Dementia and delirium, the outcomes in elderly hip fracture patients

Abstract

BackgroundDelirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium.MethodsThis is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA) was used to assess data between January 2014 and September 2015. All patients presented were aged ≥70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes.ResultsOf a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9). Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (P=0.001), increased association with complications (P<0.001), institutionalization (P<0.001), and 6-month mortality (P<0.001). Patients with dementia (N=168) had a higher delirium rate (57.7%, P<0.001) but a shorter hospital stay (P<0.001). There was no significant difference in the 6-month mortality between delirious patients with (34.0%) and without dementia (26.3%).ConclusionElderly patients with a hip fracture are vulnerable for delirium, especially when the patient has dementia. Patients who underwent an episode of delirium were at increased risk for adverse outcomes.

Dementia and CSF‐biomarkers for Alzheimer's disease predict mortality after acute hip fracture

“…However, clinical observations and previous retrospective studies have suggested a higher impact of cognitive impairment on mortality in these patients.…”

Delirium en el perioperatorio de cirugía de cadera en el adulto mayor

“…Los factores de riesgo más importantes son la demencia previa y la edad avanzada (5)(6) (7) . Es un evento prevenible hasta en un 40%, lo que resalta la importancia de su prevención, diagnóstico y tratamiento (5)(8)(9) (10) .…”

Impact of delirium on short‐term outcomes in hip fracture patients under a program of approach to delirium

“…1,4,5 Dementia, functional decline, vision impairment, history of alcohol abuse and advanced age are the leading factors associated with delirium that have been recognized on admission in both medical and non-cardiac surgery populations. 7 In the present prospective study, we analyzed the impact of delirium on short-term outcomes in HF patients admitted to an orthogeriatric share care unit where a protocol of approach to delirium was implemented. 3,6 Similarly, dementia is one of the strongest risk factors contributing to delirium, but the effects of dementia on outcomes after delirium have been hardly described in older HF patients.…”

“…3,6 Similarly, dementia is one of the strongest risk factors contributing to delirium, but the effects of dementia on outcomes after delirium have been hardly described in older HF patients. 7 In the present prospective study, we analyzed the impact of delirium on short-term outcomes in HF patients admitted to an orthogeriatric share care unit where a protocol of approach to delirium was implemented. Special attention was given to patients with delirium and dementia.…”