Team works to reduce risk of post-operative delirium in elderly


Delirium, or acute confusion, is something we rarely hear about but it can have a devastating impact on the lives of elderly patients and families.A research project at North York General Hospital is changing that.

Donna Ruffo, Clinical Nurse Specialist, Geriatrics and Chair of the delirium research group at the Hospital says that while developing a predictive tool for post-operative delirium they discovered that awareness is half the battle.

Delirium can affect up to 60% of patients following surgery and from 10-40% of other elderly hospital patients. It has been described as a medical emergency that contributes to increased illness, longer and costlier hospitalizations, nursing home placement, and even death.

Some of the characteristics of delirium are: fluctuating levels of confusion; disorganized thinking; memory impairment, agitation, reduced ability to maintain attention; and disorientation to time, place, or person.

An interdisciplinary team at North York General Hospital is developing an objective assessment tool, based on the latest research, aimed at identifying those at risk of developing post-operative delirium.

Two experiences motivated Marg Stuart, Unit Administrator, Orthopaedics, to work with her colleagues to create the tool. In one case, a patient suffering from Parkinson’s disease enjoyed a relatively good quality of life. After knee replacement surgery, however, the resulting post-operative delirium was so severe that he was placed in a nursing home. In another case, the patient took six months to recover from delirium, much to the distress of his family.

Joan Osbourne, Clinical Nurse Specialist, Surgery, says “By identifying those at-risk prior to surgery, patients and their families can be informed about the condition and its consequences. They will be able to decide whether they want to go ahead with the surgery and support will be given to the patient and family.” In some cases, the risk to the patient’s current quality of life will outweigh the benefits of elective surgery.

Marg underlines that in order to best serve patients, it is essential that honest answers be given about their physical and mental health. Some people are reluctant to admit that they, or a family member, suffer from memory loss, depression or a drug or alcohol problem. These are all factors that predispose to delirium and it is important that staff know about them.

Chair of the group, Donna Ruffo, Clinical Nurse Specialist, Geriatrics, says that with phase 1 of the research complete there are many positive outcomes.

“Although we have not been able to prove the validity of the tool, we have observed many positive outcomes,” says Donna. “Many staff and physicians are more aware of the risk factors that contribute to post operative delirium, so we have seen an increase in early identification of patients at risk. This has led to raised awareness of delirium for patients and their families, and appropriate treatment of post operative delirium.”

The team will continue to do research that will further test the validity of the tool. Then, the next step will be to develop a program to educate and support patients, families and hospital staff.

For more information about this research project, please call Donna at 416-756-6000 ext. 4294.