Postoperative Delirium

Dyer, Carmel B.; Ashton, Carol M.; Teasdale, T. A.

doi:10.1001/archinte.1995.00430050035004

Cited by 365 publications

(34 citation statements)

References 76 publications

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“…It is important to identify cognitive impairment, as these women are at the highest risk for developing postoperative delirium and prolonged recovery time. 41 A recent study evaluated the potential benefit of a formal geriatric assessment that included the instrumental activities of daily living (IADL's), activities of daily living (ADL's), Get Up and Go, Draw a Clock Test, Mini Nutritional Assessment, Geriatric Depression Scale, and Social Support Scale for a surgical cohort of women undergoing pelvic floor surgery. This formal assessment did not improve postoperative outcomes as compared to those patients who underwent the usual preoperative assessment.…”

Section: Pre-surgical Evaluation Of the Older Woman Undergoing Pelvicmentioning

confidence: 99%

Prolapse and Incontinence Surgery in Older Women

et al. 2008

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Purpose-Pelvic floor disorders including urinary incontinence, pelvic organ prolapse and fecal incontinence are common problems encountered by the older woman. With the increasing population of older American women, urologists and gynecologists can expect to provide evaluation and treatment of these conditions with increasing frequency. These conditions are amenable to both medical and surgical therapies.Materials and Methods-Contemporary published articles (year 2003 to present) that included older women undergoing urogynecologic surgical procedures were included in this review. Current data on morbidity, mortality and/or surgical outcomes are presented along with evidencebased pre, intra and post-operative surgical management strategies.Results-The older woman can expect similar operative risks as well as subjective and objective anatomic and quality-of-life outcomes as that of younger women undergoing pelvic floor surgery. Conclusion-The decision for surgical intervention for the treatment of pelvic floor disorders should not be based on chronologic age alone. Prior to selection of a specific surgical procedure, all existing pelvic floor defects should be evaluated. Further research is required to understand the impact that surgery for pelvic floor disorders has on anatomic, physiologic, and functional outcomes in older women.

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Section: Pre-surgical Evaluation Of the Older Woman Undergoing Pelvicmentioning

confidence: 99%

Prolapse and Incontinence Surgery in Older Women

et al. 2008

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“…[36] For example, a recent meta-analysis established that from 60% to 70% of elderly postoperative patients develop delirium [30] and that up to 80% of cases were undiagnosed by physicians (32% of cases missed by nurses). [49] Delirium is characterized by a disturbance in consciousness, impaired attention, and changes in cognitive abilities.…”

Section: Psychosocial and Functional Assessmentmentioning

confidence: 99%

Assessment and measurement of pain in older adults

Herr

Garand

2001

Clinics in Geriatric Medicine

347

251

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Although the empirical base is still limited when providing clear directions for pain assessment and management in older adults, it is possible to identify recommendations for guiding practice based on consensus and a developing scientific base to support best practice activities. This article offers a brief overview of the epidemiology and consequences of pain, followed by a summary of issues and approaches relevant to pain assessment in older adults. Cohort specific recommendations for comprehensive pain assessment and measurement are then addressed. Prevalence and Consequences of Pain in Older AdultsOlder individuals frequently suffer from both acute and chronic painful diseases, have multiple diseases, and take numerous pain medications, [2] although relatively little investigative or clinical attention has been paid to the assessment of pain in the geriatric population, compared with the general population. This is surprising because populationbased figures indicate that the prevalence of pain is twofold higher in those over age 60 (250 per thousand), compared with those under age 60 (125 per thousand). [24] [79] [108] Further, prevalence estimates suggest that approximately 60% of community-dwelling older adults and up to 80% of elderly long-term care facility residents experience substantial pain.[24] [79] [108] Because pain is often remediable, [2] [25] it is thought that the high prevalence estimates of unrelieved pain in elderly persons may result from underrecognition, which in turn results in undertreatment. [65] [91] [120] The consequences of untreated pain can profoundly impact the older person's quality of life. In addition to physiologic risks associated with untreated pain (e.g., cough suppression with subsequent retention of pulmonary secretions), depression, [58] [39] [90] Therefore, it is imperative that health care professionals' knowledge and skills related to pain assessment in older adults be improved, and aggressive approaches to comprehensive pain assessment be adopted, to ensure and improve the quality of life of our senior citizens. Approaches to Pain Assessment with Older Adults Clinical AssessmentIn the clinical setting, accurate assessment of pain is critical for the identification of appropriate interventions and for evaluating the effectiveness of such interventions. Patients should be assessed regularly for the presence of pain and for improvement, deterioration, or complications attributable to pain treatment.[2] The frequency of the follow-up should be a function of the severity of the pain and the potential for adverse effects of treatment. Documentation of pain assessment formalizes the pain assessment process and is essential in the provision of individualized care from both a legal and professional perspective. [17] Inherent in the assessment of pain among older adults is the understanding of its potentially remediable components. For example, if a patient has acute pain, assessment should focus on the underlying pathology responsible for the pain stimulus. If th...

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“…Pre-existing brain damage, chronic brain diseases and cognitive impairment have also been demonstrated to be predisposing factors [3,[10][11][12][13]. Additionally male sex has been reported as a predisposing factor for ACS [6,7,13,14].…”

Section: Predisposing Factorsmentioning

confidence: 99%

“…The reported incidence and prevalence rates of ACS during hospitalization ranged from 8 to 85% in a study by Foreman [2]. In a review on postoperative ACS the incidence ranged from 0 to 74% [3]. According to Lipowski [1] a tentative estimate could be that between 10 and 15% of medical and surgical general hospital inpatients are delirious at some point during their hospital stay.…”

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confidence: 99%

Acute Confusional States in Patients Undergoing Hip Surgery

Duppils

Wikblad²

1999

Gerontology

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Background: There is general agreement that acute confusional state (ACS) is common among elderly patients admitted to hospital, although exact figures are difficult to obtain. The objective of the current study was to investigate the onset of ACS during hospital stay and to isolate possible predisposing, facilitating and precipitating factors associated with the onset of ACS. Methods: Non-confused patients, ≥65 years of age, undergoing orthopedic hip surgery, were consecutively included in the study (n = 225). Of these, 149 patients were operated on because of acute hip fracture and 76 underwent elective hip-replacement surgery. ACS was diagnosed by the DSM-IV criteria for delirium. Structured observations of ACS onset were performed every 2nd to every 4th hour during the patients’ entire hospital stay. A protocol was used to document the observations on sleep, activities, well being and behavior. The Mini-Mental State Examination was used to measure cognitive functioning. Results: Of 225 patients 20% were diagnosed with ACS. The incidence of ACS was 24.3% in the group of hip-fractured patients and 11.7% in the hip-replacement surgery patients. The onset of ACS was postoperative (mean 24 ± 21 h after surgery) in all but 8 patients. The duration of ACS among recovered patients was generally less than 48 h (mean 42 ± 43 h). Predisposing factors were older age, cognitive impairment and pre-existing cerebrovascular or other brain diseases. Facilitating factors related to ACS were associated with communication and social isolation, e.g. impaired hearing and sight, reticence and passivity. One precipitating factor, besides surgery, may be the use of psychopharmacological drugs. Conclusion: The incidence of ACS was 20% among hip surgery patients. Older age and social isolation were factors associated with ACS. Increased attention and interaction with older patients could be of value in avoiding ACS during hospitalization.

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Postoperative Delirium

Cited by 365 publications

References 76 publications

Prolapse and Incontinence Surgery in Older Women

Prolapse and Incontinence Surgery in Older Women

Assessment and measurement of pain in older adults

Acute Confusional States in Patients Undergoing Hip Surgery

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