Delirium in Geriatric Trauma Patients
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GERIATRIC TRAUMA (BELLAL JOSEPH, SECTION EDITOR)
Delirium in Geriatric Trauma Patients Michael Ditillo 1
&
Abdul Tawab Saljuqi 1 & Samer Asmar 1
Accepted: 23 October 2020 / Published online: 13 November 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review This review focuses on exploring the most recent literature on delirium among older adult trauma and acute care surgery patients. Recent Findings There are numerous scientific advances in the understanding and management of delirium among geriatric trauma patients (GTP). In terms of prevention, most of these advances are focused on non-pharmacological interventions. There are several studies exploring biomarkers for the objective assessment of delirium. Current recommendations for the pharmacologic treatment of delirium suggest reserving the use of antipsychotics and other sedating medications for the treatment of severe agitation that poses a risk to the patient. Summary Despite extensive strides in the prevention and treatment of delirium, there is still a paucity of data in GTPs. Our review shows that GTPs benefit from multi-faceted interventions that serve primarily as preventive measures, and there is evidence that some novel pharmacological interventions may help in the treatment of GTPs. Keywords Delirium . Geriatric . Trauma . Emergency general surgery . Older adults . Cognitive disorder
Introduction Each year, in the USA, more than 2.6 million adults 65 years and older develop delirium, which accounts for an estimated $164 billion in annual health care expenditure [1]. Delirium has an extensive societal impact on those whom it afflicts, including their families, communities, and the whole health care system. In addition, recent studies show that delirium is significantly underdiagnosed, especially in the elderly [2]. Delirium is defined as a disturbance of consciousness (i.e., reduced clarity of awareness of the environment) that reduces one’s ability to focus, sustain, or shift attention [3]. “It is characterized by an abrupt onset, a fluctuating course, inattention, cognitive dysfunction, abnormal arousal, and
This article is part of the Topical Collection on Geriatric Trauma * Michael Ditillo [email protected] 1
Division of Trauma, Critical Care, Burns, and General Emergency Surgery, Department of Surgery, College of Medicine, The University of Arizona, 1501 N Campbell Ave, Tower 4, Suite 5304 B, Tucson, AZ 85724, USA
behavioral abnormalities” [4]. Delirium is highly prevalent (affecting 20% of hospitalized older adults) and involves enduring adverse effects, including a prolonged hospital stay, significant healthcare costs, worsening of functional and cognitive performance, and death [1]. It is a frequent complication after surgery, and it has the potential to cause adverse health outcomes for older adults after hospitalization [5]. The prevalence of delirium has been estimated between 14% and 24%, and its incidence in the hospital setting ranges from 6 to 56%. Postoperative delirium (POD) has a similar trend that f
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