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Delirium: A Cognitive Cost of the Comfort of Procedural Sedation in Elderly Patients?

Creator:

Mayo Clinic Proceedings

Topic: Chronic Conditions
Back pain
Burden
Causes
Prevention
Management
Conditions
Type: Report
Region: Republic of Ireland
Description:

Author Affiliations: Department of Anaesthesia, Harvard Medical School, Brigham and Women's HospitalBoston, MACognitive morbidity is a common complication of hospitalization in elderly patients.1,2 This morbidity takes several forms, with delirium, a confusional state defined clinically by acute and fluctuating changes in consciousness and attention, being the most frequent. The prevalence of delirium is about 20% in elderly hospitalized medical patients, can be as high as 60% after some types of surgery, and approaches 80% among patients admitted to a critical care unit.1,3,4 Delirium is also a costly complication in terms of length of stay and dollars, with a recent study5 estimating that the economic burden of delirium to the US health care system is more than $100 billion annually—enough for a small down payment on the health care legislation currently working its way through Congress. It is also costly from the patient's point of view because it is associated with a 2- to 5-fold higher incidence of other complications, a 3-fold greater likelihood of placement in a long-term care facility, and up to a 2-fold higher 1-year mortality.1,6,7 Against this background, the study by Sieber et al8 in this issue of Mayo Clinic Proceedings is important because it raises the tantalizing possibility that excessive sedation is a risk factor for delirium. If so, the implications are enormous because procedural sedation is widespread, and controlling depth of sedation might be a simple, inexpensive way to reduce the incidence of this cognitive morbidity.Sieber et al8 examined the incidence of postoperative delirium in elderly patients undergoing hip fracture repair, a procedure that required about 90 minutes. All patients received spinal anesthesia plus, by random assignment, either light or deep sedation (n=57 per group). Sedation was provided by intravenous infusion of propofol, a drug used widely for procedural sedation …  

Date:

21/01/2010

Rights: Public
Suggested citation:

Mayo Clinic Proceedings. (2010) Delirium: A Cognitive Cost of the Comfort of Procedural Sedation in Elderly Patients? [Online]. Available from: http://publichealthwell.ie/node/9793 [Accessed: 24th August 2019].

  

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