Abstract
Delirium is a common complication after surgery in elderly patients. This acute confusional state is associated with increased morbidity and mortality.
In this thesis it is shown that preoperative memory problems and severity of the surgical procedure, increase the risk for delirium after surgery for a solid tumour in frail elderly patients. To investigate how to reduce this risk, different studies concerning (non-)pharmacological interventions to prevent delirium were compared. Overall, the included studies showed a positive result of any intervention to prevent delirium. The largest effect was seen in studies in high risk populations.
The main part of this thesis is the results of the Liaison Intervention in Frail Elderly (LIFE) study. In this trial the effect of a geriatric liaison intervention on the incidence of postoperative delirium in frail elderly cancer patients treated with an elective surgical procedure for a solid tumour was compared with standard care. We experienced that conducting a clinical trial in frail elderly patients requires an increased time investment and consequently extra financial resources for staff costs. Delirium occurred in 31 patients (11.9%). Additional perioperative geriatric care did not reduce the incidence of postoperative delirium in comparison to standard care. At three month follow-up there were no differences between the intervention group and the standard-care group for any of the long-term outcomes. Postoperative delirium increased the risk of functional decline. High risk patients (undergoing a severe operation and/ or suffering from memory problems) could potentially benefit from additional perioperative geriatric care.
In this thesis it is shown that preoperative memory problems and severity of the surgical procedure, increase the risk for delirium after surgery for a solid tumour in frail elderly patients. To investigate how to reduce this risk, different studies concerning (non-)pharmacological interventions to prevent delirium were compared. Overall, the included studies showed a positive result of any intervention to prevent delirium. The largest effect was seen in studies in high risk populations.
The main part of this thesis is the results of the Liaison Intervention in Frail Elderly (LIFE) study. In this trial the effect of a geriatric liaison intervention on the incidence of postoperative delirium in frail elderly cancer patients treated with an elective surgical procedure for a solid tumour was compared with standard care. We experienced that conducting a clinical trial in frail elderly patients requires an increased time investment and consequently extra financial resources for staff costs. Delirium occurred in 31 patients (11.9%). Additional perioperative geriatric care did not reduce the incidence of postoperative delirium in comparison to standard care. At three month follow-up there were no differences between the intervention group and the standard-care group for any of the long-term outcomes. Postoperative delirium increased the risk of functional decline. High risk patients (undergoing a severe operation and/ or suffering from memory problems) could potentially benefit from additional perioperative geriatric care.
| Translated title of the contribution | Delier bij kwetsbare ouderen die geopereerd worden vanwege kanker |
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| Original language | English |
| Qualification | Doctor of Philosophy |
| Awarding Institution |
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| Supervisors/Advisors |
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| Award date | 24-Sept-2014 |
| Place of Publication | [S.l.] |
| Publisher | |
| Print ISBNs | 978-90-367-7174-0 |
| Electronic ISBNs | 978-90-367-7173-3 |
| Publication status | Published - 2014 |