Background: Delirium is a common neuropsychiatric syndrome characterized by disturbance of attention and consciousness, which develops over a short period of time and symptoms tend to fluctuate during the course of the day. Delirium is by definition a direct physiological consequence of a general medical condition and is probably the most common presenting symptom of disease in old age. Delirium is especially common among older people acutely operated for femoral fractures with a reported incidence of up to 61%. Postoperative delirium has been shown to be associated with prolonged ward stay, poor rehabilitation outcome and an increased mortality.
Method: Literature review of delirium intervention studies in hip fracture patients (PubMed and Medline) and a summary of several doctoral theses and our own clinical experience.
Results and interpretation: Several intervention studies during the last years have clearly shown that delirium can be prevented and treated in patients admitted to hospital with hip fractures. Successful intervention programs have been multi-factorial and interdisciplinary and have included assessment and treatment of underlying causes as well as prevention and treatment of factors endangering the cerebral metabolism. Especially cerebral hypoxemia caused by i.e. sleep-apnea syndrome, anemia, hypotension, pulmonary diseases, and heart failure can often be prevented and treated. Hypercortisolism due to different kinds of stress is also probably an important delirium precipitating mechanism that can be prevented both by preventing and treating medical complications as well as by providing an optimal care from the patients´ perspective. Excellent nursing care seems to be a prerequisite for successful prevention and treatment of delirium. Scientific evidence for pharmacological treatment of postoperative delirium per se is still lacking but randomized treatment studies are urgently needed. A combination of nursing and medical intervention seems so far to be the most beneficial interventions with regard to the incidence of delirium and the rehabilitation outcome. If applied, combined intervention programs could probably reduce the suffering and the care and treatment costs for elderly people with hip fractures.
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