Preventing Delirium in Older Adults with Recent Hip Fracture Through Multidisciplinary Geriatric Consultation

Deschodt, Mieke; Braes, Tom; Flamaing, Johan; Detroyer, Elke; Broos, Paul; Haentjens, Patrick; Boonen, Steven; Milisen, Koen

doi:10.1111/j.1532-5415.2012.03899.x

Cited by 121 publications

(176 citation statements)

References 29 publications

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“…In studies regarding the non-pharmacologic, multicomponent, and multi-disciplinary counseling protocol for delirium prevention, the intervention was found to be effective in reducing the incidence of delirium (Deschodt et al, 2012;Inouye et al, 1999;Martinez et al, 2012). A .71 a reduced delirium incidence, length of hospitalization, and medical costs were observed in a study regarding the application of a specialized delirium prevention program, which was developed as part of the Hospital Elder Life Program for hospitalized elderly patients (Rubin et al, 2011).…”

Section: Discussionmentioning

confidence: 94%

The effects of a tailored intensive care unit delirium prevention protocol: A randomized controlled trial

Moon

Lee

2015

International Journal of Nursing Studies

117

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Section: Discussionmentioning

confidence: 94%

The effects of a tailored intensive care unit delirium prevention protocol: A randomized controlled trial

Moon

Lee

2015

International Journal of Nursing Studies

117

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“…Friedman et al retrospectively reviewed 193 patients that received an orthogeriatric joint model of care and compared them with 121 patients who received a reactive consultation model. They found that there was a statistically significant reduction in post-operative infection, venous thromboembolism and cardiac complications within the joint care group [47].The 2012 prospective controlled trial by Deschodt et al compared a model of care that involved regular peri-operative orthogeriatric assessment with a usual model of care and found a statistically significant higher number of No improvement in functional outcome in intervention group *Significant difference between control and intervention episodes of delirium in the latter group, along with more cognitive decline at the time of hospital discharge [49]. Randomised controlled trial by Marcantonio et al in 2001 compared the effect of regular peri-operative geriatric review of patients with hip fracture with a usual model of care, and the authors reported that their proactive geriatric consultation intervention reduced delirium by over one third [74].…”

Section: Effect Of Orthogeriatric Management On Inpatient Morbiditymentioning

confidence: 95%

“…Compared to a usual model of care: -Reduced inpatient mortality rates [46] Compared to a usual model of care: -Reduced length of stay [48] Compared to a usual model of care: -Reduced incidence of delirium in patients [49] -Reduced time to surgery [48] -Improved post-operative patient self-care, mobility and depressive symptoms [50] 3. Post-operative geriatric rehabilitation unit…”

Section: Why Are Fragility Fractures Important?mentioning

confidence: 99%

Orthogeriatrics in the management of frail older patients with a fragility fracture

Sabharwal¹,

Wilson

2015

Osteoporos Int

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This review article examines the role of orthogeriatric management for frail older patients with a fragility fracture. The history of orthogeriatrics and its application in clinical practice around the world is reported, and an evidence-based evaluation for the effect of orthogeriatric management on patient morbidity and mortality is also provided. It has been more than 50 years since the role of the geriatrician in the management of patients with a hip fracture was first described. The evidence that supports an orthogeriatric model of care has grown exponentially over the last decade. This evidence base is primarily related to hip fractures and demonstrates reduced morbidity and mortality rates amongst patients managed with a recognised model of orthogeriatric care. The societal and economic burden of hip fracture has led to health economic evaluations within this field, many of which have concluded that orthogeriatric management results in cost-effective clinical practice. Based on existing clinical and economic research, national clinical practice guidelines have been developed in several countries which recommend orthogeriatric participation in the management of older patients with a hip fracture. Compliance with such guidance has already demonstrated improved patient outcomes. Although the pathogenesis and prognosis of other types of fragility fracture may be as poor, there is a dearth of clinical research that evaluates the effect of orthogeriatric management on such injuries. Looking to the future, orthogeriatric management is likely to become more widespread, and the robust collection and reporting of patient outcomes from national registries will provide a greater understanding of the impact of orthogeriatric models in the care of all frail older patients with any type of fragility fracture.

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“…To prevent and manage the occurrence of possible delirium (avoidable with a 30 % risk reduction when using a specialized geriatric intervention [32,37,38]), we used the recommendations proposed by Inouye et al [31,32] every day of hospitalization. Delirium is common after hip fracture surgery (occurring in 35% to 65% of patients) [37], frequently associated with preexisting cognitive impairment and it is predictive of functional decline, institutionalization, and mortality [33,37]: each day of delirium increased the risk of death within 6 months by 17% [34].…”

Section: Discussionmentioning

confidence: 99%

Association between Cognitive Status before Surgery and Outcomes in Elderly Patients with Hip Fracture in a Dedicated Orthogeriatric Care Pathway

Zerah

Cohen-Bittan

Raux

et al. 2017

JAD

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Background: Dementia is associated with a worse prognosis of hip fracture, but the impact of a dedicated geriatric care pathway on the prognosis of these patients has not been evaluated. Objective: According to the cognitive status before surgery, our main objective was to compare mortality rate at 6 months; secondary outcomes were to compare in-hospital complications, the risk of new institutionalization, and the ability to walk at 6 months. Methods: Between 2009 and 2015, all patients (>70 years) admitted after hip fracture surgery into a dedicated unit of perioperative geriatric care were included: patients with dementia (DP), without dementia (NDP), and with cognitive status not determined (CSND). Data are expressed as hazard ratio (HR) for multivariate cox analysis or odds ratio (OR) for multivariate logistic regression analysis and their 95% confidence interval (CI). Results: We included 650 patients (86 ± 6 years): 168 DP, 400 NDP, and 82 CSND. After adjustment for age, sex, comorbidities, polypharmacy, pre-fracture autonomy, time-to-surgery, and delirium, there were no significant differences for 6-month mortality (DP versus NDP: HR = 0.7[0.4-1.2], DP versus CSND: HR = 0.6[0.3-1.4], CSND versus NDP: HR = 0.8[0.4-1.7]); but DP and CSND were more likely to be newly institutionalized after 6 months compared to NDP (OR DP = 2.6[1.4-4.9], p = 0.003, OR CSND = 2.9[1.4-6.1], p = 0.004). 92% of population was walking after 6 months (63% with assistance): no difference was found between the three groups. Conclusion:In a dedicated geriatric care pathway, DP and CSND undergoing hip surgery have the same 6-month mortality and walking ability as NDP.

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Preventing Delirium in Older Adults with Recent Hip Fracture Through Multidisciplinary Geriatric Consultation

Cited by 121 publications

References 29 publications

The effects of a tailored intensive care unit delirium prevention protocol: A randomized controlled trial

The effects of a tailored intensive care unit delirium prevention protocol: A randomized controlled trial

Orthogeriatrics in the management of frail older patients with a fragility fracture

Association between Cognitive Status before Surgery and Outcomes in Elderly Patients with Hip Fracture in a Dedicated Orthogeriatric Care Pathway

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