Pain and cognitive dysfunction are the risk factors of delirium in elderly hip fracture Chinese patients

Abstract

Aims: To observe the incidence of delirium in elderly hip fracture patients and search for the potential risk factors. Methods: Patients over 60 years were included in this study. Gender, age, education level, fracture type, organic dysfunction, cognitive dysfunction, comorbidity, medication, time from admission to surgery, and pain intensity were collected and analyzed, together with laboratory assessments and surgery including surgery type, time in surgery and blood loss in surgery. Results: 16 in 123 patients developed delirium. The incidence rate of delirium was 13% in the period of 6 days after surgery. Pain intensity and cognitive dysfunction were the risk factors. Conclusion: Pain intensity and cognitive impairment after hip fracture were found as the risk factors for development of delirium in elder Chinese patients. Prevention and management of delirium needs pain management pre- and post-operatively.

Introduction

Delirium is an acute confusion state characterized by disturbance of consciousness, reduced ability to maintain and shift attention, and memory impairment. Delirium usually occurs in the 2–5 days post operation in hip fracture patients. The fluctuation of symptoms makes it easy for it to be neglected. The reporting incidence rates vary from 4% to 54.3% (Juliebo et al., 2009). Delirium is related to morbidity, mortality and hospital stay (Robertson and Robertson, 2006). The patients who had delirium have a higher rate of death and poorer function recovery during the months following discharge (Edlund et al., 1999). The cause of delirium in hip fracture patients is not always clear. Several factors, such as cognitive dysfunction, age, gender and comorbidity, are suggested to contribute to the development of delirium (Bruce et al., 2007). For the hip fracture patients, the potential disposing factors include mobility before injury, dependency of living, and mental disorder (Furlaneto and Garcez-Leme, 2006). Other than predisposing factors, facilitating factors, such as urinary tract infections and waiting time to surgery were also suggested to be the risk factors (Juliebo et al., 2009). In the present study, we evaluated elder Chinese patients with hip fracture during six days after surgery to investigate the incidence rate of delirium postoperatively and identify the possible risk factors.