patients are still doing The New
York Times crossword in ink,
they're probably not experiencing
any cognitive impairments.
Who's the patient's at-home
caregiver? The signs of
POCD might not emerge until after
you've discharged an elderly
patient. Confirm that there's a fam-
ily member or friend observing
senior patients after surgery to
make sure their cognitive status is
improving and they don't try to
perform tasks, such as driving,
before they're ready. Instruct the
caregiver to report anything trou-
bling to the patient's physician.
The cognitive tests mentioned
above also provide a baseline that your staff and your patient's care-
givers should use to assess whether the patient is suffering from mem-
ory loss after surgery. It is obvious when someone is having true deliri-
um after surgery, but hypoactive delirium can be more difficult to spot.
Order post-surgical meds with care. There are clearly drugs
that should be avoided if at all possible during the perioperative
period. For example, we know that certain drugs, such as benzodi-
azepines and anticholineregic agents, increase a patient's risk of expe-
riencing delirium after surgery. Here are some medication recommen-
dations:
3
2
M A Y 2 0 1 8 • O U T PA T I E N TS U R G E R Y. N E T • 2 1
The inci-
dence of
post-op
delirium ranges from 5 to
15%. However, with certain
high-risk groups such as
patients with hip fracture, the
range can be between 16 to
62%. Can you predict who's at
risk for cognitive deficit after
surgery? Go to
osmag.net/cX5YVe for a list of
pre-op screening questions
you can ask your elderly
patients.
Who's at Risk for
Cognitive Decline?
