American Geriatrics Society Releases Clinical Practice Guideline for Postoperative Delirium in Older Adults
Tuesday, November 18, 2014
EMBARGOED UNTIL NOVEMBER 18, 2014
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Kelly Mack for the American Geriatrics Society
New York, NY, November 18, 2014 — Today the American Geriatrics Society (AGS) released its new Clinical Practice Guideline for Postoperative Delirium in Older Adults for providing essential guidance to clinicians to prevent and treat postoperative delirium in older patients. Delirium, an episode of sudden confusion, is a serious medical condition that can occur following surgery and is associated with complications resulting in longer hospital stays, delayed rehabilitation, and other factors that can adversely affect an older person’s surgical recovery and longer-term mental and physical health.
“Delirium is among the most common post-operative complications for older adults undergoing surgery,” commented Andrew G. Lee, MD, chair of the AGS Section for Surgical and Related Medical Specialists. “It is upsetting for patients and families, and can be harmful if not recognized and treated. Studies have shown that delirium can be prevented in up to 40% of cases in some hospitalized older adult populations. We believe that surgical and related medical specialists, together with the multi-disciplinary members of their teams, can play an integral role in prevention.”
A panel of multi-specialty, multi-disciplinary experts developed the guideline, which was funded through a grant from the John A. Hartford Foundation in support of the AGS Geriatrics-for-Specialists Initiative (GSI).
“Our panel completed an extensive review of the literature while developing these recommendations,” noted AGS President Wayne C. McCormick, MD, MPH. “The process also included review by organizations with expertise in this area and an open public comment period.”
The new guideline offers a framework that will enable hospital systems and health care professionals to implement actionable, evidence-based measures to improve delirium prevention and treatment. As a prelude to the release, expert panel co-chairs Sharon Inouye, MD, MPH, and Thomas Robinson, MD, along with panel members Mark Katlic, MD, Jacqueline Leung, MD, MPH, and Sanjay Mohanty, MD, presented the guideline recommendations at the American College of Surgeons (ACS) 2014 Clinical Congress last month.
The comprehensive guideline and evidence tables are now available for free on GeriatricsCareOnline.org. In early December, a guideline summary will be available online in the Journal of the American Geriatrics Society (JAGS). A companion Best Practices Statement is now available through open access on the American College of Surgeons website, and will be published in the Journal of the American College of Surgeons in early 2015.
Evidence-based recommendations from The Clinical Practice Guideline for Postoperative Delirium in Older Adults include:
- Nonpharmacologic interventions delivered by an interdisciplinary team should be administered to at-risk older adults to prevent delirium. These include interventions such as mobility and walking, avoiding physical restraints, orienting older adults to their surroundings, sleep hygiene, and assuring adequate oxygen, fluids, and nutrition.
- Ongoing educational programs regarding delirium should be provided for health care professionals.
- A medical evaluation should be performed to identify and manage underlying contributors to delirium.
- Pain management (preferably with nonopioid medications) should be optimized to prevent postoperative delirium.
- Medications with high risk for precipitating delirium should be avoided.
- Cholinesterase inhibitors should not be newly prescribed to prevent or treat postoperative delirium.
- Benzodiazepines should not be used as first-line treatment of agitation associated with delirium.
- Antipsychotics and benzodiazepines should be avoided for treatment of hypoactive delirium.
“Our long-standing partnership with the AGS focused on improving surgical care of older adults laid the foundation for these important guidelines on preventing and managing the dangerous condition of delirium,” commented Marcus Escobedo, MPA, Program Officer at the John A. Hartford Foundation. “We are looking forward to working with AGS and the GSI partner organizations to move these recommendations into clinical practice and improve health outcomes for older hospitalized adults.”
About The American Geriatrics Society
Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit association of geriatrics health care professionals dedicated to improving the health, independence, and quality of life of older people. Its more than 6,200 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, consulting pharmacists and internists. The Society provides leadership to health care professionals, policymakers and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit americangeriatrics.org.
About the Geriatrics-for-Specialists Initiative
The AGS Geriatrics-for-Specialist Initiative (GSI) is a council of 12 specialty organizations committed to improving the well-being of America’s older adults by increasing specialty physicians’ competence in geriatrics. The GSI supports specialty faculty in promoting geriatrics training and research within their discipline, enhancing geriatrics knowledge and education of practicing surgeons and medical specialists, assisting professional certifying bodies and professional societies in improving the ability of their constituencies to care for older adults, and improving the amount and quality of geriatrics education received by specialist trainees.
About the John A. Hartford Foundation
The John A. Hartford Foundation is a private philanthropy working to improve the health of older Americans. After three decades of championing research and education in geriatric medicine, nursing, and social work, today the Foundation pursues opportunities to put geriatrics expertise to work in all health care settings. This includes advancing practice change and innovation, supporting team-based care through interdisciplinary education of all health care providers, supporting policies and regulations that promote better care, and developing and disseminating new evidence-based models that deliver better, more cost-effective health care. The Foundation was established by John A. Hartford. Mr. Hartford and his brother, George L. Hartford, both former chief executives of the Great Atlantic & Pacific Tea Company, left the bulk of their estates to the Foundation upon their deaths in the 1950’s. Additional information about the Foundation and its programs is available at jhartfound.org.