Tag: delirium

Categories : Mental Health Surgeries & ProceduresTags :

Mental Health Issues Before Surgery can Affect Memory and Cognition

On By ModernMedia
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Depression and other psychological factors may be linked to the risk of postoperative confusion in older adults. This is shown in a new systematic review from Karolinska Institutet, published in the British Journal of Anaesthesia. The study summarises results from more than 6700 patients.

Older individuals undergoing surgery face an increased risk of developing cognitive complications, such as postoperative delirium. Delirium is characterised by sudden changes in attention and awareness, and can lead to longer hospital stays and reduced functioning. The new study analyses 30 previously published works in which researchers examined whether preoperative psychological factors, such as depression, anxiety, stress, and personality traits, may influence these complications.

Depression most common

The review identified four groups of psychological factors. Depression was the most common and appeared in nearly all studies. In the statistical meta-analysis, no clear association between depression and delirium was observed, but when the researchers used alternative statistical synthesis methods, they found evidence suggesting that psychological factors play a role.

“Our results show that depression is the most consistently reported psychological risk factor, even though the pooled statistical analyses did not demonstrate a significant effect,” says Anahita Amirpour, PhD at the Department of Neurobiology, Care Sciences and Society.
“At the same time, we saw that anxiety, stress, and personality traits may also play a role, although the research base there is more limited.”

Postoperative delirium

In total, the study included 6714 patients from 16 different countries. Postoperative delirium was the most common outcome measure and occurred in between 9 and 55% of patients, depending on the study. Very few studies examined other cognitive complications, such as long-term effects on memory and attention.

The researchers emphasise that the results should be interpreted with caution. Many of the included studies varied greatly in how they measured both psychological factors and cognitive outcomes, and only two studies examined time periods extending beyond the immediate postoperative phase.

Source: Karolinska Institutet

Categories : AgeingTags :

1st-generation Antihistamines Linked to Delirium Risk in Older Hospitalised Patients

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An analysis in the Journal of the American Geriatrics Society reveals that older inpatients admitted to physicians who prescribe higher amounts of first-generation antihistamines face an elevated risk of delirium while in the hospital.

First-generation antihistamines, such as diphenhydramine, are among the leading causes of medication-related harms in older adults, and although these medications are indicated for histamine-related conditions such as hives and anaphylaxis, they may be prescribed inappropriately.

When investigators analysed data on 328 140 patients aged 65 years and older who were admitted by 755 attending physicians to 17 hospitals in Ontario, Canada in 2015–2022, they found that the overall prevalence of delirium was 34.8%. Patients admitted to physicians who more commonly prescribed first-generation antihistamines had 41% increased odds of experiencing delirium compared with patients admitted to physicians who rarely prescribed first-generation antihistamines.

“We hope our study raises awareness among hospitalists that sedating antihistamines can be harmful, and should be prescribed with caution,” said corresponding author Aaron M. Drucker, MD, of the University of Toronto and Women’s College Hospital.

Source: Wiley

Categories : HospitalsTags :

Windows in ICU Rooms Increase the Risk of Post-surgical Delirium

On By ModernMedia
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Delirium is a condition common in the post-surgical intensive care unit (ICU) setting, affecting up to 50-70% of those admitted, depending on individual risk profiles. ICU delirium can be associated with a multitude of factors including underlying and acute medical conditions, pharmacologic agents or treatment regimens like surgery. Currently there is no definitive consensus on drug interventions that aid in the prevention of delirium or its treatment.

While there has been some evidence that the ICU environment plays a role in delirium, more research is needed to understand this association. In a new study appearing in Critical Care Medicine, researchers found windowed patient rooms were associated with an increase in the odds of developing delirium, when compared to patient rooms without windows.

Using electronic medical records, researchers from Mass General Brigham and collaborators at Boston University Chobanian & Avedisian School of Medicine reviewed the association between patients being admitted to an ICU room with or without windows and the presence of delirium. Delirium was observed in 21% (460/2235) of patients in windowed rooms and 16% (206/1292) of patients in non-windowed rooms.

“While the findings of the study were ultimately unexpected due to prior research suggesting the importance of circadian rhythm while in the hospital, our results contribute to a growing body of evidence-based design literature around the importance of healthcare design to patient experience and outcomes,” explained corresponding author Diana Anderson, MD, FACHA, assistant professor of neurology at the school. She notes that because of the study design, these unexpected findings are not causative and may represent different patterns in which some patients – who are potentially at an increased risk of delirium – may be assigned to different room layouts by the clinical teams.

According to the authors, further research into the specific qualities of windows that may impact health is needed to better understand these results. “Although this study adds to our understanding of the relationship between delirium and characteristics of the built environment, it is clear that additional studies may provide further insight to understand these results. For example, it is possible that the window view toward adjacent landscapes or buildings may be important context to interpret these findings, or perhaps another feature of the room such as light or sound that we could consider in our next investigation,” Anderson says.

Source: Boston University School of Medicine