Elderly patients with a hip fracture: the risk for delirium

May 24, 2003Applied nursing research : ANR

Risk of Delirium in Older Adults After a Hip Fracture

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Abstract

Eighteen out of 92 elderly hip fracture patients developed delirium during the study.

Elderly patients with pre-existing functional dependency, psychiatric issues, and multiple comorbidities are at increased risk for delirium.
Factors related to surgery and postoperative complications may contribute to the onset of delirium.
Monitoring of cognitive and functional status prior to surgery is essential for identifying at-risk patients.
Nurses should remain vigilant for signs of delirium in all elderly patients, including those considered 'healthy' prior to surgery.
Postoperative monitoring for symptoms of delirium is recommended for all elderly hip fracture patients.

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This prospective study investigated risk factors for delirium in elderly hip fracture patients that could be recognized by nurses. Data were collected on predisposing and precipitating factors for delirium from 92 elderly patients with a hip fracture. Predisposing factors included age, gender, sensory impairments, functional impairment before the hip fracture, residency before admission, pre-existing cognitive impairment, comorbidities, and medication use. Precipitating factors included factors related to surgery and to the postoperative period. Factors related to surgery included time between admission and surgery, type of surgery, type of anesthesia, duration of surgery and anesthesia, and complications during surgery. Factors studied in the postoperative period were slow recovery, malnutrition, dehydration, addition of three or more medications, introduction of bladder catheter, infections, complications and falls, and use of morphine. Eighteen patients developed delirium, as diagnosed by a geriatrician by using the Diagnostic Statistical Manual-IV criteria. Data on delirious patients were compared with the data on non-delirious patients. The findings confirm that elderly hip fracture patients with premorbid ADL dependency, psychiatric comorbidities (including dementia), and a high number of other comorbid problems are at risk for the development of delirium. Based on these findings, it is recommended that nurses should assess patients' pre-fracture functional and cognitive capacities in an early stage of the hospital stay. Nurses should also be alert to postoperative delirium in "healthy elderly" patients. Monitoring of symptoms postoperatively in all elderly patients is advised.

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Elderly patients with a hip fracture: the risk for delirium

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