Delirium is a frequent complication in the geriatric patient with a fragility fracture and is present in up to 75% of older adults in the postoperative setting. It contributes to complications including falls and pressure ulcers and increases the risk of mortality (30%), long-term care needs, and cognitive and functional decline. One third of patients return to baseline cognitive function following delirium, while many others remain with a decline of cognitive function. Delirium is always an acute medical emergency.
Acute impairment of cognition that develops over a short period of time (hours to days).
This educational module presents one approach to the detection and management of non-substance-withdrawal delirium in older adults based on recent literature (see Recommended reading). It contains content related to how to assess delirium risk in older adults with a fracture, how to identify underlying problems, how to initiate treatment, and how to prevent delirium in high-risk patients.
The content and pathway in this module is not able to consider all individual circumstances in every case (eg, allergies, comorbidities). This module is to be used only as a guide, and it cannot replace clinical judgment for individual patient. Generally, there is a lack of clear guidelines regarding symptomatic pharmacological treatment of delirium. All decisions regarding treatment and the choice of medications remain the sole responsibility of the physician. Check your local prescription information for all medications, as well as your national guidelines and hospital protocols, and consider the specific patient and potential risks and benefit in all cases.
The clinical practice tools that are integrated in this module (eg, CAM, Delirium Risk Score) are for educational purposes only and are not intended to be used as the sole method of conducting patient assessment.