Prescribing health care providers should avoid medications that induce delirium postoperatively in older adults to prevent delirium. Anticholinergic medications, sedative-hypnotics, and meperidine contribute considerably to risk of postoperative delirium in older adults.1, 44, 45 and 46 The medication itself, or medications within these classes, have been shown to more than double the odds of an older patient developing delirium.1, 44, 45 and 46 Diphenhydramine increases the odds ratio of developing delirium to 2.3 (95% CI 1.4–3.6) in older adults.44 Meperidine

Epacadostat datasheet was associated with delirium in adults older than 50 years with an odds ratio of 2.7 (95% CI 1.3–5.5), and benzodiazepines had an increased odds of 3.0 (95% CI 1.3–6.8).1 Clinical guidelines to improve the safety of medication http://www.selleckchem.com/products/pexidartinib-plx3397.html use in older adults recommend avoidance of agents prone to increase the risk or severity of delirium47 (see Table 7). The use of multiple medications (five or greater) has been associated with an increased risk of delirium, likely due to the psychoactive properties of one or more of the agents in the patient’s regimen.24 Because specific needs for any

of these medications may outweigh potential risks, the approach must be customized and requires individual patient evaluation. For example, if a patient has a history of alcohol abuse or benzodiazepine dependence, then treatment with benzodiazepines is warranted even though the medication would typically be avoided. A health care

professional trained in regional anesthetic injection may consider providing regional anesthetic at the time of surgery and postoperatively to improve pain control and prevent delirium in older adults. Insufficient analgesia postoperatively contributes to delirium.48, 49 and 50 Postoperative pain control is important to minimize the rate of delirium.48, 49 and 50 Some evidence suggests that nonopioid alternatives minimize delirium in comparison with opioid-only pain regimens.51 and 52 The use of regional anesthesia nearly has been found to reduce delirium in two studies.53 and 54 Prescribing antipsychotic medications to prevent delirium in postoperative patients has limited, inconsistent, and contradictory support in the literature. Five studies found decreased incidence of delirium with prophylactic antipsychotics,55, 56, 57 and 58 and three did not.59, 60 and 61 Potential harms of this class of medication are considerable; thus, antipsychotics are not recommended to prevent delirium.62, 63, 64, 65 and 66 Prophylactic administration of newly prescribed cholinesterase inhibitors are not effective in reducing postoperative delirium67, 68 and 69 and may cause increased harm (including mortality).