Risk factors of delirium in elderly patients with hip fracture

Abstract

Background: Delirium is a leading cause of death and disability in the elderly with hip fracture. Identifying reliable risk factors for delirium is critical to support optimal outcomes for prevention and reducing delirium. Objective: To quantify the reported factors associated to delirium for patients with hip fracture. Methods: Electronic databases were searched (including Medline, Pub Med, CINAHL, EMBASE, Evidence Based Medicine Reviews, Cochrane Review, Web of Science, and PsycINFO) to identify all studies, published in English language that evaluated the risk factors of delirium hospitalized people with hip fracture. Two reviewers independently assessed methodology quality and extracted relevant data. The data from the included studies were summarized, and pooled estimates were calculated for 12 risk factors. Results: Thirty-seven studies were included in the review and 25 in the meta-analysis. The incidence of delirium was 32.4% (95% confidence interval [CI] = 25.9%-39.5%). Six predisposing and four precipitating factors predicted delirium among older patients with hip fracture confirmed. The predisposing factors included advanced age (ES = 1.06, 95% CI = 1.03-1.09), male sex (ES = 1.34, 95% CI = 1.08-1.68), impairment of cognition (ES = 2.91, 95% CI = 1.91-4.42), and function (ES = 1.75, 95% CI = 1.39-2.2), comorbidity (ES = 1.59, 95% CI = 1.30-1.96), and health problems (ES = 2.64, 95% CI = 2.04-3.42). Precipitating factors were hypo-or hypernatremia (ES = 1.73, 95% CI = 1.14-2.64), depression (ES = 4.07, 95% CI = 1.95-8.49), more than three prescribed drugs (ES = 1.28, 95% CI = 1.10-1.49), and drugs including opioids (ES = 2.13, 95% CI = 1.42-3.18) and anticholinergic agents (ES = 2.10, 95% CI = 1.60-2.75). Conclusion:This meta-analysis result provides evidence that these risk factors have a significant impact on delirium in elders with hip fracture during hospitalization. Developing formal screening, and effective preventive and management strategies for delirium is important.

Effect of a Single-dose Dexmedetomidine on Postoperative Delirium and Intraoperative Hemodynamic Outcomes in Elderly Hip Surgery; A Randomized Controlled Trial Dexmedetomidine for Postoperative Delirium

“…14,18,19,28 We hypothesized that a single small dose of DEX in this study would result in a lower incidence or no statistically significant difference between the treatments group for hypotension and bradycardia. Our results confirmed this hypothesis when comparing to previous studies 28,31 However, in our study, the DEX also exhibited statistically lower intraoperative heart rate and lower systolic blood pressure observed at the PACU. Nevertheless, these values did not show clinical significance nor required any intervention.…”

Incidence and risk factors for delirium in older patients with hip fracture

“…The increased risk of delirium in dementia patients is consistent with other studies, and confirms it as a major risk factor for delirium in older patients with hip fracture. 21 In older patients with hip fracture, those treated operatively were more susceptible to the development of delirium than those managed conservatively. General anaesthesia and surgical trauma have been shown to cause disturbances to a wide variety of neurotransmitters systems and that is the most likely substrate for their proneness to delirium.…”

“…Of these, age is the most significant predictor. [18][19][20][21] A review of 25 studies categorised risk factors of delirium into predisposing and precipitating factors. The former include age, male sex, cognitive impairment, functional impairment, sedentary lifestyle, major comorbidity such as cardiovascular disease, congestive cardiac failure, depression, and polypharmacy (>3 prescribed drugs).…”

“…The latter include laboratory abnormalities such as anaemia and disturbed electrolytes, depression, and drugs, particularly opioids and anticholinergics. 21 Other studies have suggested associations between delirium and malnutrition, sensory (vision and hearing) impairment, history of cerebrovascular disease, endocrine disease, prolonged waiting time for operation, type of fracture, type of anaesthesia, inadequate analgesia, elevated temperature, pneumonia, and urinary tract infection; however, none has shown clear single associations. In clinical practice, these factors appear to be contributary to multifactorial delirium.…”

“…In clinical practice, these factors appear to be contributary to multifactorial delirium. [21][22][23][24][25][26][27][28][29][30][31] Therefore, a better understanding of these factors is useful in attempts to identify patients at high risk of developing delirium and hence devising effective preventive and management strategies.…”