Objective: To examine the effects of pro-active geriatric consultation (PGC) on post-operative delirium in elderly patients with orthopaedic surgery.
Design: Retrospective cross-sectional study.
Materials and Methods: Patients participated in a randomized clinical trial in which the prophylactic effect of Haloperidol on post-operative delirium was evaluated. Included patients were 70 years of age and older. A total of 603 patients were admitted to the hospital. Of those who met the predefined delirium risk factor criteria 441 consented in participating in the study and were randomized to haloperidol or placebo. All 603 patients were assessed daily before and after surgery. Rating scales used were the MMSE, CAM, DRS, Barnes Akathesia-scale, and physical signs. All patients recieved pro-active geriatric consultation (PGC). The primary endpoint was post-operative delirium. Delirium prevalence was compared to pre-trail data and data from the literature which indicates a delirium prevalence of 40%. PGC consisted of reality orientation training, early recognition of dehydration and subsequent treatment, advising the nurses’ staff in case of individual patients with hearing/vision problems, immobility problems, sleep problems and other age related problems. Reality orientation by using day schedules and communication to reorient to surroundings. Cognitive stimulation by using discussion of current events, word games, and daily MMSE. Another part of PGC was to promote professional competence of nurses taking care of elderly people. This was done by giving information about delirium, how to take care of people at risk for delirium, delirium prevention, and nursing delirium patients.
Results: Only 70 (8.6%) of the 603 patients got a diagnosis of post-operative delirium. In the randomized groups (with more risk factors) the number of patients with delirium was 55 (12.5%). No prophylactic effect of Haloperidol was observed on the primary study endpoint. However, there was a reduction in delirium prevalence compared to pre-trial hospital data and literature estimates of delirium prevalence in similar patients samples.
Conclusion: This retrospective analysis suggests that PGC is strongly associated with a reduced risk of post-operative delirium in elderly orthopaedic surgery patients.
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