Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study.
BACKGROUND
There is an evident need for improved management of elderly patients with trauma in order to avoid common and troublesome complications such as delirium. The aim of this study was to investigate whether an implementation of a multi-factorial program including intensified pre-hospital and perioperative treatment and care could reduce the incidence of delirium in elderly patients with hip fracture, cognitively intact at admission to the hospital. In addition, we explored the factors that characterize patients who developed delirium.


METHODS
A prospective, quasi-experimental design was used. A total of 263 patients with hip fracture (> or = 65 years), cognitively intact at admission, were consecutively included between April 2003 and April 2004. On 1 October 2003, a new program was introduced. All patients were screened for cognitive impairment within 30 min after admission to the emergency department using The Short Portable Mental Status Questionnaire (SPMSQ). To screen for delirium, patients were tested within 4 h of admission and thereafter daily, using the Organic Brain Syndrome scale.


RESULTS
The number of patients who developed delirium during hospitalization was 74 (28.1%), with a decrease from 34% (45 of 132) in the control group to 22% (29 of 131) in the intervention group (P=0.031). Patients who developed delirium were statistically older, more often had > 4 prescribed drugs at admission and scored less well in the SPMSQ test.


CONCLUSIONS
The use of a multi-factorial intervention program in elderly hip fracture patients, lucid at admission, reduced the incidence of delirium during hospitalization by 35%.
Department of Anesthesiology and Intensive Care, Clinical Sciences, Lund University, Lund, Sweden. karin.bjorkman_bjorkelund@med.lu.se
K B
KB
Björkelund
A
A
Hommel
K-G
KG
Thorngren
L
L
Gustafson
S
S
Larsson
D
D
Lundberg
D000082:Acetaminophen / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D018680:Cholinergic Antagonists; D015897:Comorbidity; D000075202:Contraindications; D003693:Delirium / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D042241:Early Diagnosis; D004632:Emergency Medical Services; D005260:Female; D005440:Fluid Therapy; D006620:Hip Fractures / Q000523:psychology* / Q000601:surgery / Q000628:therapy; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008297:Male; D009483:Neuropsychological Tests; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy; D010146:Pain / Q000188:drug therapy; D019338:Polypharmacy; D011300:Preoperative Care; D011446:Prospective Studies
D000700:Analgesics; D018680:Cholinergic Antagonists; D006993:Hypnotics and Sedatives; D000082:Acetaminophen; D010100:Oxygen