Síndrome confusional agudo en pacientes con fractura de cadera en el área sanitaria de León: buenas prácticas de enfermería = Acute confusional syndrome in patients with hip fracture in the León health care area: good nursing practice

Abstract

Introduction: Delirium is considered one of the great geriatric syndromes because of the economic and social impact it has on the health system.The presence of this syndrome in the elderly has been shown to be more prevalent in those cases that have been operated on by orthopaedic surgeries.Objective: Firstly, the aim is to analyse the clinical and socioenvironmental predictive factors in the development of ACS or delirium during hospitalisation for hip fracture. On the other hand, it is proposed to address a nursing care plan or good practice action in nursing to prevent, palliate or reduce ACS in patients hospitalized for hip fracture. Methodology: Two types of methodology have been used to develop this work. On the one hand, a prospective cohort study carried out with a sample of 287 orthogeriatric patients (87.2 ± 3.2 years) recruited in the Trauma Unit of the Hospital Complex of León. Predisposing, precipitating and risk factors in the development of acute confusional syndrome were analysed according to sociodemographic, baseline, surgical, pharmacological variables, comorbidities and complications. The statistical data were analyzed by means of a Chi -test of association between categorical variables, Mann-Whitney U test for the contrast of means between groups, multivariate logistic regression test and segmentationanalysis by means of the CHAID method. On the other hand, a bibliometric review of the scientific literature on the approach to nursing performance in the phases of diagnosis and treatment of ACS in elderly patients hospitalized for CF diagnosis was carried out. Results:The results of the predictive factors show that the presence of anaemia (30.5 % vs 47.4 %; OR=0.48) is a significant (P<.05) and effective (although with a slight effect: 2 %) predictor of delirium. Furthermore, ASA in categories 3 or 4 (36.3 %; OR=1.95), cognitive impairment, UTI (63.4 % vs 27.6 %; OR=4.54), visual disturbances (44.8 % vs 29.7 %; OR=1.92) and RAO (58.1 % vs 29.7 %; OR=3.28), in this order, are predictive variables of delirium in hospitalized older patients with hip fracture. Based on the multidimensional nature of the variables that precipitate ACS, we propose to combine the pharmacological therapeutic approach with non-pharmacological action. In this sense, the results of the bibliometric study highlight the relevance of nonpharmacological factors to be implemented in nursing care plans or good practice for the treatment of ACS. Conclusion:The environmental predictive factors that impact on the development of delirium can be controlled from the very moment of the patient's hospitalisation. Therefore, on the basis of a good nursing practice action plan, it is possible to minimise the disruption caused by this syndrome to the patients, their families and health care providers themselves.