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Reorganization of nursing and medical care to reduce the incidence of postoperative delirium and improve rehabilitation outcome in elderly patients treated for femoral neck fractures
Department of Rehabilitation, Piteå River Valley Hospital, Umeå University Hospital, Umeå, Sweden.
Department of Rehabilitation, Piteå River Valley Hospital, Umeå University Hospital, Umeå, Sweden.
Department of Rehabilitation, Piteå River Valley Hospital, Umeå University Hospital, Umeå, Sweden.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
1999 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 13, no 3, 193-200 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to evaluate the effectiveness of a nursing and medical intervention programme for the prevention and treatment of delirium in elderly patients treated for femoral neck fractures. Forty-nine patients consecutively admitted to an orthogeriatric rehabilitation unit in a county hospital in northern Sweden were compared with historical cohorts of corresponding patients in the same and other hospitals. There was a total reorganization of nursing and medical care of patients with femoral neck fractures. The intervention programme consisted of staff education, co-operation between orthopaedic surgeons and geriatricians, individual care and planning of rehabilitation, improved ward environment, active nutrition, improved continuity of care and prevention and treatment of complications associated with delirium. The main result of the study was that the incidence of delirium was significantly lower than in all previously published studies. The incidence of other postoperative complications was also lower, and a larger proportion of the patients regained independent walking ability and could return to their previous living conditions on discharge. It can be concluded that the intervention programme reduced the incidence and duration of delirium and improved functional outcome for elderly patients treated for femoral neck fractures.

Place, publisher, year, edition, pages
1999. Vol. 13, no 3, 193-200 p.
Keyword [en]
nursing intervention, delirium, rehabilitation, hip fracture
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:umu:diva-4294DOI: 10.1111/j.1471-6712.1999.tb00539.xPubMedID: 12033125OAI: oai:DiVA.org:umu-4294DiVA: diva2:143319
Available from: 2004-11-25 Created: 2004-11-25 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Delirium in old patients with femoral neck fracture: risk factors, outcome, prevention and treatment
Open this publication in new window or tab >>Delirium in old patients with femoral neck fracture: risk factors, outcome, prevention and treatment
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Delirium is probably the most common presenting symptom of disease in old age. Delirium, as defined in DSM-IV, is a neuropsychiatric syndrome characterized by disturbance in attention and consciousness, which develops over a short period of time and where the symptoms tend to fluctuate during the course of the day. The overall aim was to increase knowledge about the risk factors and outcome of delirium in old patients with femoral neck fracture and to develop and evaluate a multi-factorial intervention program for prevention and treatment of delirium in these patients.

In a prospective study of 101 consecutive patients with a femoral neck fracture, 29.7% were delirious before surgery and another 18.8% developed delirium postoperatively. Of those who were delirious preoperatively all but one remained delirious postoperatively. The majority of those delirious before surgery were demented, treated with drugs with anticholinergic properties (mainly neuroleptics), had had previous episodes of delirium and had fallen indoors. Patients who developed postoperative delirium had perioperative falls in blood pressure and seemed to have more postoperative complications, such as infections. Patients with preoperative delirium had a poorer walking ability on discharge compared to patients with postoperative delirium only.

In a five-year prospective follow up study 30 out of 78 (38.5%) non-demented patients with a femoral neck fracture developed dementia. Twenty out of 29 (69%) who were delirious postoperatively developed dementia compared to 10 out of 49 (20%) who were not delirious during hospitalization (p<0.001). Twenty-one (72.4%) of those with postoperative delirium died within 5 years compared to 17/49 (34.7%) of those who remained lucid postoperatively (p=0.001).

A non-randomized multi-factorial intervention study with the aim of preventing and treating delirium among patients with femoral neck fracture (n=49) showed that the incidence of delirium was significantly lower than reported in previously published studies. The incidence of other postoperative complications was also lower and a larger proportion of the patients regained independent walking ability and could return to their previous living conditions on discharge.

A similar multi-factorial intervention program evaluated as a randomized controlled trial including 199 femoral neck fracture patients showed that fewer intervention patients than controls suffered postoperative delirium (56/102, 55% vs. 73/97, 75%, p=0.003). For intervention patients the postoperative delirium was also of shorter duration (5.0±7.1 days vs. 10.2±13.3 days, p=0.009). Eighteen percent in the intervention ward and 52% of controls were delirious after the seventh postoperative day (p<0.001). Intervention patients suffered from significantly fewer in-hospital complications, such as decubital ulcers, urinary tract infections, nutritional complications, sleeping problems and falls, than controls. Total postoperative hospitalization was shorter in the intervention ward (28.0±17.9 days vs. 38.0±40.6 days, p=0.028).

In conclusion, pre- and postoperative delirium is common and seems to be associated with various risk factors, which require different strategies for prevention and treatment. Delirium is also associated with the development of dementia and a higher mortality rate. Multifactorial intervention programs can successfully be implemented and result in the reduction of delirium, fewer complications and shorter hospitalization.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2004. 77 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 909
Keyword
delirium, femoral neck fractures, dementia, risk factors, RCT, intervention, multifactorial, outcome, mortality
National Category
Geriatrics
Research subject
Geriatrics
Identifiers
urn:nbn:se:umu:diva-379 (URN)91-7305-704-5 (ISBN)
Public defence
2004-12-17, Aulan, Vårdvetarhuset, Umeå, 09:00
Opponent
Available from: 2004-11-25 Created: 2004-11-25 Last updated: 2014-02-20Bibliographically approved

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