Risk of Pre-and Post-Operative Delirium and the Delirium Elderly At Risk (DEAR) Tool in Hip Fracture Patients

Content Provider	Semantic Scholar
Author	Freter, Susan Dunbar, Michael J. Koller, Katalin Knight, Chris Mac Rockwood, Kenneth
Copyright Year	2015
Abstract	BACKGROUND AND PURPOSE Delirium is common after hip fracture. Previous work has shown that a simple delirium risk factor tool, the Delirium Elderly At Risk instrument (DEAR), has a high inter-rater reliability in this population. Little research has looked at the ability of risk factor screening tools to identify patients at high risk of pre-operative delirium. This study investigates the ability of the DEAR to identify patients at high risk of pre-operative delirium, as well as reporting its performance in a post-operative validation sample. Associations between delirium risk factors and pre-operative delirium are explored. METHODS This prospective cohort study took place on an orthopedic in-patient service at a University-affiliated tertiary care hospital. Patients aged 65 and older who were admitted for surgical repair of hip fracture (N = 283) were assessed pre-operatively for 5 delirium risk factors (cognitive impairment, sensory impairment, functional dependence, substance use, age) using the DEAR. Patients were assessed for delirium using the Mini-Mental State Examination and the Confusion Assessment Method pre-operatively and on post-operative days 1, 3 and 5. Characteristics of patients who developed delirium were compared with the characteristics of those who did not. RESULTS Delirium was present in 58% (95% CI = 52-63%) of patients pre-operatively and 42% (95% CI = 36-48%) post-operatively. Individually, sensory impairment (χ(2) = 21.7, p = .0001), functional dependence (χ(2) = 24.1, p = .0001), cognitive impairment (χ(2) = 55.5, p = .0001) and substance use (χ(2) = 7.5, p = .007) were significantly associated with pre-operative delirium, as was wait-time for surgery (t = 3.1, p = .003) and length of stay (t = 2.8, p =.03). In multivariate modeling, the strongest association with pre-operative delirium was cognitive impairment. CONCLUSIONS The DEAR, a simple, delirium risk factor screening tool, can be used to identify hip fracture patients at risk of both pre-operative and post-operative delirium, which may allow targeted implementation of delirium prevention strategies.
Starting Page	212
Ending Page	216
Page Count	5
File Format	PDF HTM / HTML
DOI	10.5770/cgj.18.185
PubMed reference number	26740829
Journal	Medline
Volume Number	18
Alternate Webpage(s)	http://www.cgjonline.ca/index.php/cgj/article/download/185/267
Alternate Webpage(s)	https://doi.org/10.5770/cgj.18.185
Journal	Canadian geriatrics journal : CGJ
Language	English
Access Restriction	Open
Content Type	Text
Resource Type	Article