The Cause of Delirium in Patients With Hip Fracture

Abstract

Objectives: To ascertain the most common causes of delirium, to establish the initiation and timing of delirium, and to determine the duration of delirium in patients with hip fracture.Methods: Five hundred seventy-one (88%) of 650 patients with hip fracture admitted to 4 New York City hospitals were prospectively interviewed on a daily basis, 5 days a week, with the Confusion Assessment Method for the presence of delirium. The patients were enrolled within 48 hours of admission. Their medical charts and the data collected by the study staff were reviewed and summarized. Two of us (R.S.M. and A.L.S.) reviewed the case summaries independently and assigned a cause based on a previously developed classification system, estimated the onset of the delirious episode, and determined whether the delirium had cleared, improved, or persisted at discharge. Subsequently, discrepancies in cause, timing of initiation, and mental status on discharge between the 2 physicians reviewers were discussed until consensus was reached.Results: The prevalence of delirium was 9.5% (54/ 571; 95% confidence interval, 7.0-11.9). Seven percent of episodes were assigned a definite cause, 20% a probable cause, 11% a possible cause, and 61% were attributable to 1 or more comorbid conditions. Twenty-eight (53%) of 54 subjects developed delirium after surgery. The delirium had cleared or improved in 40 (74%) of 54 subjects at the time of discharge.Conclusions: Delirium in patients with hip fracture appears to be a different syndrome from that observed in patients who are otherwise medically ill; it also appears to follow a different clinical course. These results have important implications for the management of delirium in patients with hip fracture.

Osteoporotic fractures in older adults

“…However, 60% of delirium cases are considered to be multifactorial with no single precipitating event. 18 Patients with an attributable cause are more likely to recover by the time of hospital discharge. Delirium has been shown to prolong hospital stay, increase mortality and increase the risk of nursing home placement.…”

Postoperative Delirium After Colorectal Surgery in Older Patients

“…17 However, advanced age, 8,18,19,[21][22][23][24] preexisting impaired cognition, 8,21,22,[25][26][27] use of psychotropic medications, 22,25,26,28 and impaired functional status and sensory deficits 8,21,27,29 are recognized as predisposing factors for postoperative delirium. A diverse array of precipitating factors for delirium have also been identified in surgical patients, including impaired oxygenation, 2,30 abnormal hematological and/or biochemical status, 25,26,[30][31][32] blood loss and replacement, 19,32 and intravenous infusions. 19,25,26,33 These factors also vary according to the type of surgery undertaken.…”

Післяопераційний Делірій У Пацієнтів Похилого Віку

“…Також відзначаються нейрон-ні втрати і демієлінізація спинного мозку [6]. На функціональному рівні фіксуються зміни в рефлек-сах спинного мозку і погіршення пропріоперцепції, скорочується активність дихального центру [7,8]. Ослаблення візуальних і слухових функцій може ще більше зменшити здатність нервової системи отри-мувати й обробляти інформацію.…”

“…В опублі-кованому досліджені було проаналізовано частоту розвитку делірію, за винятком пацієнтів, оперо-ваних на серці. Було виявлено, що одна доза кета-міну (0,5 мг/кг) у період індукції була пов'язана з більш низьким рівнем у сироватці С-реактивного білка й низькою частотою делірію [8]. З огляду на цей факт авторами було висловлене припущення про нейропротекторну дію кетаміну, у тому числі для профілактики гіпоксичного апоптозу й акти-вації ЦНС.…”