Management of delirium within intraoperative settings for older adults with hip fracture: a scoping review

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Coyne, Elisabeth
Beth White, Laura
Grealish, Laurie
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2021
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Abstract

Background: Delirium is a common adverse event in older patients undergoing hip fracture repair surgery. The impact of hospital-acquired delirium during intraoperative phase of their treatment can have a significant impact on post-operative outcomes. While non-pharmacological, multicomponent delirium prevention interventions are considered standard practice in acute medical units, delirium management in the intraoperative setting is less clear. Objectives: The aim was to identify evidence-based delirium management interventions which are, and could be, undertaken within the intraoperative setting for older patients undergoing hip fracture repair surgery. Design: A scoping review following the principles developed by Arksey and O'Malley (2005). Data Sources: Seven databases including Cochrane, CINAHL, Embase, Medline, PsychINFO, Pubmed and SCOPUS were systematically searched. The search was limited to the last 11 years (2009-2020). Research studies included both primary and secondary sources of evidence. Results: A total of 2464 articles were initially identified. These articles were further refined using keyword searches and exclusion criteria, with a final set of 16 articles meeting the inclusion criteria. Three main themes were: anaesthetic related interventions used to prevent delirium; recognising non-modifiable and potentially modifiable risk factors; and screening and diagnosis of delirium. Conclusions: While there is a strong focus on anaesthetist led interventions in the intraoperative setting, there are opportunities for more nurse-led interventions through adequate pain management and hemodynamic monitoring that require further research. Identifying the best test for screening and diagnosing delirium in the intraoperative setting requires further research.

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Journal of Clinical Nursing

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© 2021 John Wiley & Sons Ltd. This is the peer reviewed version of the following article: Management of delirium within intraoperative settings for older adults with hip fracture: a scoping review, Journal of Clinical Nursing, Accepted Articles, 2021, which has been published in final form at 10.1111/jocn.15720. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-828039.html)

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Nursing

Health services and systems

Public health

Psychology

Anaesthesia

delirium

hip fracture

intraoperative

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Coyne, E; Beth White, L; Grealish, L, Management of delirium within intraoperative settings for older adults with hip fracture: a scoping review., Journal of Clinical Nursing, 2021

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