Assessment of preoperative frailty and identification of patients at risk for postoperative delirium in cardiac intensive care units: a prospective observational study.

BACKGROUND: Postoperative delirium (POD) is a common complication that may occur from 24 to 72 h after cardiac surgery. Frailty is a chronic syndrome that leads to a decline in physiological reserve and to disability. The associations between frailty and POD are unclear. AIMS: To investigate associations between POD and frailty in patients undergoing cardiac surgery and to analyse predictors of POD. METHODS AND RESULTS: Convenience sampling was used to recruit 152 patients who underwent cardiac surgery in two medical centres in northern Taiwan. Preoperative frailty in these patients was evaluated using Fried's frailty phenotype. Delirium in patients was assessed from postoperative day 1 to day 5 using the confusion assessment method for intensive care units. A total of 152 patients who underwent cardiac surgery included 68 (44.74%) prefrail patients and 21 (13.81%) patients with frailty after the surgery. Ten patients (6.58%) developed delirium after cardiac surgery. The occurrence of delirium peaked at postoperative day 2, and the average duration of delirium was 3 days. A case-control comparison revealed a significant correlation between preoperative frailty and POD. Significant predictors of POD in patients undergoing cardiac surgery included the European System for Cardiac Operative Risk Evaluation II, preoperative arrhythmia, and preoperative anxiety and depression. CONCLUSION: Preoperative frailty was correlated with POD. Preoperative arrhythmia, anxiety, and depression are predictors of POD. Nurses should perform preoperative assessments of surgical risk and physiological and psychological conditions of patients undergoing cardiac surgery and monitor the occurrence of POD.

The Relationship Between Health-Promoting Behaviors and Metabolic Syndrome in Community-Dwelling Older Adults.

BACKGROUND: Poor health-promoting behaviors increase the risk of chronic disease and disability in older adults. Nevertheless, the predictors of health-promoting behaviors and their relationship with metabolic syndrome have been poorly characterized in older Taiwanese adults. OBJECTIVE: To explore the determinants of health-promoting behaviors in community-dwelling older adults in Taiwan and the relationship of health-promoting behaviors with metabolic syndrome. METHODS: A cross-sectional design was used. A convenience sample of 200 community residents aged 60 years and over was recruited from two large communities in New Taipei City, Taiwan. Data collection included physical examination and a structured questionnaire including measures of health status, health-promoting behaviors, self-efficacy, social support, and metabolic syndrome. RESULTS: Metabolic syndrome was found in 60% of older Taiwanese adults. These participants had higher scores in interpersonal relationships but lower scores in physical activity. Half of the health-promoting behaviors were explained by behavior-specific cognitions and affect, and 44% of behavior-specific cognitions and affect was explained by the health status of the older adult. CONCLUSIONS: Physical activity should be promoted in older Taiwanese adults. Positive behavior-specific cognitions and affect and better health status might impact the health-promoting behaviors of these adults.