Post-Surgery Delirium Speeds Memory Decline in Older Adults, Study Finds

Older adults who experience delirium after hip fracture surgery face a significantly faster decline in memory and thinking skills than those who don’t, according to a new study. The findings provide strong evidence that delirium — a state of confusion that often occurs after surgery or hospitalization — is associated with lasting cognitive harm, even in people who were mentally sharp before surgery.

The study, titled “Cognitive Outcomes After Hip Fracture Surgery: The Association of Postoperative Delirium on Previously Cognitively Normal Older Adults” and published in The American Journal of Geriatric Psychiatry, analyzed older adults who underwent hip fracture repair. Researchers focused on individuals who were cognitively unimpaired before surgery to understand how developing delirium affected their long-term cognitive trajectory.

Researchers found that more than one-third of participants (36.5%) developed delirium after hip fracture surgery. When they analyzed results separately for people with normal memory and thinking before surgery versus those who already had cognitive impairment — as measured by standard tests such as the Mini-Mental State Examination and the Clinical Dementia Rating Sum of Boxes — a striking pattern emerged: delirium was associated with accelerated cognitive decline only in adults who were cognitively healthy at the start.

Among previously unimpaired participants, delirium was associated with faster decline in standard measures of memory and thinking. In contrast, delirium did not significantly affect the overall rate of decline for adults who already had cognitive impairment before surgery.

“This work highlights the crucial importance of delirium prevention and management strategies in improving cognitive outcomes in older adults,” said Mfon E. Umoh, assistant professor of medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, and the first author for the study.

“This study makes it clear that preventing delirium must be a top priority — not an afterthought — for every older adult facing surgery,” said Sharon K. Inouye, MD, MPH, senior scientist, Milton and Shirley F. Levy Family Chair, and director of the Aging Brain Center at the Hinda and Arthur Marcus Institute for Aging Research; professor of medicine at Harvard Medical School; and editor-in-chief of JAMA Internal Medicine. “Delirium is not just a temporary episode of confusion; it can be associated with longer-term cognitive decline, even in people who were cognitively healthy beforehand. By strengthening delirium-prevention strategies before surgery and improving how we identify and manage it afterward, we have the potential to make a meaningful difference in long-term brain health for millions of older adults.”

Dr. Inouye developed the Hospital Elder Life Program, now known as the American Geriatrics Society CoCare: HELP, an effective and innovative model of hospital care designed to prevent both delirium and functional decline. HELP has been demonstrated to improve patient outcomes while lowering costs by maintaining hydration, promoting sleep and early mobility, and minimizing the use of sedating medications.

In addition to Umoh and Inouye, the other researchers were Anirudh Sharma, BA, research data analyst, Johns Hopkins University School of Medicine; Jeannie-Marie S. Leoutsakos, PhD, MHS, associate professor, psychiatry and behavioral sciences, Johns Hopkins University School of Medicine; Constantine G. Lyketsos, MD, MHS, associate director, Alzheimer’s Disease Research Center, professor and chair of psychiatry, Johns Hopkins Bayview Medical Center; Edward R. Marcantonio, MD, SM, section chief for research, Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center; Paul B. Rosenberg, MD, co-director, Johns Hopkins Memory and Alzheimer’s Treatment Center, professor of psychiatry and behavioral sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine; Karin J. Neufeld, MD, MPH, FRCPC, ABPN, vice chair, professor and Morgan Firestone Chair, Department of Psychiatry & Behavioral Neurosciences, Michael G. DeGroote School of Medicine, McMaster University; Frederick E. Sieber, MD, chair and director of clinical research, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine; and Esther Oh, MD, PhD, co-director, Johns Hopkins Memory and Alzheimer's Treatment Center, professor of medicine, psychiatry and behavioral sciences and pathology, Johns Hopkins University School of Medicine.

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