Prevalence Of Delirium Research Articles

Prevalence of delirium and effect of seasonal variation in patients admitted to intensive care units of a tertiary care centre in north India

Introduction: Delirium is a quite common entity in critically ill patients and known to have several predisposing and precipitating factors

Delirium in stroke: systematic review and meta-analysis

Due to the complexity of the symptoms, delirium detection poses achallenge in stroke patients. Alarge body of literature has established that neurospecific challenges can have aconsiderable impact on diagnosis and are underrepresented in screening. An analysis of current scientific literature on delirium screening tests and their applicability in stroke patients, acknowledging neurospecific challenges and evaluating diagnostic test accuracy. Asystematic literature search was conducted in PubMed, CINAHL, and Cochrane Library databases. Studies published between 2018 and 2021 were evaluated and the study quality was assessed according to the Institute for Clinical Systems Improvement. Furthermore, the specificity and sensitivity of delirium screening tests were pooled RESULTS: The systematic literature review found atotal of 2636articles, following areview of the inclusion and exclusion criteria. Thus, 18moderate-quality studies with atotal of 3320patients and 9distinct delirium screenings were identified. Within those 18studies, the prevalence of delirium was 34.2%. However, the delirium prevalence was significantly lower in 6studies that included patients with neurologic impairments (26.5 vs. 32.1%, p = 0.0004). Pooled sensitivity and specificity for the 4AT (Rapid assessment test for delirium ) were 82 and 77%, while these values were 72 and 93% for the CAM-ICU (Confusion Assessment Method for Intensive Care Units) and 79 and 72% for the ICDSC (Intensive Care Delirium Screening Checklist). Neurological impairments may influence the test quality of delirium screening in stroke patients. The CAM-ICU can be recommended for nonaphasic patients. The ICDSC can be used in all stroke patients on stoke units with an adjusted cut-off value of > 5points.

Prospective validation of Sophia observation withdrawal symptoms: A paediatric delirium scale in critically ill children in Denmark

BackgroundPaediatric delirium (PD) is increasingly recognised as a common disorder in critically ill children with a reported prevalence ranging from 9% to 66%. We validated the PD component of the Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) scale in a Danish setting to provide increased awareness and reliable identification of this critical condition, thereby paving the way for improved pathways to targeted delirium care. ObjectiveThe objectives of this study were to criterion validate the PD component of the SOS-PD screening tool by comparing blinded psychiatric and nurse assessments and to estimate the prevalence of delirium in critically ill children in a Danish context. MethodsA prospective observational study was performed on critically ill children aged between 3 m and 18 y, admitted to an intensive care unit, with a hospital stay of 48 h or more. Assessments took place on a fixed weekday over an 18-month period. To test accuracy and criterion validity, bedside nurses’ SOS-PD assessments were compared to the reference standard, a diagnostic assessment performed by a child psychiatrist according to the Diagnostic and Statistical Manual-V criteria by use of the Vanderbilt Assessment of Delirium in Infants and Children. ResultsWe included 141 children in the study, 30 (21%) of whom were diagnosed with delirium by the child psychiatrist. The accuracy of the delirium diagnosis was 93.6% (95% confidence interval [CI]: 88.3–97.1) among the nurses’ SOS-PD assessments compared to the reference standard. The SOS-PD demonstrated a high sensitivity of 83.3% (95% CI: 65.3–94.4) and a high specificity of 96.4% (95% CI: 91.0–99.0) with five false-negative and four false-positive cases. ConclusionThe PD component of the SOS-PD tool has good accuracy and validity for assessments performed by nurses compared to a child psychiatrist's diagnosis in critically ill children in a Danish setting. We recommend the use of the SOS-PD instrument in clinical practice.

Delirium: The Next Vital Sign in the PICU?*

Delirium: The Next Vital Sign in the PICU?*

Diagnostic accuracy of the 3-minute diagnostic interview for confusion assessment method-defined delirium in delirium detection: a systematic review and meta-analysis.

Delirium is a common complication clinically and is associated with the poor outcomes, yet it is frequently unrecognised and readily disregarded. Although the 3-minute diagnostic interview for confusion assessment method-defined delirium (3D-CAM) has been used in a variety of care settings, a comprehensive evaluation of its accuracy in all available care settings has not been performed. This study aimed to evaluate the diagnostic test accuracy of the 3D-CAM in delirium detection through a systematic review and meta-analysis. We systematically searched PubMed, EMBASE, the Cochrane Library, Web of Science, CINAHL (EBSCO) and ClinicalTrials.gov published from inception to 10 July 2022. The quality assessment of the diagnostic accuracy studies-2 tool was applied to evaluate methodological quality. A bivariate random effects model was used to pool sensitivity and specificity. Seven studies with 1,350 participants and 2,499 assessments were included, which were carried out in general medical wards, intensive care units, internal medical wards, surgical wards, recovery rooms and post-anaesthesia care units. The prevalence of delirium ranged from 9.1% to 25%. The pooled sensitivity and specificity were 0.92 (95% confidence interval [CI] 0.87-0.95) and 0.95 (95% CI 0.92-0.97), respectively. The pooled positive likelihood ratio was 18.6 (95% CI 12.2-28.2), the negative likelihood ratio was 0.09 (95% CI 0.06-0.14) and the diagnostic odds ratio was 211 (95% CI 128-349). Moreover, the area under the curve was 0.97 (95% CI 0.95-0.98). The 3D-CAM has good diagnostic accuracy for delirium detection in different care settings. Further analyses illustrated that it had comparable diagnostic accuracy in older adults and patients with dementia or known baseline cognitive impairment. In conclusion, the 3D-CAM is recommended for clinical delirium detection.

Delirium, polypharmacy and adverse outcomes: findings from a hospital in Kerala, India

Introduction Delirium is an acute disorder of attention and awareness, a medical emergency associated with increased morbidity and mortality. Delirium remains under-recognised, and few studies are from India. Methods This study aimed to estimate the prevalence of delirium and its risk factors among hospitalised older patients admitted to medical and surgical wards in a teaching hospital in Central South India. We performed a retrospective cross-sectional study on 100 older patients admitted to medical and surgical wards in April-October, 2020. Patient data were obtained from a record review, extracting information on comorbidities, medications, and terms indicating delirium. Results Delirium was present in 39% of the study population and was significantly associated with older age (88%), abnormal electrolytes (59%), and polypharmacy (87%). Delirium was also significantly associated with mortality (28%) and prolonged hospital stay. (36%) Discussion The prevalence of delirium is high among older hospitalised patients and is significantly related to adverse hospital outcomes. The findings of this study could trigger changes in hospital policies in screening for delirium in older persons for its prompt recognition and prevention of adverse health outcomes.

Dysphagia in older patients admitted to a rehabilitation setting after an acute hospitalization: the role of delirium.

Dysphagia is a swallowing disorder that affects 8% of the world population. However, data are lacking on its prevalence in a heterogeneous group of older patients. The aim of this study is to evaluate the prevalence of dysphagia at admission and at discharge, and its related factors, in particular delirium, in older patients admitted to a rehabilitation setting. Retrospective cohort study of patients 65years and older admitted to a rehabilitation ward after an acute hospitalization. The presence of dysphagia at admission was screened with the 3OZ Test and confirmed by a speech-therapist. The association between clinical factors and dysphagia was investigated with a multivariate logistic regression analysis. We included 1040 patients, (65% females, mean age 81.9 ± 7.2years). The prevalence of dysphagia at admission was 14.8% and 12.8% at discharge, while the prevalence of delirium among patients with dysphagia was of 31.2% vs 6.4% among patients without dysphagia. The severity of dysphagia was moderate. In the multivariate logistic regression, delirium was associated with dysphagia at admission (OR 2.06; Confidence Interval, CI 1.08-3.23) along with a pre-hospital impairment in the Instrumental-Activities-of-Daily-Living (OR-1.26; CI - 1.1; - 1.10), a change in Barthel Index from pre-hospital to hospital admission (OR-1.02; CI - 1.01 to 1.04), comorbidity (OR 1.12; CI 0.94;1.29) and the number of antibiotics (OR-1.63; CI - 1.01;2.62). Delirium was the main factor associated with dysphagia at rehabilitation admission. The study underlines the importance of screening dysphagia in delirious patients and warrants future studies to determine the changes in dysphagia prevalence according to delirium resolution.

Evaluating the performance of machine learning methods for risk estimation of delirium in patients hospitalized from the emergency department.

Delirium is a cerebral dysfunction seen commonly in the acute care setting. It is associated with increased mortality and morbidity and is frequently missed in the emergency department (ED) and inpatient care by clinical gestalt alone. Identifying those at risk of delirium may help prioritize screening and interventions in the hospital setting. Our objective was to leverage electronic health records to identify a clinically valuable risk estimation model for prevalent delirium in patients being transferred from the ED to inpatient units. This was a retrospective cohort study to develop and validate a risk model to detect delirium using patient data available from prior visits and ED encounter. Electronic health records were extracted for patients hospitalized from the ED between January 1, 2014, and December 31, 2020. Eligible patients were aged 65 or older, admitted to an inpatient unit from the emergency department, and had at least one DOSS assessment or CAM-ICU recorded within 72 h of hospitalization. Six machine learning models were developed to estimate the risk of delirium using clinical variables including demographic features, physiological measurements, medications administered, lab results, and diagnoses. A total of 28,531 patients met the inclusion criteria with 8057 (28.4%) having a positive delirium screening within the outcome observation period. Machine learning models were compared using the area under the receiver operating curve (AUC). The gradient boosted machine achieved the best performance with an AUC of 0.839 (95% CI, 0.837-0.841). At a 90% sensitivity threshold, this model achieved a specificity of 53.5% (95% CI 53.0%-54.0%) a positive predictive value of 43.5% (95% CI 43.2%-43.9%), and a negative predictive value of 93.1% (95% CI 93.1%-93.2%). A random forest model and L1-penalized logistic regression also demonstrated notable performance with AUCs of 0.837 (95% CI, 0.835-0.838) and 0.831 (95% CI, 0.830-0.833) respectively. This study demonstrated the use of machine learning algorithms to identify a combination of variables that enables an estimation of risk of positive delirium screens early in hospitalization to develop prevention or management protocols.

Prevalence and risk factors of delirium in older patients admitted to a tertiary care centre in South India: A prospective, observational study.

Prevalence and risk factors of delirium in older patients admitted to a tertiary care centre in South India: A prospective, observational study.

Effect of Repeated Intranasal Administration of Different Doses of Insulin on Postoperative Delirium, Serum τ and Aβ Protein in Elderly Patients Undergoing Radical Esophageal Cancer Surgery.

Postoperative delirium is common after general anesthesia in older patients. However, there are currently no effective preventive measures. This study investigated the effect of repeated intranasal administration of different insulin doses before surgery on postoperative delirium in older patients with esophageal cancer, and the possible mechanism for its efficacy. In this randomized, placebo-controlled, double-blind, parallel-group study, 90 older patients were randomly assigned to either a Control (normal saline), Insulin 1 (20 U/0.5 mL intranasal insulin), or Insulin 2 (30 U/0.75 mL intranasal insulin) group. Delirium was assessed on postoperative days 1 (T2), 2 (T3), and 3 (T4) using the Confusion Assessment Method for the Intensive Care Unit. Serum τ and Aβ protein levels were measured at T0 (before insulin/saline administration), T1 (end of surgery), T2, T3 and T4. The Insulin 2 group had a significantly lower prevalence of delirium compared to the Control and Insulin 1 groups three days after surgery. Compared to baseline, τ and Aβ protein levels increased significantly at T1-T4. Compared to the Control group, the Insulin 1 and 2 groups had significantly lower τ and Aβ protein levels at T1-T4, and the Insulin 2 group had significantly lower levels than the Insulin 1 group at T1-T2. The administration of 30 U of intranasal insulin twice daily, from 2 days preoperatively until 10 minutes preanesthesia on the day of surgery, can significantly reduce postoperative delirium in older patients undergoing radical esophagectomy. It can also decrease postoperative τ and Aβ protein expression without causing hypoglycemia. This study was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn, with the unique identifier: ChiCTR2100054245; December 11, 2021).

Pharmacologic Interventions to Prevent Delirium in Trauma Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

We searched Medical Literature Analysis and Retrieval System Online, Embase, and Cochrane Registry of Clinical Trials from database inception until June 7, 2022. We included randomized controlled trials comparing pharmacologic interventions in critically ill trauma patients. Two reviewers independently screened studies for eligibility, extracted data, and assessed risk of bias. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for network analysis were followed. Random-effects models were fit using a Bayesian approach to network meta-analysis. Between-group comparisons were estimated using hazard ratios (HRs) for dichotomous outcomes and mean differences for continuous outcomes, each with 95% credible intervals. Treatment rankings were estimated for each outcome in the form of surface under the cumulative ranking curve values. A total 3,541 citations were screened; six randomized clinical trials (n = 382 patients) were included. Compared with combined propofol-dexmedetomidine, there may be no difference in delirium prevalence with dexmedetomidine (HR 1.44, 95% CI 0.39-6.94), propofol (HR 2.38, 95% CI 0.68-11.36), nor haloperidol (HR 3.38, 95% CI 0.65-21.79); compared with dexmedetomidine alone, there may be no effect with propofol (HR 1.66, 95% CI 0.79-3.69) nor haloperidol (HR 2.30, 95% CI 0.88-6.61). The results of this network meta-analysis suggest that there is no difference found between pharmacologic interventions on delirium occurrence, length of ICU stay, length of hospital stay, or mortality, in trauma ICU patients.

Anti-inflammatory medication use associated with reduced delirium risk and all-cause mortality: A retrospective cohort study

ObjectiveTo investigate the relationship between history of anti-inflammatory medication use and delirium risk, as well as long-term mortality. MethodsIn this retrospective cohort study, subjects recruited between January 2016 and March 2020 were analyzed. Information about anti-inflammatory medication use history including aspirin, NSAIDs, glucosamine, and other anti-inflammatory drugs, was collected. Logistic regression analysis investigated the relationship between anti-inflammatory medications and delirium. Log-rank analysis and cox proportional hazards model investigated the relationship between anti-inflammatory medications and one-year mortality. ResultsThe data from 1274 subjects were analyzed. The prevalence of delirium was significantly lower in subjects with NSAIDs usage (23.0%) than in those without NSAIDs usage (35.0%) (p < 0.001). Logistic regression analysis controlling for age, sex, dementia status, and hospitalization department showed that the risk of delirium tended to be reduced by a history of NSAIDs use (OR, 0.76 [95% CI, 0.55 to 1.03]). The one-year mortality in the subjects with NSAIDs (survival rate, 0.879 [95% CI, 0.845 to 0.906]) was significantly lower than in the subjects without NSAIDs (survival rate, 0.776 [95% CI, 0.746 to 0.803]) (p < 0.001). A history of NSAIDs use associated with the decreased risk of one-year mortality even after adjustment for age, sex, Charlson Comorbidity Index, delirium status, and hospitalization department (HR, 0.70 [95% CI, 0.51 to 0.96]). ConclusionThis study suggested that NSAIDs usage was associated with decreased delirium prevalence and lower one-year mortality. The potential benefit of NSAIDs on delirium risk and mortality were shown.

Relationship between angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prescribing and delirium in the ICU-A secondary analysis.

Studies suggest Angiotensin-Converting Enzyme inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) may slow the decline of memory function in individuals with mild to moderate Alzheimer's disease by regulating migroglial activation and oxidative stress within the brain's reticular activating system. Therefore, we evaluated the relationship between delirium prevalence and being prescribed ACEI and ARB in participants admitted to the intensive care units (ICU). A secondary analysis of data from two parallel pragmatic randomized controlled trials was performed. ACEI and ARB exposure was defined as being prescribed an ACEI or an ARB within six months prior to the ICU admission. The primary endpoint was the first positive delirium assessment based on Confusion Assessment Method for the ICU (CAM-ICU) for up to thirty days. A total of 4791 patients admitted to the medical, surgical, and progressive ICU and screened for eligibility for the parent studies between February 2009 and January 2015 from two level 1 trauma and one safety net hospital in a large urban academic health system were included. Delirium rates in the ICU were not significantly different among participants with no exposure to ACEI/ARB (12.6%), or exposure to ACEI (14.4%), ARB (11.8%), or ACEI and ARB in combination (15.4%) in six months prior to the ICU admission. Exposure to ACEI (OR=0.97[0.77, 1.22]), ARB (OR=0.70 [0.47, 1.05]), or both (OR=0.97 [0.33, 2.89]) in six months prior to ICU admission was not significantly associated with odds of delirium during the ICU admission after adjusting for age, gender, race, co-morbidities, and insurance status. While the impact of ACEI and ARB exposure prior to the ICU admission was not associated with the prevalence of delirium in this study, further research is needed to fully understand the impact of antihypertensive medications on delirium.

INTENSIVE CARE UNIT PATIENTS’ MORTALITY INDICATORS AND ASSOCIATED PARAMETERS

Background: Several risk factors have been associated with the intensive care unit (ICU) mortality. Identifying these factors can help predict and reduce ICU mortality rates. Objective: To determine the mortality rate, identify contributing factors, and conduct a survival analysis in ICU patients. Study Design: A retrospective cohort study. Setting: Bahria International Hospital Lahore, &amp; Services Institute of Medical Sciences, Lahore. Duration of Study: January 1, 2021, to December 5, 2022. Methods: A retrospective study was conducted in the medical &amp; surgical ICUs. Data on delirium prevalence, socioeconomic status, and clinical conditions were collected retrospectively. The information included patient admission details, ICU diagnoses, hospital stays, presence of pressure ulcers, signs of dehydration, fluid balance, urine output, skin conditions, diabetes status, temperature, oro-gastric feeding, and ventilatory support. Patients were divided into two groups based on their hospitalisation outcomes: Group A for patients who died and Group B for those who were discharged/shifted from the ICU. Results: A total of 185 patients met the inclusion criteria. The study found that 18.9% of hospitalisations resulted in death. Patients in the death group were older (54 ± 16 years vs. 46 ± 19 years, p = 0.02) and were more likely to be transferred from hospital units after a sepsis diagnosis (57.1% vs. 20.1%, p = 0.01). Delirium was observed in 54.2% of individuals in the death group compared to 47.3% in the discharge group (p = 0.14). The Charlson score was higher in the death group (2.4 ± 2.78 vs. 1.71 ± 2.41, p = 0.04). Multifactorial analysis using the Cox regression model revealed that patients admitted via the emergency room (HR 0.39, p = 0.007) and those with an abnormal glycemic index (HR 1.71, p = 0.041) had higher odds of dying in the ICU. Conclusion: Older age, medical diagnosis of sepsis, and admission from other hospital units were associated with increased ICU mortality. Additionally, water and electrolyte imbalances, variations in glycemic index with tube feeding, mechanical ventilation, and higher Charlson scores were correlated with increased mortality.

Hyperactive delirium in the emergency department: the continued case of B.M.

The prevalence of delirium in emergency department (ED) ranges from 7 to 13%; however, delirium is often underdiagnosed in that setting. This report describes two different approaches to a hypothetical case report of an old man admitted to the ED after an injurious fall, and whose clinical conditions rapidly worsen due to hyperactive delirium.

Risk factors for delirium among patients with advanced cancer in palliative care: a multicenter, patient-based registry cohort in South Korea.

Previous studies have comprehensively investigated the prevalence and various potential risk factors for delirium among patients with advanced cancer admitted to the acute palliative care unit (APCU). Our objective was to evaluate the comprehensive association between delirium and various risk factors among patients with advanced cancer in an acute palliative care setting using a patient-based multicenter registry cohort. We performed a multicenter, patient-based registry cohort study collected in South Korea between January 1, 2019, and December 31, 2020. Delirium was identified using a medical record review based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. In total, 2,124 eligible patients with advanced cancer in the APCU met the inclusion criteria. There were 127 out of 2,124 patients (prevalence, 6.0%; 95% CI, 5.0 to 7.1) with delirium during admission. Delirium in patients with advanced cancer was associated with age >70 years (OR, 1.793; 95% CI, 1.246 to 2.581), male sex (OR, 1.675; 95% CI, 1.131 to 2.479), no chemotherapy during hospitalization (OR, 2.019; 95% CI, 1.236 to 3.298), hearing impairment (OR, 3.566; 95% CI, 1.176 to 10.810), underweight (OR, 1.826; 95% CI, 1.067 to 3.124), current use of opioid medication (OR, 1.942; 95% CI, 1.264 to 2.982), previous history of delirium (OR, 12.497; 95% CI, 6.920 to 22.568), and mental illness (OR, 2.333; 95% CI, 1.251 to 4.352). In a large-scale multicenter patient-based registry cohort, delirium was associated with old age, male sex, no chemotherapy during hospitalization, hearing impairment, underweight, current use of opioid medication, and a history of delirium and mental illness. Our findings suggest physicians should pay attention to delirium in patients with advanced cancer admitted to the APCU with the above risk factors.

Predictors and outcomes of delirium in the emergency department during the first wave of the COVID-19 pandemic in Milan

BackgroundRespiratory infections can be complicated by acute brain failure. We assessed delirium prevalence, predictors and outcomes in COVID-19 ED patients.MethodsThis was a retrospective observational study conducted at the San Raffaele...

Preclinical and translational models for delirium: Recommendations for future research from the NIDUS delirium network.

Delirium is a common, morbid, and costly syndrome that is closely linked to Alzheimer's disease (AD) and AD-related dementias (ADRD) as a risk factor and outcome. Human studies of delirium have advanced our knowledge of delirium incidence and prevalence, risk factors, biomarkers, outcomes, prevention, and management. However, understanding of delirium neurobiology remains limited. Preclinical and translational models for delirium, while challenging to develop, could advance our knowledge of delirium neurobiology and inform the development of new prevention and treatment approaches. We discuss the use of preclinical and translational animal models in delirium, focusing on (1) a review of current animal models, (2) challenges and strategies for replicating elements of human delirium in animals, and (3) the utility of biofluid, neurophysiology, and neuroimaging translational markers in animals. We conclude with recommendations for the development and validation of preclinical and translational models for delirium, with the goal of advancing awareness in this important field.

Efficacy of blonanserin transdermal patch on terminal delirium in patients with respiratory diseases

BackgroundDelirium is a common distressing symptom observed in patients with terminal respiratory diseases and is treated with antipsychotic medications such as haloperidol. Its management is difficult, especially in palliative home care, because its administration is limited to oral or injection methods. Recently, the blonanserin transdermal patch was developed as the first antipsychotic percutaneous agent. After it became available, we recognized its potential for the management of delirium and the alleviation of uncontrolled dyspnea in clinical practice. Thus, this study aimed to assess its efficacy in patients with terminal respiratory diseases. MethodsThis retrospective study included 113 patients with respiratory diseases who were cared for at home. The efficacy was evaluated through the prevalence of terminal delirium before and after its treatment initiation for uncontrolled dyspnea. ResultsBlonanserin transdermal patch treatment for uncontrolled dyspnea improved the prevalence and severity of terminal delirium (from 70.4% to 16.3%, p < 0.001) and reduced the number of doctors' visits to patients’ homes within a week before their death (from 4.0 to 3.0, p = 0.086). A sub-group analysis of 23 patients with interstitial pneumonia revealed that the treatment prevented dyspnea progression by inhibiting terminal delirium. ConclusionsBlonanserin transdermal patch performed similarly to haloperidol, as previously reported, for managing terminal delirium. Our study suggests that a blonanserin transdermal patch potentially prevents terminal delirium and alleviates uncontrolled dyspnea in patients with respiratory diseases. Our findings encourage clinical trials to evaluate the safety and efficacy of blonanserin transdermal patches for patients with terminal illnesses.

Intraoperative 5-HT3 receptor antagonists decrease the prevalence of postoperative delirium in older adults undergoing hip fracture surgery: a single-center retrospective study.

Postoperative delirium (POD) occurs commonly in older adults, resulting in unfavorable outcomes. Several recent clinical studies have suggested that 5-hydroxytryptamine 3 (5-HT3) receptor antagonists can treat and prevent POD. In this retrospective study, the association between 5-HT3 receptor antagonists and POD was investigated in older adults who underwent hip fracture surgery. The electronic medical records of older adults aged ≥ 65years who underwent hip fracture surgery between January 2011 and June 2018 were reviewed retrospectively. Multivariable logistic regression analysis was used to investigate the association between 5-HT3 receptor antagonists and the occurrence of POD. In addition to the incidence of POD, anesthesia-, surgery-, and patient-related factors related to POD were evaluated. Of the 1025 patients included, 813 (79.3%) were administered 5-HT3 receptor antagonists intraoperatively; 471 (45.9%) were administered ramosetron, and 342 (33.4%) were administered palonosetron. POD was identified in 242 patients (23.6%). Ramosetron and palonosetron reduced the POD incidence by 53% (odds ratio [OR] 0.47; 95% confidence interval [CI] 0.32‒0.71; P < 0.001) and 41% (OR 0.59; 95% CI 0.39‒0.89; P = 0.011), respectively. Additionally, age, American Society of Anesthesiologists physical status class 4, and male were confirmed as risk factors for POD. Intraoperative 5-HT3 receptor antagonists may be associated with a reduced risk of POD and can be considered one of the preventive strategies for POD in older adults undergoing hip fracture surgery.