Postoperative delirium: Addressing the rising scourge in healthcare

Abstract

The rising global life expectancy comes with challenges relating to the increasing elderly population, including delirium which those with background cognitive deficits are especially prone to. Advances in anaesthesia and surgery have contributed to a rapidly increasing number of surgeries in the elderly. Postoperative delirium with its worrisome prognosis is a common complication of surgery in the elderly; yet widely under-diagnosed, and under-treated. The use of validated tools to detect delirium, and preoperative cognitive impairment which is a core risk and prognostic factor is key to risk stratification, prevention and treatment. Management of postoperative delirium is anchored on prevention through optimization of modifiable risk factors, early detection using validated tools and care directed at reducing its severity and duration when it occurs. This is best achieved by individualized care through multi-component interventions involving the anaesthesiologist, surgeon, geriatrician, psychiatrist, physiotherapist, nursing services and the patient’s family. However, It is imperative to state that while the key principles of multi-component intervention apply broadly, the specific components of each regimen may vary widely. Despite existing international guidelines on the management of postoperative delirium, wide knowledge and practice gap is still prevalent.

Keywords

• Elderly; surgery; delirium; cognitive impairment; anaesthesia