Frail Older Adults More Likely to Develop Delirium After Surgery

Frailty in older adults may double the risk of developing delirium following elective surgery compared to old age alone, according to a new Canadian study by St. Michael’s Hospital in Toronto. Frailty is defined as the condition of feeling weak, fragile, and having low energy.

The findings, published in the Journal of General Internal Medicine, reveal that a history of delirium, frailty, and cognitive impairment are the strongest risk factors associated with developing postoperative delirium.

Earlier research by the authors showed that frailty and cognitive impairment before surgery are linked to complications after surgery, but age is not. Other risk factors associated with developing postoperative delirium include smoking and the use of psychotropic medications, according to the authors.

“Chronological age from your birth date is not always an accurate assessment of how you’ve aged over your lifetime,” said Dr. Jennifer Watt, a geriatric medicine fellow at St. Michael’s and lead author of the review.

“This study highlights how common delirium is among older adults undergoing elective surgery, and the importance of geriatric syndromes, including frailty, in identifying older adults who may be at risk.”

The researchers reviewed 41 existing studies involving more than 9,000 patients (aged 60 and older) and reporting on postoperative delirium following elective surgery. The findings show that one in six older adults experience delirium following elective surgery.

The researchers also found that patients who had caregiver support are also 30 percent less likely to experience delirium following elective surgery than those who did not.

Caregiver support was defined as the patient being married or having a higher number of visitors than average, according to the review. The studies included in the review did not specify whether caregiver support came before surgery, after surgery, or both.

“Previous research has shown that when families delivered a non-pharmacological intervention, such as helping to mobilize or orient the patient, the patient was less likely to experience delirium following hip surgery,” said Watt. “What we’re seeing in this review may be a result of the fact that they’re doing some of these things for their loved ones already.”

Patients who develop delirium after elective surgery are also at an increased risk of developing other adverse postsurgical outcomes, and are more likely to be discharged to another hospital, a long-term care facility, or die following surgery, according to the review.

Although older adults are assessed for cardiovascular and respiratory risk before an elective surgery, often not enough consideration is given to risk factors that are more common in older adults, including delirium, the authors said.

“Postoperative delirium is a common, yet preventable, complication experienced by older adults undergoing elective surgery,” said Watt. “Understanding delirium risk factors may help clinicians, patients, and caregivers to target interventions aimed at lessening its burden.”

Source: St. Michael’s Hospital

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