Difficulties Diagnosing Delirium in Older Adults After Surgery

JAGS graphicJournal of the American Geriatrics Society Research Summary

Delirium is a medical term for “sudden confusion.” It is an abrupt, rapid change in mental function and can cause a wide variety of shifts in behavior ranging from aggression or agitation to feeling sleepy and inactive (or even a combination of several behaviors). When delirium occurs after an older person has had surgery, it’s called “post-operative delirium.”

Experts still don’t always agree on delirium symptoms or diagnoses, even when they are assessing the same symptoms in the same people. A team of researchers from the Netherlands designed a study to look at the accuracy of delirium diagnoses in older adults after surgeries. Their study was published in the Journal of the American Geriatrics Society.

In the study, researchers examined 167 older adults from one to three days after surgery. The researchers used a standard delirium rating scale and recorded the tests on video. Afterwards, the videos were shown to two independent delirium experts. If the experts didn’t agree on a diagnosis, the researchers asked a third expert to review the video. A third expert was called in for 21 percent of the evaluations.

According to the researchers, a relatively high number of people with delirium were not diagnosed with the condition by a physician or other healthcare practitioner in the time following their surgery. For example, the researchers found that clinical nurses recognized only 32 percent of the cases of delirium that were diagnosed by the experts reviewing the videotapes.

There is a considerable amount of disagreement among experts about what constitutes delirium among older adults after surgery. The researchers concluded that developing better, more objective screening tools may make it easier and more accurate for experts to diagnose delirium in the future. Understanding the condition—how to recognize and address it—is also an important first step for many older adults and caregivers. You can learn more about delirium at HealthinAging.org.

This summary is from “Recognition of Delirium in Postoperative Elderly Patients: A Multicenter Study.” It appears online ahead of print in the April 2017 issue of the Journal of the American Geriatrics Society. The study authors are Tianne Numan, MSc; Mark van den Boogaard, PhD; Adriaan M. Kamper, MD, PhD; Paul J.T. Rood, MSc; Linda M. Peelen, PhD; Arjen J.C. Slooter, MD, PhD.

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