DELIRIUM & HIP FRACTURE

Delirium & Hip Fracture

Gary G.Reardon

Dr Susan Folden

NGR -7826

May 1, 2010

Delirium & Hip Fracture

Introduction

Definition of The Problem

Twenty percent of all general hospital patients will experience an episode of delirium sometime during their hospital stay. According to Holroyd, Khandwala and Kaycee (2009) Delirium occurs in 25% -65% of patients admitted to hospital because of hip fracture.

Incidence and Prevalence of the problem

More than half of hospitalized older adults will experience delirium, which left untreated, can lead to detrimental outcomes (Dahlke & Phinney, 2008). According to Gonxalez, Pablo, Fuente, Valedes, Peri, Nomdedeu and Matrai (2004) Delirium has been described since the beginning of medical literature as a cute clinical disorder of attention and cognitive functioning. The prevalence of Delirium increase with the age of the patient. The rates range from 15% to 50% depending on the diagnosis at admission.

What population is affected?

Older adults, who have undergone surgery, and especially those with underlying dementia, are particularly vulnerable to delirium. Dupplis and Wikblad (2000) reported a 20% incidence of delirium among older patients undergoing hip surgery. Predisposing factors for postoperative delirium include older age, communication deficits, anesthesia, medication and social isolation. There is an increased chance that older patients who exhibit signs of dementia are three to five times more likely to develop delirium postoperatively, and it is less likely to be recognized and treated than delirium in those without dementia (Fick & Mion, 2005). Changes in the mental status of older people with dementia are often attributed to underlying dementia, or “sundowning”, and other causes for delirium are not investigated. This is particularly significant because 25% of all patients or over hospitalized patients may have underlying Alzheimer's disease or another type of dementia (Voelker, 2008).

What is known and suspected cause of the problem?

Delirium occurs as the result of complex interactions and has multiple causes (Inouye, 2006). The exact pathophysiological mechanisms involved in the development and progression of delirium remain uncertain, and further research is needed to understand the neuropathogenesis of this syndrome. Delirium is thought to be related to disturbances in the neurotransmitters in the brain which modulate the control of cognitive function, behavior, and mood. Poor cerebral blood flow is also a factor in the development of delirium (Flaherty & Morley, (2004).Kwapis (2009) says The underlying causes of delirium are multifactorial and generally happens due to the interactions of predisposing conditions such as infection, dehydration, preexisting dementia, severe illness and visual impairment metabolic abnormalities and sensory deprivation..In older adults post operative delirium often occurs as a complication of a medical illness, a drug's or substance's effect on the brain, or a surgical procedure involving general anesthesia. Delirium remains a frequently occurring and poorly diagnosed and understood phenomenon. As with other conditions that involve the geriatric patient, attention to common sense measures can reduce the occurrence and improve the management of delirium (Flaherty & Morley, 2004).According to the clinical practice guidelines developed by the Clinical epidemiology and health services unit, Melbourne Health in collaboration with the Delirium Clinical ...