Reducing delirium after hip fracture: A randomized trial

OBJECTIVES: Delirium (or acute confusional state) affects 35% to 65% of pat ients after hip-fracture repair, and has been independently associated with poor functional recovery. We performed a randomized trial in an orthopedic surgery service at an academic hospital to determine whether proactive ger iatrics consultation can reduce delirium after hip fracture. DESIGN: Prospective, randomized, blinded. SETTINC: Inpatient academic tertiary medical center. PARTICIPANTS: 126 consenting patients 65 and older (mean age 79 +/- 8 years , 79% women) admitted emergently for surgical repair of hip fracture. MEASUREMENTS: Detailed assessment through interviews with patients and desi gnated proxies and review of: medical records was performed at enrollment t o ascertain prefracture status. Subjects were then randomized to proactive geriatrics consultation, which began preoperatively or within 24 hours of s urgery, or "usual care." A geriatrician made daily visits for the duration of the hospitalization and made targeted recommendations based on a structu red protocol. To ascertain study outcomes, all subjects underwent daily, bl inded interviews for the duration of their hospitalization, including the M ini-Mental State Examination (MMSE), the Delirium Symptom Interview (DSI), and the Memorial Delirium Assessment Scale (MDAS). Delirium was diagnosed u sing the Confusion Assessment Method (CAM) algorithm.