cognitive Disorders

Price¹,

Tanner²,

Monk³

2011

Neuroscientific Foundations of Anesthesiology

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Purpose of review-The elderly are the fastest growing segment of the population and undergo 25-30% of all surgical procedures. Postoperative cognitive problems are common in older patients following major surgery. The socioeconomic implications of these cognitive disorders are profound; cognitive decline is associated with a loss of independence, a reduction in the quality of life, and death. This review will focus on the two most common cognitive problems following surgery: postoperative delirium and postoperative cognitive dysfunction (POCD).Recent findings-For years, preoperative geriatric consultation/screening was the only intervention proven to decrease postoperative delirium. There are, however, several recent publications indicating that preoperative and postoperative pharmacological and medical (hydration, oxygenation) management can reduce postoperative delirium. Spinal anesthesia with minimal propofol sedation has been shown to decrease the incidence of postoperative delirium in hip-fracture patients. Likewise, dexmedetomidine sedation in mechanically ventilated patients in the ICU is associated with less postoperative delirium and shorter ventilator times. Preoperative levels of education and brain function (cognitive reserve) may predict patients at risk for postoperative cognitive problems. Reduced white matter integrity is reported to place patients at a higher risk for both postoperative delirium and POCD.Summary-The etiology of postoperative cognitive problems is unknown, but there is emerging evidence that decreased preoperative cognitive function contributes to the development of postoperative delirium and POCD. There is growing concern that inhalation anesthetics may be neurotoxic to the aging brain, but there are no human data evaluating this hypothesis to date. Randomized controlled trials evaluating interventions to improve long-term cognitive outcomes in elderly patients are urgently needed.

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“…Early recognition and treatment of delirium may be the key to reduce the duration and severity of delirium and negative outcomes [10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Delirium pós-operatório em pacientes críticos: fatores de risco e resultados

Veiga¹,

Luís²,

Parente³

et al. 2012

Rev. Bras. Anestesiol.

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A Nurse‐Led Interdisciplinary Intervention Program for Delirium in Elderly Hip‐Fracture Patients

Abstract: This study demonstrated the beneficial effects of an intervention program focusing on early recognition and treatment of delirium in older hip-fracture patients and confirms the reversibility of the syndrome in view of the delirium's duration and severity.

Cited by 325 publications

References 64 publications

Nonpharmacological Interventions to Prevent Delirium: An Evidence-Based Systematic Review

Nonpharmacological Interventions to Prevent Delirium: An Evidence-Based Systematic Review

Postoperative Cognitive Disorders

Delirium pós-operatório em pacientes críticos: fatores de risco e resultados

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