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Prevention and Management of Perioperative Delirium

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Fractures in the Elderly

Part of the book series: Aging Medicine ((AGME))

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Abstract

Delirium, arguably the most important perioperative morbidity in patients undergoing hip fracture surgery, is underdiagnosed and undertreated. However, delirium can be diagnosed with high sensitivity and specificity, and effective means of reducing the severity of delirium and improving outcomes are known. A comprehensive history and examination are necessary with a focus on the presence of acute alteration in awareness and attention. The cardinal features of delirium are acute onset of cognitive disturbances or attention deficits and fluctuating course. Multidisciplinary teams with expertise in geriatrics have shown the most success in controlled studies of delirium postoperative prevention and treatment. Managing delirium is largely a matter of trying to reduce or eliminate risk factors. Screening for cognitive impairment, medications known to increase the risk of delirium, and acute metabolic disturbances and acute infections is key. Treatment should include correction of acute problems and scheduled use of analgesics. Eliminating physical restraints, mobilization, and minimizing room changes are important. Pain control helps to prevent delirium. Psychotropics to treat delirium are most helpful in persons with clear psychotic symptoms, and when used they should initially be given on maintenance rather than an as needed schedule.

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Authors and Affiliations

  1. Department of Medicine, Perelman School of Medicine, Center of Excellence on Minority Health, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    Jerry C. Johnson

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  1. Jerry C. Johnson
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Correspondence to Jerry C. Johnson .

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Editors and Affiliations

  1. Chair, Geriatric Medicine and Gerontology, Robert and Arlene Kogod Professor of Geriatric Medicine, Department of Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA

    Robert J. Pignolo

  2. Co-Director, Orthopaedic Trauma & Fracture Reconstruction, Advisory Dean, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA

    Jaimo Ahn

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Johnson, J.C. (2018). Prevention and Management of Perioperative Delirium. In: Pignolo, R., Ahn, J. (eds) Fractures in the Elderly. Aging Medicine. Humana Press, Cham. https://doi.org/10.1007/978-3-319-72228-3_6

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  • DOI: https://doi.org/10.1007/978-3-319-72228-3_6

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  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-72226-9

  • Online ISBN: 978-3-319-72228-3

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