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Prevention and treatment options for postoperative delirium in the elderly

Popp, Juliusa; Arlt, Sönkeb

doi: 10.1097/YCO.0b013e328357f51c
CLINICAL THERAPEUTICS: Edited by Dieter Naber and Harold Pincus

Purpose of review: To review recent findings and developments in strategies for prevention and treatment of postoperative delirium.

Recent findings: Current advances in the field include improved knowledge about predisposing and precipitating factors, evidence for efficacy of multicomponent prevention programmes, refinement of perioperative procedures, and promising pharmacological approaches for prophylaxis and management of postoperative delirium.

Summary: Postoperative delirium is a common and serious complication in elderly patients. Preoperative assessment of risk profiles and tailored multimodal prevention approaches proved effective and should be integrated into clinical practice. Despite promising recent findings, at present, the routine use of pharmacological prophylaxis cannot be recommended. Validated and easy-to-use bedside diagnostic tools are available and should be regularly applied for delirium screening in the first days after surgery. In patients developing delirium, causal conditions and contributing factors need to be identified and addressed. Whereas administration of antipsychotics may represent an option for symptomatic treatment, further studies are needed to evaluate the effects of pharmacological approaches on long-term outcomes in elderly patients with delirium.

aDepartment of Psychiatry, Division of Old Age Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland

bDepartment of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Correspondence to Julius Popp, MD, Department of Psychiatry, University Hospital of Lausanne, Rue du Mont, 1008 Prilly-Lausanne, Switzerland. Tel: +41 21 643 62 67; fax: +41 21 643 62 38; e-mail: Julius.Popp@chuv.ch

© 2012 Lippincott Williams & Wilkins, Inc.