[2026-11-04] Occurrence and Associated Factors of Delirium in Elderly Orthopedic Patients: A Prospective Observational Study
DOI:
https://doi.org/10.33165/rmj.2028.e281125Keywords:
Delirium, Elderly, Incidence, Risk factors, Orthopedic surgeryAbstract
Background: Delirium is a common neuropsychiatric disorder in elderly patients, characterized by an acute decline in cognitive function. It is associated with increased complications and mortality. Identifying factors associated with its occurrence is crucial for guiding clinical management.
Objectives: To determine the incidence of delirium during hospitalization in the orthopedic department and identify unadjusted factors associated with the occurrence of delirium in elderly patients.
Methods: Patients aged 60 years or older admitted to the orthopedic department, HRH Princess Maha Chakri Sirindhorn Medical Center between August 2024 and February 2025 were included. Data were collected using structured forms and categorized into delirium and nondelirium groups based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Statistical analyses included chi-square test, Fisher exact test for categorical variables, and independent t test for continuous variables. A P value < .05 was considered statistically significant.
Results: A total of 150 patients were enrolled, of whom 13 developed delirium, resulting in cumulative incidence of 8.67%. Unadjusted factors significantly associated with delirium included advanced age (P < .001), particularly in patients aged over 80 (P < .001), and electrolyte imbalances, specifically hyponatremia (P = .003) and hypokalemia (P = .020).
Conclusions: Delirium occurs in a notable proportion of elderly orthopedic patients, showing unadjusted associations with advanced age and electrolyte imbalances. Due to the lack of multivariable adjustment, these findings should be interpreted cautiously to guide early clinical screening and vigilant monitoring.
References
1. Maldonado JR. Delirium pathophysiology: an updated hypothesis of the etiology of acute brain failure. Int J Geriatr Psychiatry. 2018;33(11):1428-1457. doi:10.1002/gps.4823
2. Fosnight S. Delirium in the elderly. In: Chant C, Chessman KH, Finks SW, Hemstreet BA, Hume AL, eds. Pharmacotherapy Self‐Assessment Program, Geriatrics. 7th ed. American College of Clinical Pharmacy; 2011:73-95.
3. Muhammad T, Maurya P, Sharma P. Prevalence and correlates of bone and joint diseases and its association with falls among older adults in India: evidence from LASI, 2017-18. Geriatr Nurs. 2021;42(5):1143-1150. doi:10.1016/j.gerinurse.2021.07.007
4. Igwe EO, Nealon J, O'Shaughnessy P, et al. Incidence of postoperative delirium in older adults undergoing surgical procedures: a systematic literature review and meta-analysis. Worldviews Evid Based Nurs. 2023;20(3):220-237. doi:10.1111/wvn.12649
5. Inouye SK. Delirium in older persons. N Engl J Med. 2006;354(11):1157-1165. doi:10.1056/NEJMra052321
6. van der Mast RC. Pathophysiology of delirium. J Geriatr Psychiatry Neurol. 1998;11(3):138-158. doi:10.1177/089198879801100304
7. Ali S, Patel M, Jabeen S, et al. Insight into delirium. Innov Clin Neurosci. 2011;8(10):25-34.
8. Wojtasik-Bakalarz K, Woroń J, Siwek M. Adverse effects of opioid analgesics from the central nervous system. Palliat Med Pract. 2021;15(3):241-247. doi:10.5603/PMPI.2021.0013
9. Chen Y, Liang S, Wu H, et al. Postoperative delirium in geriatric patients with hip fractures. Front Aging Neurosci. 2022;14:1068278. doi:10.3389/fnagi.2022.1068278
10. Fan YY, Luo RY, Wang MT, Yuan CY, Sun YY, Jing JY. Mechanisms underlying delirium in patients with critical illness. Front Aging Neurosci. 2024;16:1446523. doi:10.3389/fnagi.2024.1446523
11. Wang LH, Xu DJ, Wei XJ, Chang HT, Xu GH. Electrolyte disorders and aging: risk factors for delirium in patients undergoing orthopedic surgeries. BMC Psychiatry. 2016;16(1):418. doi:10.1186/s12888-016-1130-0
12. Kaveenuntachai D, Prueksaanantakal N, Benyapad P, Chinpinkleaw P, Jiojinda S. Factors predicting delirium among hospitalized older adults in an urban area, Thailand: a prospective cohort study. Belitung Nurs J. 2025;11(2):186-193. doi:10.33546/bnj.3678
13. Evensen S, Hylen Ranhoff A, Lydersen S, Saltvedt I. The delirium screening tool 4AT in routine clinical practice: prediction of mortality, sensitivity and specificity. Eur Geriatr Med. 2021;12(4):793-800. doi:10.1007/s41999-021-00489-1
14. Sachdev PS, Blacker D, Blazer DG, et al. Classifying neurocognitive disorders: the DSM-5 approach. Nat Rev Neurol. 2014;10(11):634-642. doi:10.1038/nrneurol.2014.181
15. Ngamkala T, Malathum P, Krairit O. Incidence and risk factors of acute confusional state in hospitalized older patients. Nurs Res Inno J. 2018;24(2):137-149.
16. Caplan GA, Kurrle SE, Cumming A. Appropriate care for older people with cognitive impairment in hospital. Med J Aust. 2016;205(10):S12-S15. doi:10.5694/mja15.00898
17. Marcantonio ER. Delirium in hospitalized older adults. N Engl J Med. 2017;377(15):1456-1466. doi:10.1056/NEJMcp1605501
18. Giuliani C, Peri A. Effects of hyponatremia on the brain. J Clin Med. 2014;3(4):1163-1177. doi:10.3390/jcm3041163
19. Dai J. The relative deficiency of potassium ions in nerve cells causes abnormal functions and neurological and mental diseases. Nat Sci. 2022;14(10):441-447. doi:10.4236/ns.2022.1410038
20. Maldonado JR. Delirium pathophysiology: an updated hypothesis of the etiology of acute brain failure. Int J Geriatr Psychiatry. 2018;33(11):1428-1457. doi:10.1002/gps.4823
21. Hshieh TT, Fong TG, Marcantonio ER, Inouye SK. Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence. J Gerontol A Biol Sci Med Sci. 2008;63(7):764-772. doi:10.1093/gerona/63.7.764
22. Reisinger M, Reininghaus EZ, Biasi J, Fellendorf FT, Schoberer D. Delirium-associated medication in people at risk: a systematic update review, meta-analyses, and GRADE-profiles. Acta Psychiatr Scand. 2023;147(1):16-42. doi:10.1111/acps.13505
23. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911-922. doi:10.1016/S0140-6736(13)60688-1
24. Ieong C, Chen T, Chen S, et al. Differences of anticholinergic drug burden between older hospitalized patients with and without delirium: a systematic review and meta-analysis based on prospective cohort studies. BMC Geriatr. 2024;24(1):599. doi:10.1186/s12877-024-05197-6
25. Lisibach A, Gallucci G, Benelli V, et al. Evaluation of the association of anticholinergic burden and delirium in older hospitalised patients – a cohort study comparing 19 anticholinergic burden scales. Br J Clin Pharmacol. 2022;88(11):4915-4927. doi:10.1111/bcp.15432
26. Oudewortel L, van der Roest HG, Onder G, et al. The association of anticholinergic drugs and delirium in nursing home patients with dementia: results from the SHELTER study. J Am Med Dir Assoc. 2021;22(10):2087-2092. doi:10.1016/j.jamda.2021.05.039
27. Yoon HJ, Park KM, Choi WJ, et al. Efficacy and safety of haloperidol versus atypical antipsychotic medications in the treatment of delirium. BMC Psychiatry. 2013;13:240. doi:10.1186/1471-244X-13-240
28. Grover S, Avasthi A. Clinical practice guidelines for management of delirium in elderly. Indian J Psychiatry. 2018;60(Suppl 3):S329-S340. doi:10.4103/0019-5545.224473
29. Arbabi M, Ziaei E, Amini B, et al. Delirium risk factors in hospitalized patient: a comprehensive evaluation of underlying diseases and medications in different wards of a large Urban Hospital Center in Iran. BMC Anesthesiol. 2022;22(1):147. doi:10.1186/s12871-022-01690-w
30. Umurca G, Can B, Ilhan B, Tufan A. Delirium and geriatric syndromes in hospitalized older patients: results from World Delirium Awareness Day. Marmara Med J. 2022;35(1):53-60. doi:10.5472/marumj.1059577
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 by the Author(s). Licensee RMJ.
This work is licensed under a Creative Commons Attribution 4.0 International License.
