Joost Witlox, Dimitrios Adamis, Leo Koenderman, Kees Kalisvaart, Jos F M de Jonghe, Alexander P J Houdijk, Alasdair M J Maclullich, Piet Eikelenboom, Willem A van Gool
BACKGROUND: Ageing, depression, and neurodegenerative disease are common risk factors for delirium in the elderly. These risk factors are associated with dysregulation of the hypothalamic-pituitary-adrenal axis, resulting in higher levels of cortisol under normal and stressed conditions and a slower return to baseline. OBJECTIVES: We investigated whether elevated preoperative cerebrospinal fluid (CSF) cortisol levels are associated with the onset of postoperative delirium...
March 2, 2021: Dementia and Geriatric Cognitive Disorders
Masako Tachibana, Toshiya Inada, Masaru Ichida, Shihori Kojima, Takafumi Arai, Keiko Naito, Norio Ozaki
BACKGROUND: The use of benzodiazepines (BZDs) causes delirium, especially in elderly people. For this reason, suvorexant has been recommended as the first-line hypnotic in elderly patients. The aim of this study was to determine whether the first-line use of suvorexant, instead of BZDs, decreases referrals for delirium in elderly patients. METHODS: Since May 2016 at Nagoya Ekisaikai Hospital, suvorexant has been recommended as the first-line hypnotic instead of BZDs...
February 28, 2021: Psychogeriatrics: the Official Journal of the Japanese Psychogeriatric Society
Nikolaj S Baranov, Cettela Slootmans, Frans van Workum, Bastiaan R Klarenbeek, Yvonne Schoon, Camiel Rosman
BACKGROUND: An increasing number of older patients is undergoing curative, surgical treatment of esophageal cancer. Previous meta-analyses have shown that older patients suffered from more postoperative morbidity and mortality compared to younger patients, which may lead to patient selection based on age. However, only studies including patients that underwent open esophagectomy were included. Therefore, it remains unknown whether there is an association between age and outcome in patients undergoing minimally invasive esophagectomy...
February 15, 2021: World Journal of Gastrointestinal Oncology
Carol K Chan, Frederick E Sieber, Kaj Blennow, Sharon K Inouye, Geoffrey Kahn, Jeannie-Marie S Leoutsakos, Edward R Marcantonio, Karin J Neufeld, Paul B Rosenberg, Nae-Yuh Wang, Henrik Zetterberg, Constantine G Lyketsos, Esther S Oh
OBJECTIVES: While there is growing evidence of an association between depressive symptoms and postoperative delirium, the underlying pathophysiological mechanisms remain unknown. The goal of this study was to explore the association between depression and postoperative delirium in hip fracture patients, and to examine Alzheimer's disease (AD) pathology as a potential underlying mechanism linking depressive symptoms and delirium. METHODS: Patients 65 years old or older (N = 199) who were undergoing hip fracture repair and enrolled in the study "A Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients" completed the 15-item Geriatric Depression Scale (GDS-15) preoperatively...
February 4, 2021: American Journal of Geriatric Psychiatry
Smit Sunil Deliwala, Murtaza Hussain, Anoosha Ponnapalli, Dominic Awuah, Thair Dawood, Ghassan Bachuwa
COVID-19 is well known for its respiratory symptoms, but severe presentations can alter haemostasis, causing acute end-organ damage with poor outcomes. Among its various neurological presentations, cerebrovascular events often present as small-vessel strokes. Although uncommon, in predisposed individuals, large-vessel occlusions (LVOs) can occur as a possible consequence of direct viral action (viral burden or antigenic structure) or virus-induced cytokine storm. Subtle presentations and complicated stroke care pathways continue to exist, delaying timely care...
February 23, 2021: BMJ Case Reports
Ben Kim, Miranda Hunt, John Muscedere, David M Maslove, Joon Lee
BACKGROUND: Critical illness has been suggested as a sentinel event for frailty development in at-risk older adults. Frail critical illness survivors are affected by increased adverse health outcomes, but monitoring the recovery after intensive care unit (ICU) discharge is challenging. Clinicians and funders of health care systems envision an increased role of wearable devices in monitoring clinically relevant measures, as sensor technology is advancing rapidly. The use of wearable devices has also generated great interest among older patients, and they are the fastest growing group of consumer-grade wearable device users...
February 23, 2021: JMIR aging
Inke Zastrow, Peter Tohsche, Theresa Loewen, Birgit Vogt, Melanie Feige, Martina Behnke, Antje Wolff, Rainer Kiefmann, Cynthia Olotu
BACKGROUND: In elderly patients following surgery, postoperative delirium (POD) is the most frequent complication and is associated with negative outcomes. The 2017 European Society of Anaesthesiology guideline on POD aims to improve patient care by implementing structured delirium prevention, diagnosis and treatment. However, these recommendations, especially systematic delirium screening, are still incompletely adopted in clinical practice. The aim of this study was to evaluate the feasibility and acceptance of validated delirium screening tools and to identify barriers to their implementation on nonintensive care unit wards...
February 16, 2021: European Journal of Anaesthesiology
Muleta Teshome Assefa, Wubie Birlie Chekol, Debas Yaregal Melesse, Yonas Addisu Nigatu
Introduction: Emergence delirium is a common incidental trouble in elderly patients that may interfere with patient recovery and will challenge the attending staff. So, we aimed to determine the incidence and risk factors of emergence delirium after anesthesia in elderly patients at the University of Gondar Comprehensive Specialized Hospital (UOGCSH), Post Anesthesia Care Unit (PACU). Methods: A prospective observational study was conducted from February 20 to May 20, 2020 among elective and emergency procedures in patients aged 60 years and over at UOGCSH, PACU...
2021: Patient related Outcome Measures
Dickson Lee, Fiona Petersen, Maurice Wu, Gwenda Chapman, Melanie Hayman, Kerrilyn Tomkins, Jeremy Fernando
BACKGROUND: Midazolam is a benzodiazepine commonly used in procedural sedation and general anaesthesia. Current anaesthetic guidelines advise the avoidance of benzodiazepines in elderly patients due to concerns of an increased risk of delirium. Delirium is associated with significant patient morbidity and mortality, while also increasing health costs. Despite this, midazolam is often used in elderly patients undergoing low risk procedures due to the benefits of rapid onset, anxiolysis and haemodynamic stability compared to other sedatives...
February 16, 2021: BMC Anesthesiology
Yi Yuan, Yanan Song, Geng Wang, Yunyang Jia, Yang Zhou, Xinning Mi, Xixi Jia, Xiaoxiao Wang, Chang Liu, Yue Li, Chengmei Shi, Yongzheng Han, Xiangyang Guo, Wenchao Zhang, Zhengqian Li
INTRODUCTION: Postoperative delirium (POD) is a common neurological complication after hip fracture surgery and is associated with high morbidity and mortality in elderly patients. Although the specific mechanism of POD remains unclear, circadian rhythm disruptions have recently drawn increased attention. To date, only limited postoperative time points of plasma melatonin level measurements were recorded in previous studies, and such data cannot represent a comprehensive melatonin rhythm...
February 12, 2021: BMJ Open
Anca Irina Ristescu, Georgiana Pintilie, Mihaela Moscalu, Daniel Rusu, Ioana Grigoras
Preoperative cognitive impairment (PCI) in cancer patients includes a broad spectrum of neurocognitive changes produced by complex interplay of patient, tumoural and treatment-related factors. Reduced preoperative cognitive reserve can favour the emergence of postoperative delirium (POD). The study aims to document PCI prevalence and to assess the relationship with POD in elderly cancer patients. The prospective observational study included consecutive patients scheduled for elective surgery; PCI was assessed with Mini-Cog test and defined at a score ≤ 3, POD was screened using Nursing Delirium Screening Scale (Nu-DESC) and defined at a score ≥ 2...
February 10, 2021: Diagnostics
Isabel Costa-Martins, Joana Carreteiro, Ana Santos, Mariana Costa-Martins, Vanessa Artilheiro, Sofia Duque, Luís Campos, Manuel Chedas
PURPOSE: Hip fractures are a worldwide health issue primarily for older patients, conditioning major morbidity and mortality. An experienced multidisciplinary team is essential to manage surgery and peri-operative implications, to enable rapid functional and cognitive recovery. Delirium is a recognizable problem associated with negative outcomes. Our study aims to determine the influence of pre-operative delirium in the incidence of post-operative delirium, and to evaluate the association between other known peri-operative risk factors with both conditions...
February 11, 2021: European Geriatric Medicine
Rebecca McClay
The purpose of this project was to determine if bedside intensive care unit (ICU) nurse buy-in to the Family Hospital Elder Life Program (HELP) protocol was sufficient to make implementation feasible at one county hospital in West Texas. Surveys were anonymous with ballot box collection being available to the bedside ICU nurses for one week each. Questions were based on literature findings of expected outcomes, identified barriers and facilitators, Calgary Family Intervention Method framework domains, and the Centers for Disease Control and Prevention Framework for program evaluation...
February 2, 2021: Healthcare (Basel, Switzerland)
Justyna Zielińska-Turek, Anna Jasińska, Jolanta Kołakowska, Joanna Szadurska, Dariusz A Kosior, Małgorzata Dorobek
BACKGROUND: Since the emergence of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) in Wuhan, China, it has been extensively studied by many scientists. Susceptibility to SARS-CoV-2 infection is shown by people of all ages, especially those with different comorbidities. Our goal was to describe the clinical characteristics, treatment, course, and outcome of COVID-19 in patients with pre-existing neurological disorders. METHOD: We retrospectively studied 70 patients with COVID-19 and previous neurological diseases who were treated in the Central Clinical Hospital of the Ministry of the Interior and Administration from 16 March to 15 June 2020...
February 2, 2021: Neurologia i Neurochirurgia Polska
Lisbeth A Evered, Peter A Goldstein
General anesthesia has been administered for over 150 years, and in that time, has become progressively safer. Improvements in outcomes have been driven by multiple advances, including the use of non-invasive monitors to assess cardiovascular and respiratory status. More recent advances have included the development and use of monitors to measure neurologic status by means of "processed" electroencephalography (pEEG), wherein the frontal EEG signal is analyzed by proprietary algorithms to produce a dimensionless number (scaled from 0 to 100), wherein low values are associated with deepening levels of sedation that progresses to loss of consciousness...
2021: International Journal of General Medicine
O Akoria, F Osian, B Akene, E Ugorji, O Emore
BACKGROUND AND AIMS: The Geriatrics Unit in University of Benin Teaching Hospital (UBTH), Nigeria was established in March 2014 to provide specialized healthcare to older persons. We undertook a review of admissions into the unit in order to characterize disease patterns, identify gaps and make recommendations for service improvement. METHODS: Admissions from April 1, 2014, to March 31, 2018, were classified into age groups. Diseases were classified using the International Classification of Diseases (ICD-10 CM)...
January 2021: West African Journal of Medicine
T Oberai, K Laver, R Woodman, M Crotty, G Kerkhoffs, R Jaarsma
BACKGROUND: Delirium is commonly detected in older people after hip fracture. Delirium is considered to be a multifactorial disorder which is often seen post-operatively (incidence ranging from 35% to 65%). Hospitals in Australia are required to meet eight standards including the comprehensive care standard to be able to maintain their accreditation. The standard includes actions related to falls, pressure injuries, nutrition, mental health, cognitive impairment and end-of-life care. Delirium prevention was identified as an area for improvement in our Orthopaedic unit in a Level 1 University Trauma Centre in Australia...
January 15, 2021: International Journal for Quality in Health Care
He Liu, Mingsheng Dai, Huilian Guan, Xing Gao, Yang Zhou, Xun Sun, Jian Zhou, Xiaoyi Hu, Xiang Li, Yu Song, Yuan Han, Junli Cao
Purpose: Malnutrition has been considered as a risk factor for postoperative delirium (POD). The Prognostic Nutritional Index (PNI) is a validated tool for assessing nutritional status. This study aimed to investigate the association between preoperative PNI values and the occurrence of POD in elderly surgical patients. Methods: The retrospective cohort study included 361 elderly individuals who underwent noncardiac surgery between 2018 and 2019. Perioperative data were collected from the patients' medical records...
2021: Risk Management and Healthcare Policy
Takehiko Yamanashi, Mari Kajitani, Masaaki Iwata, Kaitlyn J Crutchley, Pedro Marra, Johnny R Malicoat, Jessica C Williams, Lydia R Leyden, Hailey Long, Duachee Lo, Cassidy J Schacher, Kazuaki Hiraoka, Tomoyuki Tsunoda, Ken Kobayashi, Yoshiaki Ikai, Koichi Kaneko, Yuhei Umeda, Yoshimasa Kadooka, Gen Shinozaki
Current methods for screening and detecting delirium are not practical in clinical settings. We previously showed that a simplified EEG with bispectral electroencephalography (BSEEG) algorithm can detect delirium in elderly inpatients. In this study, we performed a post-hoc BSEEG data analysis using larger sample size and performed topological data analysis to improve the BSEEG method. Data from 274 subjects included in the previous study were analyzed as a 1st cohort. Subjects were enrolled at the University of Iowa Hospitals and Clinics (UIHC) between January 30, 2016, and October 30, 2017...
January 11, 2021: Scientific Reports
An-Min Hu, Yan Qiu, Peng Zhang, Rui Zhao, Shu-Tao Li, Yao-Xian Zhang, Zi-Hao Zheng, Bai-Long Hu, Ya-Li Yang, Zhong-Jun Zhang
STUDY OBJECTIVE: This study aimed to evaluate the effects of low versus high mean arterial pressure (MAP) levels on the incidence of postoperative delirium during non-cardiothoracic surgery in older patients. DESIGN: Multicenter, randomized, parallel-controlled, open-label, and assessor-blinded clinical trial. SETTING: University hospital. PATIENTS: Three hundred twenty-two patients aged ≥65 with an American Society of Anesthesiologists physical status of I-II who underwent non-cardiothoracic surgery with general anaesthesia...
January 6, 2021: Journal of Clinical Anesthesia
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