The development of Preoperative screening tool for Postoperative Delirium in elderly patients

Main Article Content

Aimpapha Prechaterasat


Introduction: Postoperative delirium (POD) in the elderly patients have sign and symptom; change in consciousness levels, lack of concentration, loss of perception, date, time, place and person, decision making, reasoning deficiencies, duration period in hours or days. Most common on day 1-3 after surgery. Purpose: To develop and test the pre-operative screening tool for post-operative delirium in elderly patients. Material and methods:      The study is prospective descriptive. Review literature about post-operative delirium risks in elderly patients and to develop the pre-operative screening tool for the post-operative delirium in elderly patients. There are 9 delirium risks factors which are 1) age 2) history of alcoholism 3) intelligence disorders, cognition, awareness 4) pre-operative depression 5) history of drug use in Anticholinergics and Benzodiazepines. 6) Unbalanced levels of serum potassium in the blood. 7) Lower hemoglobin and hematocrit levels. 8) Malnutrition and 9) Taking medication ≥ 5 types through the content validation from experts is equal to 1.0, applied to the 200 elderly patients, male and female aged 65 years and older, who are in major surgery in General Surgery Department. Colorectal Surgery Department, Cardiac Surgery Department, Orthopedic Surgery Department at King Chulalongkorn Memorial Hospital. Result: The results of pre-operative screening tool for the post-operative delirium in elderly patients are 81.50% Sensitivity, 39.30% Specificity, 81.40% Positive Predictive Value, 60.70% Negative Predictive Value and 2,057 likelihood ratios. Conclusion: The developed tools can screen the post-operative delirium in elderly patients and predict the post-operative delirium is quite accurate.

Article Details

นิพนธ์ต้นฉบับ (Original Article)


1. Lin YT, Lan KM, Wang LK, Chu CC, Wu SZ, Chang CY. et. al. Incidence, risk factors, and phenomenological characteristics of postoperative delirium in patients receiving intravenous patient-controlled analgesia: a prospective cohort study. Neuropsychiatr Dis Treat. 2016; 12: 3205-12.
2. Rizk P, Morris W, Oladeji P, Huo M. Review of postoperative delirium in geriatric patients undergoing hip surgery. Geriatr Orthop Surg Rehabil. 2016;7(2):100-105.
3. Reus VI, Fochtmann LJ, Eyler AE, Hilty DM, Horvitz-Lennon M, Jibson MD. et al. The American psychiatric association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. Am J Psychiatry. 2016;173: 543-46.
4. Veerasak Muangpisarn editors. Gerontology and geriatrics for primary care practice. 1st ed. Bangkok: Union Creation;2016. p. 121-45.
5. Alcover L, Badenes R, Montero MJ, Soro M, Belda FJ. Postoperative delirium and cognitive dysfunction. BJA. 2013; 3:199-204.
6. Miang ying tan A. Amoako D. Postoperative cognitive dysfunction after cardiac surgery. Critical care & Pain. 2013;13(6): 218-23.
7. Kobayashi K. Imagama S, Ohtori S. Risk factors for delirium after spine surgery in extremely elderly patients aged 80 years or older and review of the literature: Japan association of spine surgeons with ambition multicenter study. Global Spine Journal. 2017; 1010:1-7.
8. Liao Y, Flaherty JH, Yue J, Wang Y, Deng C, Chen L. The incidence of delirium after cardiac surgery in the elderly: protocal for a systematic review and meta-analysis. BMJ Open. 2017;7: 1-3.
9. Prechaterasat K. Nursing care for the elderly with postoperative delirium. Thai Red Cross Nursing Journal. 2012; 7(2): 10-22.
10. Rundshagen I. Postoperative cognitive dysfunction. Dtsch Arztebl Int. 2014; 111(8): 119-25.
11. Xue P, Wu Z, Wang K, Tu C, Wang X. Incidence and risk factors of postoperative delirium in elderly patients undergoing transurethral resection of prostate: a prospective cohort study. Neuropsychiatr Dis Treat. 2016; 12: 137-42.
12. Demeure JM, Fain JM. The elderly surgical patient and postoperative delirium. Jamcollsurg. 2006;203(5):752-57.
13. Alldred DP. Avoid benzodiazepines and opioids in people at risk of delirium. Evid Based Nurs. 2001;14(3): 75-76
14. Sanders RD. Maze M. Contribution of sedative-hypnotic agents to delirium via modulation of the sleep pathway. Can J Anaesth. 2011;5(2):149-56.
15. Ansaloni L, Catena F, Chattat R, Fortuna D, Franceschi C, Mascitti T. et. al. Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. BJS. 2010;97: 273-80.
16. Witlox J, Eurelings LSM, de Jonghe JFM, Kalisvaart KJ, Eikelenboom P, Gool WA. et al. Delirium in elderly patients and the risk of post discharge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304(4): 443-51.
17. Robinson TN, Raeburn CD, Tran ZV, Angles EM, Brenner LA, Moss M. Postoperative delirium in the elderly: risk factors and outcomes. Ann Surg. 2009;249(1):173-78.
18. Angelino AF, Schmidt CW. Principles of ambulatory medicine. Philadelphia: Limpincott Williams & Wilkins;2007.
19. Zweig RY, Galvin EJ. Lewy body dementia: the impact on patients and caregivers. Alzheimers Res Ther. 2014;6(2): 21.
20. Young J, Cheater F, Collinson M, Fletcher M, Forster A, Godfrey M. Prevention of delirium for older people in hospital: study protocol for a randomized controlled feasibility trial. BioMed Central. 2015;16: 340-51.
21. Gaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MD. Fast, systemic, and continuous delirium assessment in hospitalized patients: The Nursing Delirium Screening Scale. JPSM. 2005;29(4): 368-375.
22. Prechaterasat A, Kespichayawatana J. A construction of a Delirium risk factors screening tool for postoperative elderly patients. Journal of Nursing Science Chulalongkorn University. 2016; 28(1): 79-89.
23. Polit DF. Beck CT. Essentials of nursing research: Appraising evidence for nursing practice. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2014.
24. Kanjanawasee S. Modern test theory. 4th ed. Bangkok: CUprint; 2012
25. Xue P, Wu Z, Wang K, Tu C. Wang X. Incidence and risk factors of postoperative delirium in elderly patients undergoing transurethral resection of prostate: a prospective cohort study. Neuropsychiatr Dis Treat. 2016;12: 137-42.
26. Gani, H. The incidence of postoperative delirium in elderly patients after urologic. Med Arch.2013; 67(1): 45-47.
27. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383: 911-22.
28. Hebert C. Evidence-based oractice in perianesthesia nursing: Application of the American Geriatrics Society clinical practice guideline for postoperative delirium in older adults. J Perianesth Nurs. 2018; 33(3): 253-64.
29. Burns, N. and Grove, S. K. Measuring concepts. In The practice of nursing research: Apprisal, synthesis and generation of evidence. 6th ed. St. Louis: Saunders Elsevier; 2009.
30. Devillis, R. F. Scale Development: Theory and Applications. 4th ed. Los Angelis: Sage; 2017.
31. Burns, N., Grey, R. J. and Groove, S. K. Understanding Nursing Research: Building an Evidence-Based Practice. 7th ed. St. Louis: Saunders Elsevier; 2017.