A recent study shows that post-surgical delirium can accelerate cognitive decline, even in individuals who were cognitively healthy before treatment.
Experts now emphasise that preventing delirium should be a top priority for all older adults undergoing surgery, rather than an afterthought.
Evidence indicates that older adults who develop delirium after hip fracture surgery experience markedly faster deterioration in memory and reasoning skills than those who do not.
The study, published in The American Journal of Geriatric Psychiatry, analysed older adults who underwent hip fracture repair.
Researchers focused on individuals who were cognitively unimpaired before surgery to understand how developing delirium affected their long-term cognitive trajectory.
More than one-third of participants (36.5%) developed delirium after hip fracture surgery.
When the results were analysed separately for people with normal memory and thinking before surgery and those with pre-existing cognitive impairment – as measured by standard tests such as the Mini-Mental State Examination and the Clinical Dementia Rating Sum of Boxes – a striking pattern emerged.
Delirium was associated with accelerated cognitive decline only among adults who were cognitively healthy at baseline.
Among previously unimpaired participants, delirium was linked to faster decline in standard measures of memory and thinking.
In contrast, delirium did not significantly affect the overall rate of decline for adults who already had cognitive impairment before surgery.
Mfon E Umoh, assistant professor of medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, and the first author of the study, said: ‘This work highlights the crucial importance of delirium prevention and management strategies in improving cognitive outcomes in older adults.’
Sharon K Inouye, senior scientist, Milton and Shirley F. Levy Family Chair, and director of the Ageing Brain Centre at the Hinda and Arthur Marcus Institute for Ageing Research; professor of medicine at Harvard Medical School; and editor-in-chief of JAMA Internal Medicine, said: ‘This study makes it clear that preventing delirium must be a top priority – not an afterthought – for every older adult facing surgery.
‘Delirium is not just a temporary episode of confusion; it can be associated with longer-term cognitive decline, even in people who were cognitively healthy beforehand. By strengthening delirium-prevention strategies before surgery and improving how we identify and manage it afterwards, we have the potential to make a meaningful difference in long-term brain health for millions of older adults.’
Dr Inouye developed the Hospital Elder Life Program, now known as the American Geriatrics Society CoCare: HELP, an effective and innovative model of hospital care designed to prevent delirium and functional decline.
HELP has been shown to improve patient outcomes while lowering costs by maintaining hydration, promoting sleep and early mobility, and minimising the use of sedating medications.
The paper is available here.
