The current status of delirium after elderly hip fracture

Abstract

Delirium is a common complication after elderly hip fracture, and is associated with high rates of mortality and morbidity. There is no enough attention for delirium compared to deep vein thrombosis, pulmonary embolism, heart failure, etc. This paper reviews the definition, diagnosis, incidence, prognosis, treatment and other aspects of delirium in order to better under-stand delirium clinically. Delirium is an acute mental disorder of consciousness, attention, perception, thinking ability, memory, mental activity, and emotion. It is characterized by the disorder of sleep or wakefulness, and these changes are difficult to explain by dementia. The confusion assessment method(confusion assessment method, CAM)is generally accepted as the current diagnostic tools for delirium, and mainly depends on the patient's consciousness and cognitive function. The mechanisms of delirium are unclear, and it is influenced by many factors, such as agedness, cognitive impairment, pain, sleep rhythm disorders, and theories mainly include neurotransmitter theory, the central inflammatory response theory, the theory of stress response, sleep wake cycle, et al. The delirium is difficult to explain by using single, liner factor, but is elaborated by many various factors. However, the influences of delirium on outcome for hip fracture are unclear, and it is definite that these patients have poor functional recovery, poor independent living ability, longer time in bed, demand for more care. The prevention should be implemented as mainly measures for delirium. Elimination of risk factors, including correct hypoxia, reduce pain, avoid water electrolyte disorders, improve sleep rhythm, and avoid using of opioids should be tried. In addition, adequate analgesia and appropriate anesthesia should used, and some inappropriate drugs should be avoided. Multidisciplinary cooperation mode, including doctors from orthopedics, anesthesiology, and geriatric department should be conducted to reduce the incidence of delirium as far as possible. Once diagnosed, some measures should be applied, such as maintaining of airway patency, adequate nutritional support, correction of water and electrolyte disorders, anemia and low serum albumin, to ensure adequate physical and mental support, and to create a good environment for the ward, as well as to remove the possible etiological factors, such as anemia, low protein acidosis and electrolyte disturbance.