Objective: A haloperidol prophylaxis study to prevent delirium in elderly surgery patients
Design: A randomised controlled study
Materials and Methods: 602 patients with hip-fracture randomised for either haloperidol prophylaxis or placebo after risk-assessment using the Inouye criteria
Results: Very common after hip surgery. In various studies we see a prevalence of up to 65%. In one Dutch study a prevalence of 97% delirium was seen in demented nursing home patients with hip fracture. Other recent publications show a prevalence of 22-89% of delirium in dementia and tell that delirium is often the first symptom of dementia. Behavioural and psychological symptoms are also highly prevalent in patients with dementia (up to 90%). As in delirium a change in behaviour in demented patients is very often a sign a medical or neurological disease is present. A delirium should be considered in every change of behaviour in demented patients. Both delirium and dementia with BPSD have a lot of symptoms in common. Therefore it’s often difficult to differentiate between the two syndromes. In situations with patients with a lot of co-morbidity and after/during surgery, it’s even more difficult. In this recent study in The Netherlands we used both the Confusion Assessment Method (CAM) and the Delirium Rating Scale (DRS) for assessing delirium and delirium severity. It was often difficult by means of the assessment scales alone to differentiate between severely demented patients and superimposed delirium and changes in the severity of BPSD and delirium. The mean MMSE of the patients who developed delirium was 21/30. The MMSE was the most important risk factor for developing delirium in this group.
Conclusion: It’s often difficult to differentiate between BPSD and delirium, especially in post-surgery patients. A change in behaviour in demented surgery patients should be considered delirium and treated as such
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