Risk for post‐operative delirium related to comorbidities in older adult cardiac patients: An integrative review

Abstract

Background Delirium is defined as a sudden onset of confusion due to disruption in normal brain functioning. Although it is highly prevalent in post‐operative patients, most significantly the older adult population, limited information exists explaining why its onset occurs. Purpose This integrative review aimed to synthesise specific comorbidities that can contribute to the development of post‐operative delirium in older adult cardiac surgical patients. Methods PRISMA statement was used to report the identification, selection, appraisal and synthesis of articles and the PRISMA diagram reports the selection process. The Johns Hopkins Evidence‐Based Practice Tools were used as guide in literature review, critical analysis, levelling of evidence and quality rating. PubMed, ProQuest, CINAHL plus, EMBASE, MEDLINE, Ovid Nursing Collection and Cochrane databases were searched from 2015 to 2020. Results The initial search yielded 1529 articles. Following the removal of duplicates and screening, 14 articles were included for this review. The following comorbidities were identified in the studies: Diabetes mellitus, atrial fibrillation, depression, impaired olfaction, pre‐existing cerebrovascular disease, pre‐existing cardiovascular disease, insomnia and frailty. Conclusion There was a strong indication of the development of post‐operative delirium among older adult cardiac surgical patients with comorbidities. Relevance to clinical practice Awareness of the impact of comorbidities in developing post‐operative delirium may help healthcare providers to plan and implement proper care management among older adult cardiac surgical patients with comorbidities.

Thoracic delirium index for predicting postoperative delirium in elderly patients following thoracic surgery: A retrospective case‐control study

“…Moreover, more comorbidities and complex medication use in geriatric patients may increase the likelihood of POD (Kassie et al, 2019;Ramos et al, 2022). Our results also further proved that older patients were more prone to develop delirium after surgery.…”

Associated factors for postoperative delirium following major abdominal surgery: A systematic review and meta‐analysis

“…4,7,11 This pooled result also demonstrated that older patients had an increased risk of developing POD, which may be due to poor physical condition, more comorbidities, and complex medication use in senile patients. [32][33][34] Unfortunately, our results indicated high heterogeneity in age. After subgroup analysis, heterogeneity decreased by 80%, but the significance did not change, which can be explained by the small sample size.…”

“…Age has been well‐established as an independent predisposing factor for POD 4,7,11 . This pooled result also demonstrated that older patients had an increased risk of developing POD, which may be due to poor physical condition, more comorbidities, and complex medication use in senile patients 32–34 . Unfortunately, our results indicated high heterogeneity in age.…”

The Age-adjusted Charlson Comorbidity Index predicts post-operative delirium in the elderly following thoracic and abdominal surgery: A prospective observational cohort study

“…Some reports have proved that comorbidities were independently correlated with POD, such as hypertension and dementia etc. ( Pérez-Ros et al, 2019 ; Ramos et al, 2022 ). Moreover, it has been well-established that patients with advanced age were more prone to develop POD ( Lee et al, 2020 ).…”