Seeing older perioperative patients in 3-D: when your patient is demented, delirious, or depressed
A large proportion of older patients needing orthopaedic surgical care suffer from dementia, delirium, or depression. These disorders may present before or after surgical treatment and increase the risk of surgical complications including death. Dementia is characterized by insidious loss of intellectual functions as well as by behavioral and affective disturbances. Delirium is characterized by disturbances in consciousness, attention, and cognition. Both dementia and delirium cause confusion and lack of compliance with medical care. Unlike dementia or chronic confusion, delirium or acute confusion develops over a relatively short period of time, and in many instances is caused by stress, metabolic imbalances, infection, or medications. Furthermore, it is often reversible. Depression is a heterogeneous affective disorder characterized by disturbances in mood, lack of interest and pleasure, and vegetative signs and symptoms. It may also cause noncompliance, and can contribute to diminished self-care and health-related activities, such as poor nutrition. All three of these conditions may be exacerbated by the stress of injury or surgical treatment. Early recognition and treatment of these disorders is critical to prevent complications and give patients the best possible outcome.
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