Prevention and treatment of postoperative delirium in the elderly, non-critically ill people: A literature review

Abstract

Delirium is a common yet severely underdiagnosed neuropsychiatric condition with short and long spanning implications regarding the risk of death, quality of life and economic burden. There is a moderate body of evidence when it comes to delirium in an ICU or medical setting, whereas data on this pathology in a surgical setting is sparse. In this article, we aim to converge all the relevant and up-to-date evidence on preventing and treating postoperative delirium. We have searched the PubMed and Cochrane databases with the following keywords: “delirium”, “postoperative”, “prevention”, “treatment”, “surgery”, “elderly”. There are currently no validated markers to determine the persons at risk of developing postoperative delirium. No current guidelines exist on preventing or treating postoperative delirium. Even so, multicomponent nonpharmacological interventions like early mobilization, hearing and visual orientation, healthy sleeping routines etc. seem to have positive results in preventing delirium, but have no effect in treating it once it develops. Hitherto, there is currently no consensus when it comes to pharmacological prevention or treatment with the literature being divided due to a low number of randomized controlled studies with different terminology, high heterogeneity and poorly reported adverse effects. Amid this debate, there are still promising molecules like suvorexant and dexmedetomidine with positive outcomes in preventing postoperative delirium but they are still far away from clinical validation. In conclusion, this important and often missed topic needs further study in a more homogenous and controlled manner at all levels – basic science, translational science and clinical trials.