Zeitschrift für Gerontologie und Geriatrie

, Volume 41, Issue 6, pp 447–452 | Cite as

How to prevent perioperative delirium in the elderly?

Originalarbeit

Abstract

Due to increasing life expectancy, the number of elderly patients needing surgical care is increasing. Improvements in surgical techniques and anesthetic procedures offer the opportunity of surgical intervention even in frail patients. Delirium on admission to the hospital or in the perioperative setting is a common and often serious complication. Cognitive impairment is regarded as the main risk factor for delirium; unfortunately, under routine clinical conditions, these deficits often remain undetected. Postoperative delirium is associated with increased morbidity and mortality, as well as increased length of hospitalization, resulting in increased suffering and costs. The aim of the intervention presented here was to prevent delirium in a general hospital without a geriatric specialty department. Geriatric nurses became part of the team in the perioperative setting, giving psychological support and being a continuous companion to the patient and his/her proxies. Co-operation between all professions involved throughout hospitalization of the patient was emphasized. The low incidence of delirium in elderly surgical patients resulting from our efforts indicate that – for this setting in a general hospital – the strategy was effective for the prevention of delirium. Nowadays, geriatric nurses are an essential part of the perioperative team and delirium has lost much of its imminence.

Keywords

Perioperative Delirium Emergency Surgery Pain Geriatric Nurse Continuity 

Zusammenfassung

In Allgemeinkrankenhäusern kann Verwirrtheit zum Aufnahmezeitpunkt als Begleitsymptom vieler somatischer Erkrankungen beobachtet werden. Delirien treten aber auch besonders häufig perioperativ auf – prinzipiell in allen Altersgruppen. Besonders gefährdet sind geriatrische Patienten, in erster Linie die (in der klinischen Routine leider häufig unerkannt) dementiell Vorerkrankten. Gerade für diese Patientengruppe wird die langfristige Prognose eines solchen akuten Verwirrtheitszustandes auch bei adäquater Therapie als ungewiss eingestuft.

Ziel unseres Projektes war es, in einem Krankenhaus ohne eigene geriatrische Fachabteilung die perioperative Versorgung geriatrischer Patienten zu verbessern und damit die Entstehungsrate eines solchen Delirs deutlich zu senken. Hierzu wurde ein innovatives Konzept für die umfassende Betreuung dieser Patienten etabliert, in dem die Altenpflege perioperativ einen besonders hohen Stellenwert hat und das eine interdisziplinäre und professionenübergreifende Zusammenarbeit voraussetzt.

Schlüsselwörter

Perioperatives Delir Notfallchirurgie Schmerz Altenpflegerin Betreuungskontinuität 

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Copyright information

© Spinger 2008

Authors and Affiliations

  1. 1.Dept. of Anesthesia and Intensive Care Perioperative Geriatric TeamSt. Franziskus-Hospital MuensterMuensterGermany

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