We talk a lot about delirium after hip fracture, but what can we do about it?

Dr. Susan Freter is an Associate Professor of Medicine at Dalhousie University, and a staff geriatrician at the Nova Scotia Health Authority in Halifax, Canada.  She has a special interest in delirium prevention and management in orthopaedic patients.  

Geriatricians talk a lot about post-operative delirium.  It is common after surgeries, especially in people with a lot of risk factors (or we could say, especially in the presence of frailty), and even with recovery it makes for a bad experience.  The occurrence of hip fracture, which mostly befalls patients who are older and frail, demonstrates this routinely.  We know that taking extra care with at-risk patients can help to prevent delirium.  Taking extra care can manifest in different forms: educating the caregivers, paying attention to hydration (is the patient actually drinking the cup of water that is plonked down in front of them?), paying attention to constipation (preferably before a week has gone by), making sure hearing aids are in the ears, and using medication doses that are geared for frailty, rather than for strapping 20 year olds. But how can what we talk about be translated into what we do? Does the ‘doing’ actually work in practice? Continue reading

For he’s a jolly good fellow…

David Shipway is a final year registrar in geriatric medicine working at London’s Charing Cross and St Mary’s Hospitals, Imperial College NHS Trust. He is currently developing a new comprehensive surgical liaison service for patients undergoing gastrointestinal surgery.shutterstock_154668242

With population ageing, the number of oldest old undergoing surgery is increasing markedly. For anyone who’s recently been the medical registrar on-call, it will come as no surprise to hear that there is considerable unmet need on the surgical wards of the UK. But the experience of pioneers in this field has proved that reactive post-operative care is not enough: a proactive approach immediately following the decision to operate is needed to improve outcomes for older patients undergoing surgery. Continue reading