This document discusses postoperative delirium, which is more common in elderly patients. Risk factors include advanced age, comorbidities, cognitive impairment, reduced functional status, and malnutrition. Incidence rates of postoperative delirium range from 3.6% to 53.3%. Preventative measures include fast-track surgery, avoiding unnecessary premedication, adequate pain management, and prompt diagnosis and treatment if delirium occurs.

1. POSTOPERATIVE DELIRIUM
FOCUS ON ELDERLY PATIENTS
Ade Wijaya, MD – November 2018

2. INTRODUCTION
 More common in elderly
 Need to be prevented or treated immediately
 POD is associated with deteriorating cognition in
both the short term (months) and long term (1 year)
after its occurrence
 Incidence: 3.6 % - 53.3 %
Aldecoa, C., Bettelli, G., Bilotta, F., Sanders, R. D., Audisio, R., Borozdina, A., ... & Radtke, F. (2017). European Society of Anaesthesiology evidence-based and consensus-
based guideline on postoperative delirium. European Journal of Anaesthesiology (EJA), 34(4), 192-214.

4. RISK FACTORS
 Advanced age
 Comorbidities
 ASA / CCI / CIAS
 Hydration status
 Hypo- or hypernatremia
 Anticolinergic drugs
 Alcohol
 Site of surgery and intraoperative bleeding
 Duration of surgery
 Post operative pain
Aldecoa, C., Bettelli, G., Bilotta, F., Sanders, R. D., Audisio, R., Borozdina, A., ... & Radtke, F. (2017). European Society of Anaesthesiology evidence-based and consensus-
based guideline on postoperative delirium. European Journal of Anaesthesiology (EJA), 34(4), 192-214.

5. Witlox J, Kalisvaart KJ, de Jonghe JFM, et al. Cerebrospinal fluid ß-amyloid and tau are not associated with risk of delirium: a prospective cohort study in older adults with hip
fracture. J Am Geriatr Soc 2011; 59 :1260 – 1267

6. Aldecoa, C., Bettelli, G., Bilotta, F., Sanders, R. D., Audisio, R., Borozdina, A., ... & Radtke, F. (2017). European Society of Anaesthesiology evidence-based and consensus-
based guideline on postoperative delirium. European Journal of Anaesthesiology (EJA), 34(4), 192-214.

7. RISK FACTORS IN ELDERLY
 Cognitive impairment
 Reduced functional status and/or frailty
 Malnutrition (low serum albumin)
 Sensory impairment
Aldecoa, C., Bettelli, G., Bilotta, F., Sanders, R. D., Audisio, R., Borozdina, A., ... & Radtke, F. (2017). European Society of Anaesthesiology evidence-based and consensus-
based guideline on postoperative delirium. European Journal of Anaesthesiology (EJA), 34(4), 192-214.

8. MANAGEMENT
 Fast-track surgery
 Avoiding routine premedication with
benzodiazepines except for patients with severe
anxiety
 Monitoring depth of anaesthesia
 Adequate pain assessment and treatment
 Continuous intraoperative analgesia regimen
 Promptly diagnosing POD, establishing a
differential diagnosis, and instituting treatment
 Low dose haloperidol or atypical neuroleptics
Aldecoa, C., Bettelli, G., Bilotta, F., Sanders, R. D., Audisio, R., Borozdina, A., ... & Radtke, F. (2017). European Society of Anaesthesiology evidence-based and consensus-
based guideline on postoperative delirium. European Journal of Anaesthesiology (EJA), 34(4), 192-214.

9. SUMMARY
 More common in elderly
 Needed to be prevented or treated early
 Pharmacological: low dose haloperidol or atypical
neuroleptics

10. THANK YOU