Geriatric Medicine

Identifying Older Adults at Risk of Delirium Following Elective Surgery: A Systematic Review and Meta-Analysis

Watt J, Tricco AC, Talbot-Hamon C, Rios P, Grudniewicz A, Wong C, Sinclair D. Straus SE. Identifying Older Adults at Risk of Delirium Following Elective Surgery: A Systematic Review and Meta-Analysis. Journal of General Internal Medicine. 2018;33(4):500-509. DOI: 10.1007/s11606-017-4204-x.

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Bottom Line:

• Potentially modifiable prognostic factors including frailty, psychotropic medication use, smoking status, and the availability of caregiver support in the perioperative period should be studied further to improve patient outcomes
• Even in the setting of elective surgery, delirium was common (1 in 6 older adults) and associated with other adverse postoperative complications including death

Impact:

• This review aims to improve clinician-patient discussions on informed consent prior to elective surgery in older adults and to help researchers and policy-makers develop interventions that effectively target modifiable risk factors for post-operative complications

Additional Resources: 

• Research brief
• Full publication

Funding:

Dr. Jennifer Watt is funded by the Ontario Ministry of Health and Long-Term Care (OMHLTC) Clinician Investigator Program, the Canadian Institutes of Health Research (CIHR) Frederick Banting and Charles Best Canada Graduate Scholarship (Master’s Award), and the Eliot Phillipson Clinician Scientist Training Program. Dr. Andrea C. Tricco is funded by a Tier 2 Canada Research Chair (CRC) in Knowledge Synthesis. Dr. Sharon E. Straus is funded by a Tier 1 Canada Research Chair (CRC) in Knowledge Translation.

Watt J, Tricco AC, Talbot-Hamon C, Rios P, Grudniewicz A, Wong C, Sinclair D. Straus SE. Identifying Older Adults at Risk of Harm Following Elective Surgery: A Systematic Review and Meta-Analysis. BMC Medicine. 2018;16(1):2. DOI: 10.1186/s12916-017-0986-2.

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Bottom Line:

• Postoperative complications were common (1 in 4 older adults). Frailty, which is often synonymous with someone’s biological age, was associated with increased risk of postoperative complications; however, neither chronological age nor ASA status were associated this outcome. Potentially modifiable prognostic factors (e.g. frailty) should be studied further to improve patient outcomes

Impact:

• This review aims to improve clinician-patient discussions on informed consent prior to elective surgery in older adults and to help researchers and policy-makers develop interventions that effectively target modifiable risk factors for post-operative complications

Additional Resources: 

• Research brief
• Full publication

Funding:

Dr. Jennifer Watt is funded by the Ontario Ministry of Health and Long-Term Care (OMHLTC) Clinician Investigator Program, the Canadian Institutes of Health Research (CIHR) Frederick Banting and Charles Best Canada Graduate Scholarship (Master’s Award), and the Eliot Phillipson Clinician Scientist Training Program. Dr. Andrea C. Tricco is funded by a Tier 2 Canada Research Chair (CRC) in Knowledge Synthesis. Dr. Sharon E. Straus is funded by a Tier 1 Canada Research Chair (CRC) in Knowledge Translation.