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Melegari, G. Delirium in Older Adults. Encyclopedia. Available online: (accessed on 22 April 2024).
Melegari G. Delirium in Older Adults. Encyclopedia. Available at: Accessed April 22, 2024.
Melegari, Gabriele. "Delirium in Older Adults" Encyclopedia, (accessed April 22, 2024).
Melegari, G. (2022, March 07). Delirium in Older Adults. In Encyclopedia.
Melegari, Gabriele. "Delirium in Older Adults." Encyclopedia. Web. 07 March, 2022.
Delirium in Older Adults

Delirium remains a challenging clinical problem in hospitalized older adults, especially for postoperative patients. This syndrome consists of a disturbance in attention and awareness that develops acutely and tends to fluctuate; it is one of the most well-known diseases and cognitive changes, with manifestation during hospitalization or soon after anesthesia and surgery. This complication frequently occurs in older adult patients, has a high risk of in-hospital death, and increases the length of stay. 

delirium postoperative complications delirium perspectives

1. Delirium Definition

Postoperative delirium comprises acute onset of disturbances in arousal, attention, and other domains of cognition, hallucinations, and delusions; it can be a hypoactive or hyperactive state or mixed [1]. It is an acute disease that requires the following features:
(A) Disturbance in attention (for example, reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment);
(B) Disturbance that develops over a short period (usually hours to a few days), represents an acute change from baseline attention and awareness, and tends to fluctuate in severity during a day;
(C) An additional disturbance in cognition (for example, deficit of memory, disorientation, language, visuospatial ability, or perception);
(D) The disturbances in Criteria A and C are not better explained by a pre-existing, established, or evolving neurocognitive disorder, and do not occur in the context of a severely reduced level of arousal, such as a coma (Criterion D must not occur in the context of a severely reduced level of arousal, such as a coma);
(E) There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e., due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies [2][3].
Delirium occurs in the hospital up to 1 week post-procedure or until discharge and meets DSM-5 diagnostic criteria. It is also often undetected and underdiagnosed. The screening tools most used for delirium are the four ‘A’s test (Arousal, Attention, Abbreviated Mental Test 4, Acute change) and the Confusion Assessment Method (CAM4) [4]. Cognitive decline is accelerated in people with delirium, and the appearance of delirium after a surgical procedure acts as an alarm for postoperative cognitive dysfunction [5][6].

2. Delirium Pathophysiology

Neuroinflammation, neurotransmitter dysregulation, and brain network disconnection are the common causes of delirium. However, in recent years, it is common to think of delirium as a consequence of multiple simultaneous molecular dysfunctions, which, due to multiple reasons, can lead to this disease [7].
  • Systemic inflammation, as a septic shock syndrome, can lead to neuroinflammation with microglial cells activation, neuronal dysfunction, synaptic dysfunction, cellular apoptosis, and neuronal ischemia by the passage through a damaged blood–brain barrier (BBB) of proinflammatory cytokines (such as interleukin (IL) IL6, IL1, IL8, tumor necrosis factor alpha (TNFα), and C reactive protein CRP [8]).
  • Stress conditions cause neuroinflammation with the unbalance of the limbic–hypothalamic–pituitary–adrenal axis (LHPA) by increasing cortisol blood levels. Several factors can influence cortisol levels, one of them being an alteration in melatonin pathways caused by sleep deprivation [9].
  • Studies have demonstrated that prolonged exposure of neurons to high levels of cortisol, insulin, and glucose leads to neuronal malfunction and damage because of continuous metabolic stress. Therefore, people develop cognitive failure, and the devastating effect is more evident in older adults in which the LHPA axis is often already dysregulated. Inflammatory conditions can lead to hyperactivation of microglia and the consequent release of inflammatory cytokines and direct neuronal damage [10].
  • Abnormal gamma-aminobutyric acid (GABA)-related transmission in the nervous system actively contributes to the development of delirium. It has been largely demonstrated that the use of drugs that increase GABAergic synaptic transmission, such as benzodiazepines, increases the risk of delirium manifestation [11].
All these hormonal and neurotransmitter alterations cause oxidative stress to cells which are exacerbated in hypoxic conditions that lead to chaotic neuronal signaling.

3. Delirium Assessment

Firstly, it is fundamental to assess the cognitive function and presurgical mental condition to detect any underdiagnosed pre-existing cognitive function decline [12].
There are several cognitive tests:
  • The mini-mental test is one of the most accurate and known cognitive tests, but is often not simple to perform.
  • However, the Rapid Cognitive Screen Test (Appendix A) and the Six-Item Cognitive Test are rapid, applicable, and feasible in the surgery ward units [13][14][15][16][17].
People with cognitive deficit have a greater risk of developing delirium, and sometimes this problem is difficult to distinguish from dementia [5].
The delirium diagnosis is a clinical one and must be confirmed by an expert in the field. This acute disease is often underestimated because of its fluctuating nature or the hypoactive delirium type [18].
There are three principal delirium assessment tools.
  • The four ‘A’s test (4AT) (Appendix B) is a simple, quick clinical test that requires less than 2 min to perform and is a well-validated bedside test to detect delirium in day-to-day practice and different settings [19]. It does not require special training, and it is easy to implement for delirium diagnosis. A recent article reported this test’s sensitivity and specificity as over 81.5% and 87.5%, respectively [20][21][22][23].
In the end, the 4AT test investigates acute changes or fluctuations [24].
  • The Confusion Assessment Method (CAM4) (Appendix C) was developed in 1990. It has high sensitivity (94–100%) and high specificity (90–95%), and is easy to perform [25]. Nurses and physicians can perform it, but delirium diagnosis can only be confirmed by physician experts in the field. It can be used in clinical and research settings, with expert judgment, and is helpful to avoid hypoactive delirium.
  • In recent years, the CAM4 score was also adapted for intensive care units and critically ill patients. The CAM-ICU score for intensive care unit (ICU) patients (Appendix D) has a pooled sensitivity of 80.0% and a pooled specificity of 95.9% [26]. This score investigates the presence of acute onset or fluctuating course and inattention with either disorganized thinking or altered level of consciousness; these features indicate a possible delirium diagnosis [27][28]. Like the CAM4, this tool evaluates the same core features of delirium, but in a different way, with clinical tests or observations. Furthermore, this assessment needs to be combined with the Richmond Agitation–Sedation Scale to evaluate the arousal/sedation [29]. This test is helpful in conditions such as coma or arousal, which nurses can easily perform.
  • An alternative to CAM-ICU is the Intensive Care Delirium Screening Checklist (ICDSC). However, this tool must be integrated with agitation [27][30][31][32]. By the way, CAM4, CAM-ICU, and 4AT tools required multiple interviews or clinical observations of the patients.
  • The severity of delirium and the clinical course of the delirium can be measured with these tools [33][34][35]. The Delirium Rating Scale—Revised-98 and The Memorial Delirium Assessment have both been traduced in many languages, which is helpful for longitudinal studies and assessing and evaluating answers to the treatments.
  • Recently, two delirium-prediction models in ICUs have been introduced: the model for delirium (PRE-DELIRIC) and the early prediction model for delirium (E-PRE-DELIRIC). In these models, the delirium prediction, as reported above, demonstrated both a moderate-to-good performance to predict delirium, especially in ICU; however, more validations are necessary [36][37][38][39]. These tools allow practicing preventive strategies to avoid delirium in critical patients.
Instruments such as EEG have been proposed to exclude conditions, such as non-convulsive status epilepticus, which, in some instances, can present with behavioral cognitive alterations that can mimic ‘delirium’. Moreover, intraoperative EEG monitoring has increased its relevance for its potential role in finding a pattern related to postoperative delirium [40][41][42].
Differently, in recent years, several biomarkers have also been studied, but the best tools with the highest specificity and sensitivity are clinical [43].

4. Postoperative Delirium: Epidemiology and Risk Factors

Postoperative delirium infrequently affects young adults who undergo minor elective surgery. Interestingly, the incidence increases to 15–25% after elective surgery in older adults and reaches more than 50% of cases in high-risk elderly patients who undergo major surgery, such as cardiac surgery, requiring cardiopulmonary bypass or orthopedic hip fracture repair [44][45]. Notably, patients who need ICU admission after the surgery have a higher risk of developing delirium, which is worsened by prolonged mechanical ventilation [45]. Risk factors of developing postoperative delirium could be patient-related, could be different depending on the timing of appearance during hospitalization, and could be medical- or surgery-related factors [46][47]. More generally, the risk of developing postoperative delirium derives from the presence of some predisposing factors in addition to one or more precipitant factors[45][46][47][48][49].

5. Perioperative Management of Delirium

The management of delirium starts in the preoperative period, with environmental and clinical strategies and daily neurological assessment by clinicians, and is fundamental. First of all, physicians should promote fast-track surgery and short hospitalization [50][51][52]. The right approach to treat delirium disturbances begins with administrating drugs and medications correctly, avoiding benzodiazepines, and promoting dexmedetomidine and clonidine as sedative and analgesic drugs [53]. During the entire period, physicians should exclude acute neurological damage or metabolic or infective CNS involvement, ensuring correct oxygen delivery (DO2) by maintaining normal hemoglobin levels, avoiding blood loss, and avoiding uncontrolled pain because it is a possible delirium trigger. Avoiding metabolic alterations, as well as ensuring normal blood glucose, physiologic endocrine function, normal renal function, and hydro electrolytic balance, can reduce delirium risk [10][54]. Furthermore, nurses and physicians should take care of the environmental factors in the hospital unit, and clocks, radio or television, and books could be helpful to maintain attention and orientation. It is crucial to assess CAM fluctuations during the day, and the presence of relatives or next of kin of the patients could also be a resource in delirium prevention [55]. To summarize, actions to avoid or reduce delirium incidence can be divided into three categories: preoperative, intraoperative, and postoperative strategies [56][57][58][59][60][61][62][63][64][65].

6. Therapies for Postoperative Delirium

As primary measures, once postoperative delirium starts, it is possible to use non-pharmacological and pharmacological interventions.
Due to the paucity of evidence, the actual guidelines suggest avoiding pharmacological approaches as first-line therapy both in non-intensive and intensive care settings [66][67][68].

6.1. Non-Pharmacological Interventions: Behavioral and Multimodal Approach

This method seems to be the most effective in delirium treatment. It includes non-pharmacological approaches described as preventive actions above, which can also be treatment solutions.
  • It is necessary to understand why the patient is delirious and to treat precipitating factors (such as treating hypotension, giving oxygen therapy when needed, treating overdose of drugs, and controlling pain).
  • It is fundamental to free the patient from medical devices as soon as possible. This allows starting early rehabilitation and promoting a reorientation program with the patient’s family collaboration.
  • In addition, some advantages could come from educational programs for staff to illustrate how to deal with this pathology [69].
However, even if effective, in several circumstances of hospital restrictions or logistic limitations, this therapeutic approach could have a difficult realization. When the behavioral and multimodal approach is not enough to treat delirium, the use of antipsychotic drugs is suggested.

6.2. Pharmacological Interventions

Several drugs have been historically used to treat postoperative delirium, but only a few of them have strong evidence of efficacy.
  • Haloperidol (a dopaminergic agonist) is the antipsychotic drug traditionally used in emergency intravenously in both non-intensive and intensive care settings. It seems to reduce the length of delirium and agitation. However, there are some safety issues because it can prolong QTc on ECG. In addition, there are little evidence and guidelines that support its use, with a paucity of data regarding its use in non-intensive care settings [70][71].
  • Second-generation antipsychotic drugs, such as risperidone, olanzapine, and quetiapine, have been used in place of haloperidol. However, there is a lack of evidence of their superiority in solving delirium [53][72][73].
  • An α2 agonist, dexmedetomidine, has been used in the ICU setting to treat delirium in mechanically ventilated patients. Recent guidelines suggest it helps to wean patients from ventilators by reducing ventilation days and the length of stay in the ICU. Evidence suggests that it reduces delirium in postoperative cardiovascular patients and. When haloperidol fails, it can be used in non-ventilated patients. As well as dexmedetomidine, the use of clonidine (α2 agonist) seems to be promising, but further studies are necessary to better define its role in delirium treatment [29][74][75].
  • In the end, acetylcholinesterase inhibitors, such as rivastigmine and donepezil or melatonin, seem to help in some clinical settings, but more data are needed [76][77].


  1. Marcantonio, E.R. Delirium in Hospitalized Older Adults. N. Engl. J. Med. 2017, 377, 1456–1466.
  2. Hshieh, T.T.; Inouye, S.K.; Oh, E.S. Delirium in the Elderly. Clin. Geriatr. Med. 2020, 36, 183–199.
  3. Association, A.P. Diagnostic and Statistical Manual of Dsm-5 TM, 5th ed.; American Psychiatric Association: Washington, DC, USA, 2013.
  4. Maclullich, A.M.J.; Shenkin, S.D.; Goodacre, S.; Godfrey, M.; Hanley, J.; Stíobhairt, A.; Lavender, E.; Boyd, J.; Stephen, J.; Weir, C.; et al. The 4 ‘a’s test for detecting delirium in acute medical patients: A diagnostic accuracy study. Health Technol. Assess. 2019, 23, 1–193.
  5. Browndyke, J.N.; Devinney, M.; Mathew, J.P. The Devil Is in the Details: Comparison of Postoperative Delirium and Neurocognitive Dysfunction. Anesthesiology 2019, 131, 456–458.
  6. Daiello, L.A.; Racine, A.M.; Yun Gou, R.; Marcantonio, E.R.; Xie, Z.; Kunze, L.J.; Vlassakov, K.V.; Inouye, S.K.; Jones, R.N.; Alsop, D.; et al. Postoperative Delirium and Postoperative Cognitive Dysfunction: Overlap and Divergence. Anesthesiology 2019, 131, 477–491.
  7. Mattison, M.L.P. Delirium. Ann. Intern. Med. 2020, 173, ITC49–ITC64.
  8. Maldonado, J.R. Acute Brain Failure: Pathophysiology, Diagnosis, Management, and Sequelae of Delirium. Crit. Care Clin. 2017, 33, 461–519.
  9. Wang, Y.; Shen, X. Postoperative delirium in the elderly: The potential neuropathogenesis. Aging Clin. Exp. Res. 2018, 30, 1287–1295.
  10. Yang, T.; Velagapudi, R.; Terrando, N. Neuroinflammation after surgery: From mechanisms to therapeutic targets. Nat. Immunol. 2020, 21, 1319–1326.
  11. Arumugam, S.; El-Menyar, A.; Al-Hassani, A.; Strandvik, G.; Asim, M.; Mekkodithal, A.; Mudali, I.; Al-Thani, H. Delirium in the Intensive Care Unit. J. Emerg. Trauma. Shock 2017, 10, 37.
  12. Kapoor, I.; Prabhakar, H.; Mahajan, C. Postoperative Cognitive Dysfunction. Indian J. Crit. Care Med. 2019, 23, S162.
  13. Charbek, E.; Huynh, K.; Kim, E.; Nayak, R.P. Assessment of Cognitive Impairment in Patients with Chronic Obstructive Pulmonary Disease Using the Rapid Cognitive Screen. J. Nutr. Health Aging 2019, 23, 102–104.
  14. Lucke, J.A.; De Gelder, J.; Heringhaus, C.; Van Der Mast, R.C.; Fogteloo, A.J.; Anten, S.; Blauw, G.J.; De Groot, B.; Mooijaart, S.P. Impaired cognition is associated with adverse outcome in older patients in the emergency department; the Acutely Presenting Older patients (APOP) study. Age Ageing 2018, 47, 679–684.
  15. O’Reilly-Shah, V.N.; Hemani, S.; Davari, P.; Glowka, L.; Gebhardt, E.; Hill, L.; Lee, S.; Master, V.A.; Rodriguez, A.D.; García, P.S. A Preoperative Cognitive Screening Test Predicts Increased Length of Stay in a Frail Population: A Retrospective Case-Control Study. Anesth. Analg. 2019, 129, 1283–1290.
  16. Amado, J.; Gago, P.; Santos, W.; Mimoso, J.; de Jesus, I. Choque cardiogénico–fármacos inotrópicos e vasopressores. Rev. Port. Cardiol. 2016, 35, 681–695.
  17. Amado, L.A.; Perrie, H.; Scribante, J.; Ben-Israel, K.A. Preoperative cognitive dysfunction in older elective noncardiac surgical patients in South Africa. Br. J. Anaesth. 2020, 125, 275–281.
  18. Oh, E.S.; Fong, T.G.; Hshieh, T.T.; Inouye, S.K. Delirium in Older Persons: Advances in Diagnosis and Treatment. JAMA 2017, 318, 1161–1174.
  19. Shenkin, S.D.; Fox, C.; Godfrey, M.; Siddiqi, N.; Goodacre, S.; Young, J.; Anand, A.; Gray, A.; Hanley, J.; MacRaild, A.; et al. Delirium detection in older acute medical inpatients: A multicentre prospective comparative diagnostic test accuracy study of the 4AT and the confusion assessment method. BMC Med. 2019, 17, 138.
  20. Jeong, E.; Park, J.; Lee, J. Diagnostic test accuracy of the Nursing Delirium Screening Scale: A systematic review and meta-analysis. J. Adv. Nurs. 2020, 76, 2510–2521.
  21. Jeong, E.; Park, J.; Lee, J. Diagnostic Test Accuracy of the 4AT for Delirium Detection: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2020, 17, 7515.
  22. Myrstad, M.; Kuwelker, K.; Haakonsen, S.; Valebjørg, T.; Langeland, N.; Kittang, B.R.; Hagberg, G.; Neerland, B.E.; Bakken, M.S. Delirium screening with 4AT in patients aged 65 years and older admitted to the Emergency Department with suspected sepsis: A prospective cohort study. Eur. Geriatr. Med. 2021. epub ahead of print.
  23. Tieges, Z.; Maclullich, A.M.J.; Anand, A.; Brookes, C.; Cassarino, M.; O’connor, M.; Ryan, D.; Saller, T.; Arora, R.C.; Chang, Y.; et al. Diagnostic accuracy of the 4AT for delirium detection in older adults: Systematic review and meta-analysis. Age Ageing 2021, 50, 733–743.
  24. 4AT-Rapid Clinical Test for Delirium. Available online: (accessed on 28 November 2021).
  25. Chaiwat, O.; Chanidnuan, M.; Pancharoen, W.; Vijitmala, K.; Danpornprasert, P.; Toadithep, P.; Thanakiattiwibun, C. Postoperative delirium in critically ill surgical patients: Incidence, risk factors, and predictive scores. BMC Anesthesiol. 2019, 19, 39.
  26. Kotfis, K.; Marra, A.; Wesley Ely, E. ICU delirium—A diagnostic and therapeutic challenge in the intensive care unit. Anaesthesiol. Intensive Ther. 2018, 50, 128–140.
  27. Krewulak, K.D.; Rosgen, B.K.; Ely, E.W.; Stelfox, H.T.; Fiest, K.M. The CAM-ICU-7 and ICDSC as measures of delirium severity in critically ill adult patients. PLoS ONE 2020, 15, e0242378.
  28. Riker, R.R.; Fraser, G.L. Delirium-Beyond the CAM-ICU. Crit. Care Med. 2020, 48, 134–136.
  29. Pop, M.K.; Dervay, K.R.; Dansby, M.; Jones, C. Evaluation of Richmond Agitation Sedation Scale (RASS) in Mechanically Ventilated in the Emergency Department. Adv. Emerg. Nurs. J. 2018, 40, 131–137.
  30. Krewulak, K.D.; Hiploylee, C.; Ely, E.W.; Stelfox, H.T.; Inouye, S.K.; Fiest, K.M. Adaptation and Validation of a Chart-Based Delirium Detection Tool for the ICU (CHART-DEL-ICU). J. Am. Geriatr. Soc. 2021, 69, 1027–1034.
  31. Wang, C.; Qin, Y.; Wan, X.; Song, L.; Li, Z.; Li, H. Incidence and risk factors of postoperative delirium in the elderly patients with hip fracture. J. Orthop. Surg. Res. 2018, 13, 186.
  32. Shi, Z.; Wu, Y.; Li, C.; Fu, S.; Li, G.; Zhu, Y.; Swain, C.A.; Marcantonio, E.R.; Xie, Z.; Shen, Y. Using the Chinese version of Memorial Delirium Assessment Scale to describe postoperative delirium after hip surgery. Front. Aging Neurosci. 2014, 6, 297.
  33. Noh, G.; Kwon, I.; Lee, M.; Ahn, S.H.; Kim, J.L. Factor Analysis of Delirium in Elderly, Using the Korean Version of Delirium Rating Scale-Revised-98. Psychiatry Investig. 2018, 15, 484–489.
  34. Grover, S.; Ghosh, A.; Sarkar, S.; Desouza, A.; Yaddanapudi, L.N.; Basu, D. Delirium in Intensive Care Unit: Phenomenology, Subtypes, and Factor Structure of Symptoms. Indian J. Psychol. Med. 2018, 40, 169–177.
  35. Sharma, A.; Malhotra, S.; Grover, S.; Jindal, S.K. Symptom profile as assessed on delirium rating scale-revised-98 of delirium in respiratory intensive care unit: A study from India. Lung India 2017, 34, 434–440.
  36. Wassenaar, A.; Schoonhoven, L.; Devlin, J.W.; van Haren, F.M.P.; Slooter, A.J.C.; Jorens, P.G.; van der Jagt, M.; Simons, K.S.; Egerod, I.; Burry, L.D.; et al. External Validation of Two Models to Predict Delirium in Critically Ill Adults Using Either the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist for Delirium Assessment. Crit. Care Med. 2019, 47, e827–e835.
  37. Wassenaar, A.; Schoonhoven, L.; Devlin, J.W.; van Haren, F.M.P.; Slooter, A.J.C.; Jorens, P.G.; van der Jagt, M.; Simons, K.S.; Egerod, I.; Burry, L.D.; et al. Delirium prediction in the intensive care unit: Comparison of two delirium prediction models. Crit. Care 2018, 22, 114.
  38. Chen, T.J.; Chung, Y.W.; Chang, H.C.; Chen, P.Y.; Wu, C.R.; Hsieh, S.H.; Chiu, H.Y. Diagnostic accuracy of the CAM-ICU and ICDSC in detecting intensive care unit delirium: A bivariate meta-analysis. Int. J. Nurs. Stud. 2021, 113, 103782.
  39. Ho, M.H.; Shen, S.T.H. Application of the delirium risk prediction model in the TED ICU smart intensive care system during the current COVID-19 pandemic. Intensive Crit. Care Nurs. 2021, 63, 103007.
  40. Wildes, T.S.; Mickle, A.M.; Abdallah, A.B.; Maybrier, H.R.; Oberhaus, J.; Budelier, T.P.; Kronzer, A.; McKinnon, S.L.; Park, D.; Torres, B.A.; et al. Effect of electroencephalography-guided anesthetic administration on postoperative delirium among older adults undergoing major surgery the engages randomized clinical trial. JAMA-J. Am. Med. Assoc. 2019, 321, 473–483.
  41. Wildes, T.S.; Winter, A.C.; Maybrier, H.R.; Mickle, A.M.; Lenze, E.J.; Stark, S.; Lin, N.; Inouye, S.K.; Schmitt, E.M.; McKinnon, S.L.; et al. Protocol for the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) study: A pragmatic, randomised clinical trial. BMJ Open 2016, 6, e011505.
  42. Punjasawadwong, Y.; Chau-in, W.; Laopaiboon, M.; Punjasawadwong, S.; Pin-on, P. Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non-neurosurgical procedures in adults. Cochrane Database Syst. Rev. 2018, 2018, 1465–1858.
  43. Dunne, S.S.; Coffey, J.C.; Konje, S.; Gasior, S.; Clancy, C.C.; Gulati, G.; Meagher, D.; Dunne, C.P. Biomarkers in delirium: A systematic review. J. Psychosom. Res. 2021, 147, 110530.
  44. Wilson, J.E.; Mart, M.F.; Cunningham, C.; Shehabi, Y.; Girard, T.D.; MacLullich, A.M.J.; Slooter, A.J.C.; Ely, E.W. Delirium. Nat. Rev. Dis. Prim. 2020, 6, 90.
  45. Slooter, A.J.C.; Van De Leur, R.R.; Zaal, I.J. Delirium in critically ill patients. Handb. Clin. Neurol. 2017, 141, 449–466.
  46. Folbert, E.C.; Hegeman, J.H.; Gierveld, R.; van Netten, J.J.; van der Velde, D.; Ten Duis, H.J.; Slaets, J.P. Complications during hospitalization and risk factors in elderly patients with hip fracture following integrated orthogeriatric treatment. Arch. Orthop. Trauma Surg. 2017, 137, 507–515.
  47. Cui, X.P.; Jing, Z.Z.; Song, J.F.; Zhang, P. A retrospective study on risk factors associated with postoperative delirium in elderly patients with spinal operation. Zhongguo Gu Shang 2019, 32, 549–554.
  48. Pérez-Ros, P.; Martínez-Arnau, F.M.; Baixauli-Alacreu, S.; Caballero-Pérez, M.; García-Gollarte, J.F.; Tarazona-Santabalbina, F. Delirium Predisposing and Triggering Factors in Nursing Home Residents: A Cohort Trial-Nested Case-Control Study. J. Alzheimers. Dis. 2019, 70, 1113–1122.
  49. Seiler, A.; Blum, D.; Deuel, J.W.; Hertler, C.; Schettle, M.; Zipser, C.M.; Ernst, J.; Schubert, M.; Von Känel, R.; Boettger, S. Delirium is associated with an increased morbidity and in-hospital mortality in cancer patients: Results from a prospective cohort study. Palliat. Support. Care 2021, 19, 294–303.
  50. Zhang, X.; Yang, J.; Chen, X.; Du, L.; Li, K.; Zhou, Y. Enhanced recovery after surgery on multiple clinical outcomes: Umbrella review of systematic reviews and meta-analyses. Medicine 2020, 99, e20983.
  51. Monacelli, F.; Signori, A.; Prefumo, M.; Giannotti, C.; Nencioni, A.; Romairone, E.; Scabini, S.; Odetti, P. Delirium, Frailty, and Fast-Track Surgery in Oncogeriatrics: Is There a Link? Dement. Geriatr. Cogn. Dis. Extra 2018, 8, 33–41.
  52. Golder, H.J.; Papalois, V. Enhanced Recovery after Surgery: History, Key Advancements and Developments in Transplant Surgery. J. Clin. Med. 2021, 10, 1634.
  53. Wu, Y.C.; Tseng, P.T.; Tu, Y.K.; Hsu, C.Y.; Liang, C.S.; Yeh, T.C.; Chen, T.Y.; Chu, C.S.; Matsuoka, Y.J.; Stubbs, B.; et al. Association of Delirium Response and Safety of Pharmacological Interventions for the Management and Prevention of Delirium: A Network Meta-analysis. JAMA Psychiatry 2019, 76, 526–535.
  54. Yang, Y.; Zhao, X.; Dong, T.; Yang, Z.; Zhang, Q.; Zhang, Y. Risk factors for postoperative delirium following hip fracture repair in elderly patients: A systematic review and meta-analysis. Aging Clin. Exp. Res. 2017, 29, 115–126.
  55. Melegari, G.; Albertini, G.; Romani, A.; Malaguti, S.; Traccitto, F.; Giuliani, E.; Cavallini, G.M.; Bertellini, E.; Barbieri, A. Why should you stay one night? Prospective observational study of enhanced recovery in elderly patients. Aging Clin. Exp. Res. 2020, 33, 1955–1961.
  56. Jin, Z.; Hu, J.; Ma, D. Postoperative delirium: Perioperative assessment, risk reduction, and management. Br. J. Anaesth. 2020, 125, 492–504.
  57. Miller, D.; Lewis, S.R.; Pritchard, M.W.; Schofield-Robinson, O.J.; Shelton, C.L.; Alderson, P.; Smith, A.F. Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery. Cochrane Database Syst. Rev. 2018, 8, 1465–1858.
  58. Ishii, K.; Makita, T.; Yamashita, H.; Matsunaga, S.; Akiyama, D.; Toba, K.; Hara, K.; Sumikawa, K.; Hara, T. Total intravenous anesthesia with propofol is associated with a lower rate of postoperative delirium in comparison with sevoflurane anesthesia in elderly patients. J. Clin. Anesth. 2016, 33, 428–431.
  59. Kinjo, S.; Lim, E.; Magsaysay, M.V.; Sands, L.P.; Leung, J.M. Volatile anaesthetics and postoperative delirium in older surgical patients-A secondary analysis of prospective cohort studies. Acta Anaesthesiol. Scand. 2019, 63, 18–26.
  60. Shaefi, S.; Shankar, P.; Mueller, A.L.; O’Gara, B.P.; Spear, K.; Khabbaz, K.R.; Bagchi, A.; Chu, L.M.; Banner-Goodspeed, V.; Leaf, D.E.; et al. Intraoperative Oxygen Concentration and Neurocognition after Cardiac Surgery. Anesthesiology 2021, 134, 189–201.
  61. Shaefi, S.; Marcantonio, E.R.; Mueller, A.; Banner-Goodspeed, V.; Robson, S.C.; Spear, K.; Otterbein, L.E.; O’Gara, B.P.; Talmor, D.S.; Subramaniam, B. Intraoperative oxygen concentration and neurocognition after cardiac surgery: Study protocol for a randomized controlled trial. Trials 2017, 18, 600.
  62. Leenders, J.; Overdevest, E.; van Straten, B.; Golab, H. The influence of oxygen delivery during cardiopulmonary bypass on the incidence of delirium in CABG patients; a retrospective study. Perfusion 2018, 33, 656–662.
  63. Janssen, T.L.; Alberts, A.R.; Hooft, L.; Mattace-Raso, F.U.S.; Mosk, C.A.; Van Der Laan, L. Prevention of postoperative delirium in elderly patients planned for elective surgery: Systematic review and meta-analysis. Clin. Interv. Aging 2019, 14, 1095–1117.
  64. Rains, J.; Chee, N. The role of occupational and physiotherapy in multi-modal approach to tackling delirium in the intensive care. J. Intensive Care Soc. 2017, 18, 318–322.
  65. Simons, K.S.; Laheij, R.J.F.; van den Boogaard, M.; Moviat, M.A.M.; Paling, A.J.; Polderman, F.N.; Rozendaal, F.W.; Salet, G.A.M.; van der Hoeven, J.G.; Pickkers, P.; et al. Dynamic light application therapy to reduce the incidence and duration of delirium in intensive-care patients: A randomised controlled trial. Lancet. Respir. Med. 2016, 4, 194–202.
  66. Soiza, R.L.; Myint, P.K. The Scottish Intercollegiate Guidelines Network (SIGN) 157: Guidelines on Risk Reduction and Management of Delirium. Medicina 2019, 55, 491.
  67. Méndez-Martínez, C.; Fernández-Martínez, M.N.; García-Suárez, M.; Martínez-Isasi, S.; Fernández-Fernández, J.A.; Fernández-García, D. Related Factors and Treatment of Postoperative Delirium in Old Adult Patients: An Integrative Review. Healthcare 2021, 9, 1103.
  68. Ludolph, P.; Stoffers-Winterling, J.; Kunzler, A.M.; Rösch, R.; Geschke, K.; Vahl, C.F.; Lieb, K. Non-Pharmacologic Multicomponent Interventions Preventing Delirium in Hospitalized People. J. Am. Geriatr. Soc. 2020, 68, 1864–1871.
  69. Enomoto, K.; Kosaka, S.; Kimura, T.; Matsubara, M.; Kitada, Y.; Mieno, M.; Okamura, H. Prevention of postoperative delirium after cardiovascular surgery: A team-based approach. J. Thorac. Cardiovasc. Surg. 2021, 24, in press.
  70. Rood, P.J.T.; Zegers, M.; Slooter, A.J.C.; Beishuizen, A.; Simons, K.S.; van der Voort, P.H.J.; van der Woude, M.C.E.; Spronk, P.E.; van der Hoeven, J.G.; Pickkers, P.; et al. Prophylactic Haloperidol Effects on Long-term Quality of Life in Critically Ill Patients at High Risk for Delirium: Results of the REDUCE Study. Anesthesiology 2019, 131, 328–335.
  71. Duprey, M.S.; Devlin, J.W.; Der Hoeven, J.G.V.; Pickkers, P.; Briesacher, B.A.; Saczynski, J.S.; Griffith, J.L.; Boogaard, M. Van Den Association between Incident Delirium Treatment with Haloperidol and Mortality in Critically Ill Adults. Crit. Care Med. 2021, 1303–1311.
  72. Devlin, J.W.; Skrobik, Y. Antipsychotics for the prevention and treatment of delirium in the intensive care unit: What is their role? Harv. Rev. Psychiatry 2011, 19, 59–67.
  73. Neufeld, K.J.; Yue, J.; Robinson, T.N.; Inouye, S.K.; Needham, D.M. Antipsychotic Medication for Prevention and Treatment of Delirium in Hospitalized Adults: A Systematic Review and Meta-Analysis. J. Am. Geriatr. Soc. 2016, 64, 705–714.
  74. Frölich, M.A.; Banks, C.; Ness, T.J. The effect of sedation on cortical activation: A randomized study comparing the effects of sedation with midazolam, propofol, and dexmedetomidine on auditory processing. Anesth. Analg. 2017, 124, 1603–1610.
  75. Soltani, F.; Tabatabaei, S.; Jannatmakan, F.; Nasajian, N.; Amiri, F.; Darkhor, R.; Moravej, M. Comparison of the Effects of Haloperidol and Dexmedetomidine on Delirium and Agitation in Patients with a Traumatic Brain Injury Admitted to the Intensive Care Unit. Anesthesiol. Pain Med. 2021, 11, e113802.
  76. Dawson, A.H.; Buckley, N.A. Pharmacological management of anticholinergic delirium—Theory, evidence and practice. Br. J. Clin. Pharmacol. 2016, 81, 516–524.
  77. Alagiakrishnan, K. Melatonin based therapies for delirium and dementia. Discov. Med. 2016, 21, 363–371.
Subjects: Neurosciences
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