Acute Confusional States in Elderly Patients Treated for Femoral Neck Fracture

Abstract

The aims of this study were to estimate the incidence of acute confusional state (ACS), its predisposing factors and consequences in 111 consecutive patients operated for fractured neck of the femur. The incidence of ACS was 61 percent and the predicting factors were old age and dementia. Drugs with anticholinergic effect, depression, and previous stroke were factors that seemed to be associated with the development of ACS. Ninety-two percent of the patients who had severe perioperative blood pressure drops developed ACS. The consequences of ACS were prolonged ward-stay at the orthopedic department, a greater need for long-term care after discharge, and poor walking ability at discharge and six months after surgery. The confused patients also had more complications, such as urinary problems, feeding problems and decubital ulcers, as compared with the nonconfused patients.

Use of Femoral Nerve Blocks to Manage Hip Fracture Pain among Older Adults in the Emergency Department: A Systematic Review

“…5 The prevalence of delirium amongst hip fracture patients has been shown to range from 13% to 61% 6 Furthermore, the occurrence of delirium has been shown to increase the incidence of adverse outcomes post fracture, including functional decline, permanent cognitive impairment, and death. [7][8][9][10][11] These data highlight the acute need for alternative methods of pain management in elderly patients suffering from hip fracture.…”

Delirium risk factors in elderly hospitalized patients

“…26 Other surgical risks were unplanned surgery 22 and low mobility after surgery. 25 Not shown to have an influence on the development of delirium were surgical technique, 19 number of previous surgeries, 26 time between surgeries, 19 type of anesthesia, 19 and surgery duration. 19 Furthermore, Schor et al did not find surgery in itself a risk factor for their mixed medicalsurgical population.…”

Psychiatric illness predicts poor outcome after surgery for hip fracture: a prospective cohort study

“…Prevalences of 9-47 % for depression and 31-88 % for cognitive impairment are described Billig et al 1986 ;Berggren et al 1987 ;Gustafson et al 1988 ;Brannstrom et al 1989 ;Lyons et al 1989 ;Magaziner et al 1990 ;Strain et al 1991 ;Shamash et al 1992 ;Parker & Palmer, 1993 ;de Jaeger et al 1994 ;Withey et al 1995 ;Holmes,1996 ;Shepherd & Prescott, 1996). Such wide ranges in prevalence are probably due to differing sampling techniques, timing of interviews and diagnostic instruments used.…”