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Should This Patient Receive Prophylactic Medication to Prevent Delirium?: Grand Rounds Discussion From Beth Israel
Anjala V Tess1, Melissa L P Mattison2, Joshua R Leo1
1Beth Israel Deaconess Medical Center, Boston, Massachusetts (A.V.T., J.R.L., E.E.R.).
Annals of Internal Medicine
|April 4, 2018
Summary
The American Geriatrics Society recommends nonpharmacologic strategies for preventing and managing postoperative delirium. Antipsychotics are not recommended for prevention but may be considered for short-term agitation management when other methods fail.
Area of Science:
- Geriatrics
- Pharmacology
- Patient Safety
Background:
- Postoperative delirium (POD) is a common complication in older adults.
- The American Geriatrics Society (AGS) published guidelines in 2015 for POD prevention and management.
- Guidelines emphasize nonpharmacologic interventions and judicious pharmacologic approaches.
Observation:
- AGS guidelines prioritize nonpharmacologic measures like reorientation, early mobility, and nutrition.
- Pain management should optimize nonopioid medications, avoiding benzodiazepines except for withdrawal.
- Evidence for prophylactic antipsychotics in POD prevention is insufficient.
Findings:
- Antipsychotics may be considered for short-term treatment of agitation in POD when nonpharmacologic methods fail.
- Lowest effective dose for the shortest duration is recommended for antipsychotic use.
- A case discussion explores prophylactic antipsychotic use in a high-risk patient.
Implications:
- Optimizing nonpharmacologic strategies is key for POD prevention and management.
- Careful consideration of pharmacologic options, including risks and benefits, is crucial.
- Further research may clarify the role of specific medications in POD management.
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