ABSTRACT
BACKGROUND: Delirium is defined as a sudden onset of confusion due to disruption in normal brain functioning. Although it is highly prevalent in post-operative patients, most significantly the older adult population, limited information exists explaining why its onset occurs. PURPOSE: This integrative review aimed to synthesise specific comorbidities that can contribute to the development of post-operative delirium in older adult cardiac surgical patients. METHODS: PRISMA statement was used to report the identification, selection, appraisal and synthesis of articles and the PRISMA diagram reports the selection process. The Johns Hopkins Evidence-Based Practice Tools were used as guide in literature review, critical analysis, levelling of evidence and quality rating. PubMed, ProQuest, CINAHL plus, EMBASE, MEDLINE, Ovid Nursing Collection and Cochrane databases were searched from 2015 to 2020. RESULTS: The initial search yielded 1529 articles. Following the removal of duplicates and screening, 14 articles were included for this review. The following comorbidities were identified in the studies: Diabetes mellitus, atrial fibrillation, depression, impaired olfaction, pre-existing cerebrovascular disease, pre-existing cardiovascular disease, insomnia and frailty. CONCLUSION: There was a strong indication of the development of post-operative delirium among older adult cardiac surgical patients with comorbidities. RELEVANCE TO CLINICAL PRACTICE: Awareness of the impact of comorbidities in developing post-operative delirium may help healthcare providers to plan and implement proper care management among older adult cardiac surgical patients with comorbidities.
Subject(s)
Cardiac Surgical Procedures , Emergence Delirium , Aged , Humans , Cardiac Surgical Procedures/adverse effects , Comorbidity , Emergence Delirium/epidemiology , Risk Factors , Male , Female , Aged, 80 and overABSTRACT
The Australian Council on Healthcare Standards (ACHS) Evaluation, Quality and Improvement (EQuIP 4)1 standards provide a useful clinical and corporate framework for the analysis of quality projects by both health and disability services. Two ACHS EQuIP 4 clinical standards were used to compare quality projects conducted by community-based and on-site rehabilitation and disability services, as generated by a commercial database. Reliable information is a major asset for healthcare organisations, and the use of the ACHS clinical standards to interpret quality project data can overcome a lack of conceptual framework to interpret data. Key differences in the types of quality projects entered in the database by the rehabilitation and disability services may be attributed to the rehabilitation services' relationship with the client (patient), which is time-limited according to the clients' rehabilitation progress, while in comparison, disability services provide life-long support.
