From the Guidelines
Nursing Considerations for an 87-year-old Patient with Dementia Post-operatively
The most critical nursing consideration for an 87-year-old patient with dementia post-operatively following a partial hip replacement is to ensure adequate nutritional intake and hydration as part of a multidisciplinary team approach to reduce the risk of complications and improve clinical outcomes 1.
Key Considerations
- Nutritional Interventions: Provide oral nutritional supplements (ONS) and consider peripheral parenteral nutrition (PN) in the acute perioperative period to increase nutritional intake and reduce the risk of complications 1.
- Multidisciplinary Team Approach: Involve a team of healthcare professionals, including geriatricians, nurses, and dietitians, to provide comprehensive care and address the patient's nutritional, medical, and social needs 1.
- Individualized Care Planning: Develop an individualized care plan that takes into account the patient's dietary needs, preferences, and abilities, as well as their dementia diagnosis and any related cognitive or functional impairments.
- Assistance with Eating: Provide assistance with eating and offer preferred foods to improve energy intake and reduce the risk of mortality 1.
- Hydration: Ensure adequate hydration to prevent dehydration and related complications, although the evidence for hydration interventions in preventing delirium is limited 1.
- Monitoring and Evaluation: Regularly monitor the patient's nutritional status, fluid intake, and overall health, and evaluate the effectiveness of the care plan to make adjustments as needed.
Dementia-Specific Considerations
- Simplified Communication: Use simple and clear communication to help the patient understand their care plan and any instructions or explanations.
- Consistent Caregivers: Assign consistent caregivers to provide care and support to the patient to reduce confusion and anxiety.
- Environmental Modifications: Modify the patient's environment to reduce stress and promote safety, such as using visual aids and minimizing noise levels.
From the Research
Nursing Considerations for Post-Operative Care
Nursing considerations for an 87-year-old patient with dementia post-operatively following a partial hip replacement (hemiarthroplasty) include:
- Providing early analgesia and timely surgical fixation of fracture to reduce morbidity and mortality 2
- Implementing early and intensive inpatient rehabilitation to improve postoperative outcomes in patients with dementia 2
- Coordinating care within an "orthogeriatric" team to decrease mortality and improve long-term outcomes 2
- Assessing self-care ability, nutritional status, self-rated health, health-related quality of life, and self-efficacy to identify areas for improvement 3
- Providing family caregiver-training for dementia care to enhance family caregivers' self-efficacy and competence 3
Risk Factors and Complications
The patient is at a higher risk of:
- Postoperative mortality, with a 67% higher risk of all-cause 30-day postoperative mortality compared to patients without dementia 4
- Cardiovascular, respiratory, and cerebrovascular events, with up to a sevenfold increase in the risk of cerebrovascular mortality 4
- Readmission, with patients with dementia being more likely to be readmitted than patients without dementia 5
- Proximal femur fracture plating, with patients with dementia being more likely to have proximal femur fracture plating than patients without dementia 5
Individualized Care
Considering the patient's age, dementia, and hip fracture, individualized care should be provided, taking into account the patient's unique needs and circumstances. This may include: