Enlist Families to Help Prevent Delirium for Post-operative Elders


Do you have an older adult relative or friend planning surgery? Or do you have older surgical patients?

If so, you should be thinking about Post-operative delirium (POD), which is the most common surgical complication in older adults, occurring in 5% to 50% of older patients after an operation.

The stakes are high for elders because delirium contributes to a higher risk of other serious adverse events such as falls, increased length of stay (LOS), functional decline, dementia, loss of independence, and death.

Up to 40% of delirium cases are preventable.  Best practices and emerging evidence offer helpful strategies on how to provide optimal surgical care for older patients to reduce the risk of delirium.

In a recent clinical trial, Wang and colleagues report success in implementation of a family tailored version of the Hospital Elder Life Program (HELP). HELP  targets preventing delirium and functional decline in hospitalized elders with the use of supervised volunteers to implement  non-pharmacological prevention interventions.  The hospital leveraged the Chinese and hospital culture that welcomed family members’ presence at the bedside and involved them instead of volunteers. Families and caregivers were educated  and supported in implementing orientation and therapeutic activities and in supporting mobilization.

The results:  In the intervention group receiving family caregiver delirium prevention interventions had a POD rate of 2.6% and the usual care group had a POD rate of 19.4%. The intervention group had less functional and cognitive decline and LOS was four days shorter.

This study result should be a call to action! Families and Healthcare Providers of older adults can help prevent delirium.

If you have an older family member planning surgery, make sure friends and family are available to be at the bedside every day while they recover. Ask yourself, can coverage be arranged for visits at each meal?

If you have older patients, make sure you are incorporating the latest evidence into your surgical care.  Ask yourself, is the perioperative experience family friendly? Are friends or family part of the pre-operative assessment and teaching?  Are friends or families educated about delirium and how they can help prevent it with simple activities like walking, getting up to a chair, listening to music together, reminiscing?

We all have an important role to play in improving outcomes for older surgical patients.



Wang Y-Y, Yue J-R, Xie D-M, et al. Effect of the Tailored, Family-Involved Hospital

Elder Life Program on postoperative delirium and function in older adults: a

randomized clinical trial [published online October 21, 2019]. JAMA Intern Med.


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