Running head: POST-OPERATIVE DELIRIUM 1

The Risk of Post-Operative Delirium in Older Adults

Avery Figliomeni

0595 350

N3035: FA Complex Care of Older Adults

Professor: Nancy Fleming

January 16th, 2018

I declare that this paper is my original work. Excepting where I have cited my own previous
work, this paper in its entirety, or any portion thereof, has not been submitted to meet the
requirements of any other university course.

Student Signature: Avery Figliomeni Date: Tuesday January 16th, 2018

POST-OPERATIVE DELIRIUM 2

Imagine waking up after surgery not quite sure where you are, a new environment and an

altered state of consciousness. The older adult population is at significant risk of postoperative

delirium as a surgical complication, which could have detrimental effects on the patient’s

outcomes. Delirium is a medical condition characterized by general disorientation accompanied

by cognitive impairment, mood shift, self-awareness, and inability to focus and maintain

attention (Booth 2013). The change occurs over a short period, and the disturbance in

consciousness varies throughout the day.

One study conducted by, Brown et al. 2016, found that among 89 participants with a

median age of 74, 36 developed delirium after undergoing spinal surgery. Although a small

study, 40.5% of older adult patients developed delirium post-surgery. Another study found that

“postoperative delirium is a frequent complication after major surgery in elderly patients and is

related to an increase in adverse events, length of hospital stays and mortality” (Raats, Eijsden,

Crolla, Steyerberg, and Laan, 2015). In this study, post-operative delirium occurred in 15% of

patients over 65 years of age. Evidence from both studies above supports that the older adult

population is at high risk for postoperative delirium.

However, Layne, Haas, Davidson, and Klopp (2015) suggests that the occurrence of

postoperative delirium in the older adult can be improved by using delirium screening tools. The

College of Nurses of Ontario supports that entry-level registered nurses must use appropriate

assessment tools and techniques in consultation with clients and other health care team members

(CNO, 2014). A reliable delirium screening tool that valuable in detecting the condition in

hospitalized older adults is the Confusion Assessment Method (CAM) (Rice, Bennett, Ciesi, &

Linville, 2014). Using the CAM assessment on older adult’s post-surgery can offset the risk of

postoperative delirium.
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Overall, the older adult population is at significant risk for experiencing postoperative

delirium, however, with the proper approach and screening tools healthcare providers can

identify delirium appropriately and intervene.

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References:

Booth, J. H. (2013). Delirium. In Gale (Ed.), The Gale encyclopedia of nursing and allied

health (2nd ed.). Farmington, MI: Gale. Retrieved from

http://ezproxy.lakeheadu.ca/login?url=https://search.credoreference.com/content/entry/ga

legnaah/delirium/0?institutionId=7307

Brown, C. H., LaFlam, A., Max, L., Wyrobek, J., Neufeld, K. J., Kebaish, K. M., … Riley, L. H.

(2016). Delirium after Spine Surgery in Older Adults: Incidence, Risk Factors, and

Outcomes. Journal of the American Geriatrics Society, 64(10), 2101–2108. doi:

10.1111/jgs.14434

College of Nurses of Ontario. (2014). Competencies for entry-level registered nurse practice.
Retrieved from http://www.cno.org/globalassets/docs/reg/41037_entrytopracitic_final.pdf
Layne, T., Haas, S. A., Davidson, J. E., & Klopp, A. (2015). Postoperative Delirium Prevention
in the Older Adult: An Evidence-Based Process Improvement Project. MEDSURG
Nursing, 24(4), 256-263.
Rice, K., Bennett, M., Clesi, T., & Linville, L. (2014). Mixed-methods approach to

understanding nurses’ clinical reasoning in recognizing delirium in hospitalized older

adults. The Journal of Continuing Education in Nursing, 45(3), 136-148