Delirium in the Elderly Surgical Patient

Purpose of Review Delirium is an unfortunately frequent complication in the postoperative course of elderly patients, affecting as much as half of all patients with even higher rates in the intensive care unit. Early recognition and diagnosis are tantamount to prevention of the associated increased morbidity and mortality. In this review, we will summarize the current literature pertaining to the diagnosis, prevention, and treatment of delirium in the elderly surgical patient population. Recent Findings Several large randomized control trials looking at the treatment of delirium with neuroleptic medications have been published in the last decade. None has proven that these medications have any benefit in terms of incidence, duration, or severity. In the surgical population, there has been particular interest in contributory intraoperative factors. Fluctuations in blood pressure, Bispectral index monitoring, and regional anesthesia have been shown to play a role. Well-validated screening tools are available for use in the hospital setting. Prevention and subsequent treatment with environmental and supportive methods is considered first-line therapy. Precipitating causes, such as sepsis, electrolyte imbalances, and hypoxia, should be identified and treated. Subsequent use of antipsychotic medications is described for patients with severe agitation only, despite a lack of definitive evidence to suggest benefit.