Delirium and the older adult after surgery

Nurses are in an excellent position to positively impact the quality of care for this group of patients. By developing a knowledge base of risk factors with a special emphasis on modifiable risks factors, nurses become pivotal in the development of an client focused plan of care. The value of the plan of care is to target intervention protocols to ameliorate the effect of the hospital environment on the at-risk patient with the goal of decreasing the incidence of delirium. Careful screening and a systematic approach to assessment (using a validated assessment tool) can result in early detection and rapid intervention to treat the modifiable causative factors while continuing to provide supportive pharmacological and nonpharmacological care. A sample care path for hospitalized older patients at-risk for developing delirium is described in Figure 1. Delirium is a common occurrence in the older surgical patient and is a contributing cause of functional disability, morbidity, and mortality. Unfortunately, it remains underdiagnosed and undertreated. Nurses can improve patients' quality of care and outcomes by implementing interventions targeted at modifiable risk factors and early recognition of delirium. The care of older surgical patients requires a rigorous approach to prevention, detection and management. Close attention to ensure adequate oxygenation, perfusion, hydration, nutrition and stimulation is critical. Commitment to improve outcomes in a decidedly vulnerable patient population holds the potential to reduce morbidity and mortality as well as reducing costs and length of stay for the older surgical population who experience an episode of acute post-operative delirium.