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Chapter 36 - Management of the surgical patient with dementia

from Section 11 - Neurology

Published online by Cambridge University Press:  05 September 2013

By
Monica W. Parker ,
James J. Lah  and
Allan I. Levey
Edited by
Michael F. Lubin ,
Thomas F. Dodson  and
Neil H. Winawer
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
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Summary

Improvement in medical care and lifestyle practice has resulted in greater life expectancy for American adults. In 2008, 39 million people aged 65 and over lived in the USA, accounting for 13% of the total population. This older population grew from 3 million in 1900 to 39 million in 2008. The “oldest-old” population grew from just over 100,000 in 1900 to 5.7 million in 2008 [1].

Older adults frequently have multiple medical problems that can result in an increased need for hospitalization and utilization of healthcare expenditures. Older age, cognitive impairment, polypharmacy, and functional and sensory impairment are risk factors most likely to result in postoperative delirium [2]. Geriatric patients with dementia are at higher risk for the development of delirium. Delirium costs are $38–$152 billion dollars per year [3]. Management of the surgical dementia patient is geared toward prevention of delirium. Delirium is prevented through the identification of dementia and preoperative management of risk factors. This will improve surgical outcomes, decrease length of hospitalization, and reduce healthcare costs.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 396 - 403
Publisher: Cambridge University Press
Print publication year: 2013

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References

AgingStats.gov – Federal Interagency Forum on Aging-Related Statistics. Older Americans 2010: Key Indicators of Well-Being.
Dasgupta, D, Hillier, LM.Factors associated with prolonged delirium: a systematic review. Int Psychogeriatr 2010; 22: 373–94.CrossRefGoogle ScholarPubMed
Leslie, DL, Marcantonio, ER, Zhang, Y et al. One-year health care costs associated with delirium in the elderly population. Arch Intern Med 2008; 168: 27–32.CrossRefGoogle ScholarPubMed
Alzheimer’s Association. 2010 Alzheimer’s Disease Facts and Figures..
Robinson, TN, Raeburn, CD, Tran, AZ et al. Postoperative delirium in the elderly: risk factors and outcomes. Ann Surg 2009; 249: 173–8.CrossRefGoogle ScholarPubMed
Reisberg, B, Ferris, SH, Kluger, A et al. Mild cognitive impairment (MCI): a historical perspective. Int Psychogeriatr 2008; 20: 18–31.CrossRefGoogle ScholarPubMed
Bekker, A, Lee, C, de Santi, S et al. Does mild cognitive impairment increase the risk of developing postoperative cognitive dysfunction?Am J Surg 2010; 199: 782–8.CrossRefGoogle ScholarPubMed
Bellelli, G, Frisoni, GB, Turco, R, Trabucchi, M.Depressive symptoms combined with dementia affect 12-months survival in elderly patients after rehabilitation post-hip fracture surgery. Int J Geriatr Psychiatry 2008; 23: 1073–7.CrossRefGoogle ScholarPubMed
Mayeux, R, Foster, NL, Rossor, M et al. The clinical evaluation of patients with dementia. In Whitehouse, PJ, ed. Dementia, Vol. 40. Philadelphia, PA: Davis; 1993, pp. 92–129.Google Scholar
Milne, AJ, Culverwell, A, Guss, R et al. Screening for dementia in primary care: a review of the use, efficacy and quality of measures. Int Psychogeriatr 2008; 20: 911–26.CrossRefGoogle ScholarPubMed
Steenland, NK, Auman, CM, Patel, PM et al. Development of a rapid screening instrument for mild cognitive impairment and undiagnosed dementia. J Alzheimer’s Dis 2008; 15: 419–27.CrossRefGoogle ScholarPubMed
Evans, C.Malnutrition in the elderly: a multifactorial failure to thrive. Permanente J 2005; 9: 38–41.CrossRefGoogle ScholarPubMed
Beers, MH, Porter, RH, Jones, TV et al., eds. The Merck Manual of Diagnosis and Therapy. 18th edn. Whitehouse Station, NJ: Merck Research Laboratories; Hoboken, NJL John Wiley and Sons; 2006.Google Scholar
Rudolph, JL, Jones, RN, Levkoff, SE et al. Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery. Circulation 2009; 119: 229–36.CrossRefGoogle ScholarPubMed
Mafrica, F, Fodale, V.Thyroid function, Alzheimer's disease and postoperative cognitive dysfunction: a tale of dangerous liaisons?J Alzheimers Dis 2008; 14: 95–105.CrossRefGoogle ScholarPubMed
Papageorgiou, SG, Christou, Y, Kontaxis, T et al. Dementia as presenting symptom of primary hyperparathyroidism: favourable outcome after surgery. Clin Neurol Neurosurg 2008; 110: 1038–40.CrossRefGoogle ScholarPubMed
Deiner, S, Silverstein, JH.Postoperative delirium and cognitive dysfunction. Br J Anaesth 2009; 103 (Suppl 1): i41–6.CrossRefGoogle ScholarPubMed
Xie, Z, Tanzi, RE.Alzheimer’s disease and post-operative cognitive dysfunction. Exp Gerontol 2006; 41: 346–59.CrossRefGoogle ScholarPubMed
Hayes, BD, Klein-Schwartz, W, Barrueto, F. Polypharmacy and the geriatric patient. Clin Geriatr Med 2007; 23: 371–90.CrossRefGoogle ScholarPubMed
Lin, R, Heacock, LC, Fogel, JF.Drug-induced, dementia-associated and non-dementia, non-drug delirium hospitalizations in the United States, 1998–2005: an analysis of the National Inpatient Sample. Drugs Aging 2010; 27: 51–61.CrossRefGoogle ScholarPubMed
Fick, DM, Cooper, JW, Wade, WE et al. Updating the Beers criteria for potentially inappropriate medication use in older adults. Arch Intern Med 2003; 163: 2716–24.CrossRefGoogle ScholarPubMed
Levy, HB, Marcus, EL, Christen, C.Beyond the Beers criteria: a comparative overview of explicit criteria. Ann Pharmacother 2010; 44: 1968–75.CrossRefGoogle ScholarPubMed
Winkel, TA, Schouten, O, Hoeks, SE et al. Prognosis of transient new-onset atrial fibrillation during vascular surgery. Eur J Vasc Endovasc Surg 2009; 386: 683–8.CrossRefGoogle Scholar
Banach, M, Kazmierski, J, Kowman, M et al. Atrial fibrillation as a nonpsychiatric predictor of delirium after cardiac surgery: a pilot study. Med Sci Monit 2008; 14: CR286–291.Google ScholarPubMed
Appelbaum, PS.Assessment of patient’s competence to consent to treatment. N Engl J Med 2007; 357: 1834–40.CrossRefGoogle Scholar
Curtis, JR, Vincent, JL.Ethics and end-of-life care for adults in the intensive care unit. Lancet 2010; 376: 1347–53.CrossRefGoogle ScholarPubMed
Rodin, MB, Mohile, SG.Assessing decisional capacity in the elderly. Semin Oncol 2008; 35: 625–32.CrossRefGoogle ScholarPubMed
Marson, DC, Hawkins, L, McInturff, B, Harrell, LE.Cognitive models that predict physician judgments of capacity to consent in mild Alzheimer’s disease. J Am Geriatr Soc 1997; 45: 458–64.CrossRefGoogle ScholarPubMed
Supreme Court of the United States. Cruzan v. Director, Missouri Department of Health.
Hornbostel, R.Legal and financial decision making in dementia care. In Whitehouse, PJ, ed. Dementia, Vol. 40. Philadelphia, PA: Davis; 1993, pp. 417–32.Google Scholar
Iserson, KV.Nonstandard advance directives: a pseudoethical dilemma. J Trauma-Injury Infect Crit Care 1998; 44(1): 139–42.CrossRefGoogle ScholarPubMed
Williams, AS.Perianesthesia care of the Alzheimer’s patient. J Perianesth Nurs 2009; 24: 343–7.CrossRefGoogle ScholarPubMed
Sieber, FE, Zakriya, KJ, Gottschalk, A et al. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clinic Proceedings 2010; 85: 18–26.CrossRefGoogle ScholarPubMed
Shetty, VD, Vowler, SL, Villar, RN.The role of anaesthesia and the anaesthetist in reducing the length of stay after primary total hip replacement. J Bone Joint Surg – Br Vol 2009; 91B (Suppl 1): 19.Google Scholar
DiNino, G, Adversi, M, Dekel, BG et al. Peri-operative risk management in patients with Alzheimer’s disease. J Alzheimer’s Dis 2010; 22 (Suppl 3): 121–7.CrossRefGoogle Scholar
Radtke, FM, Franck, M, MacGuill, M et al. Duration of fluid fasting and choice of analgesic are modifiable factors for early postoperative delirium. Eur J Anaesthesiol 2010; 27: 411–16.CrossRefGoogle ScholarPubMed
Halaszyni, TM.Pain management in the elderly and cognitively impaired patient: the role of regional anesthesia and analgesia. Curr Opin Anaesthesiol 2009; 22: 594–9.CrossRefGoogle Scholar
Fayers, PM, Hjermstad, MJ, Ranhoff, AH et al. Which Mini-Mental State Exam items can be used to screen for delirium and cognitive impairment?J Pain Symptom Manage 2005; 30: 41–50.CrossRefGoogle ScholarPubMed
Leung, JM, Sands, LP, Paul, S et al. Does postoperative delirium limit the use of patient-controlled analgesia in older surgical patients?Anesthesiology 2009; 111: 625–31.CrossRefGoogle ScholarPubMed
Inouye, SK, Vandyck, CH, Alessi, CA et al. Clarifying confusion: The Confusion Assessment Method – a new method for detection of delirium. Ann Intern Med 1990; 113: 941–8.CrossRefGoogle Scholar
Sieber, FE.Postoperative delirium in the elderly surgical patient. Anesthesiol Clin 2009; 27: 451–64.CrossRefGoogle ScholarPubMed
Lonergan, E, Britton, AM, Luxenberg, J, Wyller, T.Antipsychotics for delirium. Cochrane Database Syst Rev 2007; 2: CD005594.Google Scholar
Gleason, OC.Delirium. Am Fam Physician 2003; 67: 1027–34.Google ScholarPubMed
Derry, C, Derry, S, Moore, RA, McQuay, HJ.Single dose oral naproxen and naproxen sodium for acute postoperative pain in adults. Cochrane Database Syst Rev 2009; 1: CD004234.Google Scholar
Post, ZD, Restrepo, C, Kahl, LK et al. A prospective evaluation of 2 different pain management protocols for total hip arthroplasty. J Arthroplasty 2010; 25: 410–15.CrossRefGoogle ScholarPubMed

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