Delirium in older adults / Delirium em idosos

This narrative review provides a broad examination of the most current concepts on the etiopathogenesis, diagnosis, prevention, and treatment of delirium, an acute neuropsychiatric syndrome characterized by fluctuating changes in cognition and consciousness. With the interaction of underlying vulnerability and severity of acute insults, delirium can occur at any age but is particularly frequent in hospitalized older adults. Delirium is also associated with numerous adverse outcomes, including functional impairment, cognitive decline, increased healthcare costs, and death. Its diagnosis is based on clinical and cognitive assessments, preferably following systematized detection instruments, such as the Confusion Assessment Method (CAM). Delirium and its consequences are most effectively fought using multicomponent preventive interventions, like those proposed by the Hospital Elder Life Program (HELP). When prevention fails, delirium management is primarily based on the identification and reversal of precipitating factors and the non-pharmacological control of delirium symptoms. Pharmacological interventions in delirium should be restricted to cases of dangerous agitation or severe psychotic symptoms.

Esta revisão narrativa examina de maneira abrangente os conceitos mais atuais sobre etiopatogenia, diagnóstico, prevenção e tratamento do delirium, uma síndrome neuropsiquiátrica aguda caracterizada por mudanças flutuantes na cognição e na consciência. Com a interação entre a vulnerabilidade subjacente e a gravidade dos insultos agudos, delirium pode ocorrer em qualquer idade, mas afeta com notória frequência idosos hospitalizados. Delirium também está associado a diversos desfechos adversos, incluindo prejuízo funcional, declínio cognitivo, aumento dos custos de saúde e morte. O diagnóstico é baseado em avaliações clínicas e cognitivas, com preferência para o uso de instrumentos de detecção sistematizados, como o Confusion Assessment Method (CAM). Delirium e suas consequências são combatidos de forma mais eficaz por meio de intervenções preventivas com múltiplos componentes, como as propostas pelo Hospital Elder Life Program (HELP). Quando há falha na prevenção, o manejo do delirium se baseia principalmente na identificação e na reversão dos fatores precipitantes e no controle não farmacológico dos sintomas do delirium. As intervenções farmacológicas no delirium devem ser restritas aos casos de agitação perigosa ou sintomas psicóticos graves.

Slower walking speed forecasts increased postoperative morbidity and 1-year mortality across surgical specialties.

OBJECTIVE: The purpose of this study was to determine the relationship between the Timed Up and Go test and postoperative morbidity and 1-year mortality, and to compare the Timed Up and Go to the standard-of-care surgical risk calculators for prediction of postoperative complications. METHODS: In this prospective cohort study, patients 65 years and older undergoing elective colorectal and cardiac operations with a minimum of 1-year follow-up were included. The Timed Up and Go test was performed preoperatively. This timed test starts with the subject standing from a chair, walking 10 feet, returning to the chair, and ends after the subject sits. Timed Up and Go results were grouped as fast ≤ 10 seconds, intermediate = 11-14 seconds, and slow ≥ 15 seconds. Receiver operating characteristic curves were used to compare the 3 Timed Up and Go groups to current standard-of-care surgical risk calculators at forecasting postoperative complications. RESULTS: This study included 272 subjects (mean age of 74 ± 6 years). Slower Timed Up and Go was associated with increased postoperative complications after colorectal (fast 13%, intermediate 29%, and slow 77%; P < 0.001) and cardiac (fast 11%, intermediate 26%, and slow 52%; P < 0.001) operations. Slower Timed Up and Go was associated with increased 1-year mortality following both colorectal (fast 3%, intermediate 10%, and slow 31%; P = 0.006) and cardiac (fast 2%, intermediate 3%, and slow 12%; P = 0.039) operations. Receiver operating characteristic area under curve of the Timed Up and Go and the risk calculators for the colorectal group was 0.775 (95% CI: 0.670-0.880) and 0.554 (95% CI: 0.499-0.609), and for the cardiac group was 0.684 (95% CI: 0.603-0.766) and 0.552 (95% CI: 0.477-0.626). CONCLUSIONS: Slower Timed Up and Go forecasted increased postoperative complications and 1-year mortality across surgical specialties. Regardless of operation performed, the Timed Up and Go compared favorably to the more complex risk calculators at forecasting postoperative complications.