Italian intersociety consensus on prevention, diagnosis, and treatment of delirium in hospitalized older persons

Bellelli, Giuseppe; Morandi, Alessandro; Trabucchi, M.; Caironi, Guido; Coen, Daniele; Fraticelli, Carlo; Paolillo, Ciro; Prevaldi, Carolina; Riccardi, A.; Cervellin, Gianfranco; Carabellese, Corrado; Putignano, Salvatore; Cherubini, Antonio; Gnerre, Paola; Fontanella, Andrea; Latronico, Nicola; Tommasino, Concezione; Corcione, Antonio; Ricevuti, Giovanni; Ferrara, Nicola; Filippi, Francesco De; Ferrari, Alberto; Guarino, Mario; Ruggieri, Maria Pia; Modesti, Pietro Amedeo; Perticone, Francesco; Locatelli, Carlo; Hrelia, Patrizia; M, Toscano; Bondi, Emi; Tarasconi, Antonio; Ansaloni, Luca; Maggi, Stefania

doi:10.1016/j.eurger.2017.06.010

Cited by 5 publications

(3 citation statements)

References 61 publications

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“…It is also important to recognize the potential role of family and caregivers in supporting the patient. Flexibility of visiting hours, and the use of investigative tools to determine the patient's needs and preferences, should be encouraged [146].…”

Section: Strength Of Recommendationmentioning

confidence: 99%

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

et al. 2020

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Background Surgical outcomes in geriatric patients may be complicated by factors such as multiple comorbidities, low functional performance, frailty, reduced homeostatic capacity, and cognitive impairment. An integrated multidisciplinary approach to management is, therefore, essential in this population, but at present, the use of such an approach is uncommon. The Perioperative Management of Elderly patients (PriME) project has been established to address this issue. Aims To develop evidence-based recommendations for the integrated care of geriatric surgical patients. Methods A 14-member Expert Task Force of surgeons, anesthetists, and geriatricians was established to develop evidence-based recommendations for the pre-, intra-, and postoperative care of hospitalized older patients (≥ 65 years) undergoing elective surgery. A modified Delphi approach was used to achieve consensus, and the strength of recommendations and quality of evidence was rated using the U.S. Preventative Services Task Force criteria. Results A total of 81 recommendations were proposed, covering preoperative evaluation and care (30 items), intraoperative management (19 items), and postoperative care and discharge (32 items). Conclusions These recommendations should facilitate the multidisciplinary management of older surgical patients, integrating the expertise of the surgeon, the anesthetist, the geriatrician, and other specialists and health care professionals (where available) as needed. These roles may vary according to the phase and setting of care and the patient’s conditions.

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Section: Strength Of Recommendationmentioning

confidence: 99%

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

et al. 2020

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“…Yearly 1.6 million hip fractures (HFs) occur worldwide, with over 610,000 cases in Europe and more than 123.000 in Italy 1 . HFs are a major issue for National Health Systems worldwide: 2 within one year after HF, nearly one third of all patients die and about 50% of the survivors do not regain their pre‐fracture functional status 3–5 …”

Section: Introductionmentioning

confidence: 99%

Frailty, post‐operative delirium and functional status at discharge in patients with hip fracture

Gandossi

Zambon

Oliveri

et al. 2021

Int J Geriat Psychiatry

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Objective To explore the effect of frailty, alone and in combination with post‐operative delirium (POD), on the risk of poor function at discharge in patients with hip fracture (HF). Methods This is a prospective cohort study of patients with HF admitted to an Orthogeriatric Unit (OGU) between October 1, 2011 and March 15, 2019. POD was assessed using the 4AT and the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5‐edition criteria. A 22‐items Frailty Index (FI) was created using the data collected on admission. The outcome measure was the Cumulated Ambulation Score (CAS) score at discharge. A log‐binomial regression model was used to assess the effect of frailty and POD on CAS. Results A total of 988 patients (median age = 84.9 years, Interquartile range = 80.6‐89.2) were included: 360 patients (36.4%) were frail and 411 (42%) developed POD. Poor functional status at discharge (CAS score ≤2) was more common in frail than non‐frail patients (68.3% vs. 53.8%, p < 0.001) In a regression adjusted for confounders, frailty alone (Relative Risk, RR = 1.33, 95% Confidence Intervals, CI = 1.14–1.55) and POD alone (RR 1.38, 95% CI = 1.2–1.59) were associated with poor functional status at discharge; when combined, frailty and POD had an interaction, yielding a mild increase in the risk of poor outcome (RR 1.47, 95% CI = 1.28–1.69). Conclusions In older patients undergoing HF surgery, frailty, POD and their combination, are associated with poor functional status at discharge.

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“…Delirium is a common condition in older people admitted to hospital and is associated with adverse outcomes [51]. In the absence of effective treatments, prevention should be the main aim of healthcare interventions to reduce the clinical consequences of delirium [52].…”

Section: Discussionmentioning

confidence: 99%

Non-pharmacological approaches in the prevention of delirium

et al. 2020

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Aim To summarize the evidence concerning the efficacy of non-pharmacological interventions in delirium prevention in older adults admitted to hospital. Findings The evidence for non-pharmacological, multi-component interventions is sufficiently robust for clinical practice recommendations to be formulated. However, no conclusive effects have been demonstrated on outcomes more distal to delirium occurrence and for single-component interventions. Message Pragmatic studies should be conducted, aimed at investigating the effectiveness of delirium prevention by nonpharmacological interventions in usual clinical practice.

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Italian intersociety consensus on prevention, diagnosis, and treatment of delirium in hospitalized older persons

Cited by 5 publications

References 61 publications

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

Frailty, post‐operative delirium and functional status at discharge in patients with hip fracture

Non-pharmacological approaches in the prevention of delirium

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