Risk for post-operative delirium related to comorbidities in older adult cardiac patients: An integrative review

Mary Dioise Ramos, Kennesaw State University
Franz Henryk Vergara, HCA Florida Fawcett Hospital
Jenna Shackleford, Kennesaw State University
Christina Briggs, Kennesaw State University
Carolina Gomez, Kennesaw State University
Mahdi Mofazali, Kennesaw State University
Jade Preston, Kennesaw State University


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.