Table J6Content of the structured geriatrics consultation*

Module/RecommendationRecommended n (%)
1. Adequate CNS oxygen delivery:
a) Supplemental oxygen to keep saturation > 90%, preferably > 95%18 (29%)
b) Treatment to raise systolic blood pressure > 2/3 baseline of > 90mmHg4 (6%)
c) Transfusion to keep hematocrit > 30%57 (92%)
2. Fluid/electrolyte balance:
a) Treatment to restore serum sodium, potassium, glucose to normal limits (glucose < 300mg/dl, <16.5mmol/L for diabetics)23 (37%)
b) Treat fluid overload or dehydration detected by examination or blood tests30 (48%)
3. Treatment of severe pain:
a) Around-the-clock acetaminophen (1 gram four times daily)25 (40%)
b) Early-stage break-through pain: low-dose subcutaneous morphine, avoid meperidine13 (21%)
c) Late-stage break-through pain: oxycodone as needed3 (5%)
4. Elimination of unnecessary medications:
a) Discontinue/minimize benzodiazepines, anticholinergics, antihistamines42 (68%)
b) Eliminate drug interactions, adverse effects, modify drugs accordingly13 (21%)
c) Eliminate medication redundancies8 (13%)
5. Regulation of bowel/bladder function:
a) Bowel movement by postoperative day 2 and every 48 hours42 (68%)
b) D/c urinary catheter by postoperative day 2, screen for retention or incontinence44 (71%)
c) Skin care program for patients with established incontinence2 (3%)
6. Adequate nutritional intake:
a) Dentures used properly, proper positioning for meals, assist as needed35 (56%)
b) Supplements: 1 can Ensure,** 3 cans Ensure* for poor oral intake22 (35%)
c) If unable to take food orally, feed via temporary nasogastric tube1 (2%)
7. Early mobilization and rehabilitation:
a) Out of bed on postoperative day 1 and several hours daily36 (58%)
b) Mobilize/ambulate by nursing staff as tolerated, such as to bathroom18 (29%)
c) Daily physical therapy; occupational therapy if needed1 (2%)
8. Prevention, early detection, and treatment of major postoperative complications:
a) Myocardial infarction/ischemia - electrocardiogram, cardiac enzymes if needed21 (34%)
b) Supraventricular arrhythmias/atrial fibrillation - appropriate rate control, electrolyte adjustments, anticoagulation3 (5%)
c) Pneumonia/chronic obstructive pulmonary disease - screening, treatment, including chest therapy27 (44%)
d) Pulmonary embolus - appropriate anticoagulation31 (50%)
e) Screening for and treatment of urinary tract infection32 (52%)
9. Appropriate environmental stimuli:
a) Appropriate use of glasses and hearing aids3 (5%)
b) Provision of clock and calendar0 (0%)
c) If available, use of radio, tape recorder, and soft lighting0 (0%)
10. Treatment of agitated delirium:
a) Appropriate diagnostic workup/management1 (2%)
b) For agitation, calm reassurance, family presence, and/or sitter2 (3%)
c) For agitation, if absolutely necessary, low-dose haloperidol 0.25 – 0.5mg every 4 hours as needed; if contraindicated, use lorazepam at same dose12 (19%)
*

Taken from Marcantonio 2001,

**

Ensure is the trade name of a nutritional supplement

From: Appendix J, Health economics appendix

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Delirium: Diagnosis, Prevention and Management [Internet].
NICE Clinical Guidelines, No. 103.
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