Last updated March 15, 2022

Postoperative Delirium in Older Adults

Recommendations

Healthcare systems and hospitals should implement multicomponent nonpharmacologic intervention programs delivered by an interdisciplinary team (including physicians, nurses, and possibly other healthcare professionals) for the entire hospitalization in at-risk older adults undergoing surgery to prevent delirium. (Strong, Moderate)
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Healthcare systems and hospitals should implement formal educational programs with ongoing formal and/or informal refresher sessions for healthcare professionals on delirium in at-risk older surgical adults to improve understanding of its epidemiology, assessment, prevention, and treatment. (Strong, Low)
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The healthcare professional should perform a medical evaluation, make medication and/or environmental adjustments, and order appropriate diagnostic tests and clinical consultations after an older adult has been diagnosed with postoperative delirium to identify and manage underlying contributors to delirium. (Strong, Low)
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Healthcare professionals should optimize postoperative pain control, preferably with nonopioid pain medications, to minimize pain in older adults to prevent delirium. (Strong, Low)
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The prescribing practitioner should avoid medications that induce delirium postoperatively in older adults to prevent delirium. (Strong, Low)
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In older adults not currently taking cholinesterase inhibitors, the prescribing practitioner should not newly prescribe cholinesterase inhibitors perioperatively to older adults to prevent or treat delirium. (Strong, Low)
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The prescribing practitioner should not use benzodiazepines as a first line treatment of the agitated post-operative delirious patient who is threatening substantial harm to self and/or others to treat postoperative delirium except when benzodiazepines are specifically indicated (including but not limited to treatment of alcohol or benzodiazepine withdrawal). Treatment with benzodiazepines should be at the lowest effective dose for the shortest possible duration, and should be employed only if behavioral measures have failed or are not possible and ongoing use should be evaluated daily with in-person examination of the patient. (Strong, Low)
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The prescribing practitioner should not prescribe antipsychotic or benzodiazepine medications for the treatment of older adults with postoperative delirium who are not agitated and threatening substantial harm to self or others. (Strong, Low)
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Healthcare professionals should consider multicomponent interventions implemented by an interdisciplinary team in older adults diagnosed with postoperative delirium to improve clinical outcomes. (Weak, Low)
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A healthcare professional trained in regional anesthetic injection may consider providing regional anesthetic at the time of surgery and postoperatively to improve pain control and prevent delirium in older adults. (Weak, Low)
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The prescribing practitioner may use antipsychotics at the lowest effective dose for the shortest possible duration to treat patients who are severely agitated or distressed, and are threatening substantial harm to self and/or others. In all cases, treatment with antipsychotics should be employed only if behavioral interventions have failed or are not possible, and ongoing use should be evaluated daily with in-person examination of patients. (Weak, Low)
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The anesthesia practitioner may use processed electroencephalographic (EEG) monitors of anesthetic depth during intravenous sedation or general anesthesia of older patients to reduce postoperative delirium. (Insufficient, Low)
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There is insufficient evidence to recommend for or against the use of antipsychotic medications prophylactically in older surgical patients to prevent delirium. (Not Applicable, Low)
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There is insufficient evidence to recommend for or against hospitals creating, and healthcare professionals using, specialized hospital units for the inpatient care of older adults with postoperative delirium to improve clinical outcomes. (Not Applicable, Low)
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Recommendation Grading

Overview

Title

Postoperative Delirium in Older Adults

Authoring Organization

Publication Month/Year

May 1, 2016

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Present nonpharmacologic and pharmacologic interventions that should be implemented perioperatively for the prevention of postoperative delirium; and second, to present nonpharmacologic and pharmacologic interventions that should be implemented perioperatively for the treatment of postoperative delirium.

Target Patient Population

Patients who are at risk for postoperative delirium

Inclusion Criteria

Female, Male, Older adult

Health Care Settings

Hospital, Long term care, Operating and recovery room, Outpatient

Intended Users

Occupational therapist, counselor, nurse, nurse practitioner, physician, physician assistant

Scope

Prevention, Management, Treatment

Diseases/Conditions (MeSH)

D003693 - Delirium

Keywords

delirium, postoperative delirium, delirium prevention