For the patient, surgery involves extreme physical stress, and in older patients especially this can lead to disorders of consciousness or cognition. The acute confusional state known as delirium, however, can often be prevented by specialist nursing care after the operation, as Torsten Kratz and co-authors show in an original article in the current issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2015; 112: 289-96). In their study delirium liaison nurses were employed to help care for surgical patients aged 70 years and over. In every patient, the risk of postoperative delirium was reduced compared to patients who received routine care.
Delirium is a frequent occurrence after surgery in older patients: among those aged 70 and older, up to one in two is affected. Besides age, risk factors for delirium include mental illness-such as dementia-and infections. The approach to care assessed by Torsten Kratz and co-authors focuses on patients' cognitive problems. Specially trained nurses support patients to achieve early self-feeding, improved cognitive activity, and restorative sleep. In this study in a Berlin hospital, one patient in five receiving routine care suffered from postoperative delirium, whereas in the group receiving support from delirium liaison nurses, fewer than 1 in 20 developed cognitive disorders. The authors point out that the study was unable to identify which specific measures reduced the risk for delirium-that would require more studies in larger numbers of patients.