Preoperative cognitive impairment and postoperative delirium among Holocaust survivors who achieved longevity.
Holocaust
anesthesia
delirium
loneliness
perioperative
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
14 Mar 2024
14 Mar 2024
Historique:
revised:
28
01
2024
received:
17
10
2023
accepted:
05
02
2024
medline:
15
3
2024
pubmed:
15
3
2024
entrez:
14
3
2024
Statut:
aheadofprint
Résumé
Holocaust survivors (HS) experience higher rates of physiological and psychological morbidities, increasing their vulnerability to perioperative complications. Limited information exists regarding their perioperative neurocognitive disorders. This study aimed to assess the rates of preoperative cognitive impairment, postoperative delirium, and other complications among HS aged 75+ undergoing elective surgery. This is a single-center retrospective cohort study that analyzed prospectively collected data. All surgical patients born before 1945 who underwent elective noncardiac surgery at a tertiary hospital in Israel during 2020-2021 were included. The HS group was identified through the hospital's information system. Preoperative cognitive impairment was assessed using the Mini-Cog test. Postoperative delirium was defined as a combined outcome, which included a positive 4A's-Test (4AT) result during the postanesthesia care unit stay up to the second postoperative day, a positive 3-Minute Diagnostic Confusion Assessment Method (3D-CAM) test administered by the geriatric team, and identification through the medical records using the Chart-based Delirium Identification Instrument (CHART-DEL). We used multivariable regression to assess the risk factors for postoperative delirium. Out of 1332 eligible patients, 422 (32%) were HS, while the others served as controls. Both groups had a similar rate of preoperative cognitive impairment (24%, p = 0.89) and postoperative delirium (16%, p = 0.95). HS exhibited a higher risk of the composite adverse events (24% vs. 20%, p = 0.05, aOR [95% CI] 1.3 [1.0-1.7]), driven mainly by falls during hospitalization (4% vs. 2%, p = 0.03, aOR 2.1 [1.1-4.1]). HS patients were more likely to be childless (33% vs. 11%, p = 0.001) and had higher rates of chronic antidepressant and benzodiazepine use. HS achieving longevity do not face increased risks of preoperative cognitive impairment and postoperative delirium. However, special care is still warranted due to their elevated rate of other complications during hospitalization.
Sections du résumé
BACKGROUND
BACKGROUND
Holocaust survivors (HS) experience higher rates of physiological and psychological morbidities, increasing their vulnerability to perioperative complications. Limited information exists regarding their perioperative neurocognitive disorders. This study aimed to assess the rates of preoperative cognitive impairment, postoperative delirium, and other complications among HS aged 75+ undergoing elective surgery.
METHODS
METHODS
This is a single-center retrospective cohort study that analyzed prospectively collected data. All surgical patients born before 1945 who underwent elective noncardiac surgery at a tertiary hospital in Israel during 2020-2021 were included. The HS group was identified through the hospital's information system. Preoperative cognitive impairment was assessed using the Mini-Cog test. Postoperative delirium was defined as a combined outcome, which included a positive 4A's-Test (4AT) result during the postanesthesia care unit stay up to the second postoperative day, a positive 3-Minute Diagnostic Confusion Assessment Method (3D-CAM) test administered by the geriatric team, and identification through the medical records using the Chart-based Delirium Identification Instrument (CHART-DEL). We used multivariable regression to assess the risk factors for postoperative delirium.
RESULTS
RESULTS
Out of 1332 eligible patients, 422 (32%) were HS, while the others served as controls. Both groups had a similar rate of preoperative cognitive impairment (24%, p = 0.89) and postoperative delirium (16%, p = 0.95). HS exhibited a higher risk of the composite adverse events (24% vs. 20%, p = 0.05, aOR [95% CI] 1.3 [1.0-1.7]), driven mainly by falls during hospitalization (4% vs. 2%, p = 0.03, aOR 2.1 [1.1-4.1]). HS patients were more likely to be childless (33% vs. 11%, p = 0.001) and had higher rates of chronic antidepressant and benzodiazepine use.
CONCLUSIONS
CONCLUSIONS
HS achieving longevity do not face increased risks of preoperative cognitive impairment and postoperative delirium. However, special care is still warranted due to their elevated rate of other complications during hospitalization.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.
Références
Stone L. Quantifying the holocaust: Hyperintense kill rates during the Nazi genocide. Sci Adv. 2019;5(1):eaau7292. doi:10.1126/sciadv.aau7292
Schwartz E. Holocaust Survivors Living in Israel - Data and Characteristics. The Knesset, Research and Information Center; 2014.
Sheps M, Phren S, Ovadia L. On the occasion of international holocaust day on January 27th: in December 2020, 179,600 holocaust survivors live in Israel. Central Bureau of Statistics - State of Israel; 2021:26.
Fund N, Ash N, Porath A, Shalev V, Koren G. Comparison of mortality and comorbidity rates between holocaust survivors and individuals in the general population in Israel. JAMA Netw Open. 2019;2(1):e186643. doi:10.1001/jamanetworkopen.2018.6643
Ben David R, Biderman A, Sherf M, Zamstein O, Dreiher J. Elevated cancer risk in holocaust survivors residing in Israel: a retrospective cohort study. Eur J Cancer. 2018;95:85-92. doi:10.1016/j.ejca.2018.03.011
Stessman J, Paris B, Jacobs JM. Holocaust survivors: health and longevity 70 years later. J Am Geriatr Soc. 2023;71(10):3199-3207. doi:10.1111/jgs.18485
Carmel S, Bachner YG, Cohn-Schwartz E. Psychological reactions to the coronavirus pandemic: a comparative study of holocaust survivors and other older adults in Israel. BMC Psychiatry. 2022;22(1):438. doi:10.1186/s12888-022-04052-5
Trappler B, Cohen CI, Tulloo R. Impact of early lifetime trauma in later life: depression among Holocaust survivors 60 years after the liberation of Auschwitz. Am J Geriatr Psychiatry. 2007;15(1):79-83. doi:10.1097/01.JGP.0000229768.21406.a7
Barel E, Van IJzendoorn MH, Sagi-Schwartz A, Bakermans-Kranenburg MJ. Surviving the Holocaust: a meta-analysis of the long-term sequelae of a genocide. Psychol Bull. 2010;136(5):677-698. doi:10.1037/a0020339
Leventhal Perek S, Thomas K, Gaver A, Matalon A, Yeshua H. Comparison of antidepressant use between adult populations living in urban and rural communities in Israel. Fam Pract. 2019;36(1):21-26. doi:10.1093/fampra/cmy085
Ravona-Springer R, Beeri MS, Goldbourt U. Exposure to the Holocaust and world war II concentration camps during late adolescence and adulthood is not associated with increased risk for dementia at old age. J Alzheimers Dis. 2011;23(4):709-716. doi:10.3233/JAD-2010-101327
Weinstein G, Lutski M, Keinan-Boker L, Goldbourt U, Tanne D. Holocaust exposure and late-life cognitive performance in men with coronary heart disease. J Psychiatr Res. 2021;134:1-7. doi:10.1016/j.jpsychires.2020.12.044
Kodesh A, Levav I, Levine SZ. Exposure to genocide and the risk of dementia. J Trauma Stress. 2019;32(4):536-545. doi:10.1002/jts.22406
Wilson JE, Mart MF, Cunningham C, et al. Delirium. Nat Rev Dis Primers. 2020;6(1):90. doi:10.1038/s41572-020-00223-4
Ormseth CH, LaHue SC, Oldham MA, Josephson SA, Whitaker E, Douglas VC. Predisposing and precipitating factors associated with delirium: a systematic review. JAMA Netw Open. 2023;6(1):e2249950. doi:10.1001/jamanetworkopen.2022.49950
Saller T, MacLullich AMJ, Schäfer ST, et al. Screening for delirium after surgery: validation of the 4 A's test (4AT) in the post-anaesthesia care unit. Anaesthesia. 2019;74(10):1260-1266. doi:10.1111/anae.14682
Tieges Z, Maclullich AMJ, Anand A, et al. Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis. Age Ageing. 2021;50(3):733-743. doi:10.1093/ageing/afaa224
Shenkin SD, Fox C, Godfrey M, et al. Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the confusion assessment method. BMC Med. 2019;17(1):138. doi:10.1186/s12916-019-1367-9
Robson C, Cheong P, Walker I, Garbharran U. 1494AT vs cam in diagnosis of delirium: a junior doctor's view. Age Ageing. 2017;46(suppl_1):i41-i43, i43. doi:10.1093/ageing/afx060.149
Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive “vital signs” measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000;15(11):1021-1027.
Weiss Y, Zac L, Refaeli E, et al. Preoperative cognitive impairment and postoperative delirium in elderly surgical patients: a retrospective large cohort study (the CIPOD study). Ann Surg. 2023;278(1):59-64. doi:10.1097/SLA.0000000000005657
Marcantonio ER, Ngo LH, O'Connor M, et al. 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study. Ann Intern Med. 2014;161(8):554-561. doi:10.7326/M14-0865
Inouye SK, Leo-Summers L, Zhang Y, Bogardus ST, Leslie DL, Agostini JV. A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method. J Am Geriatr Soc. 2005;53(2):312-318. doi:10.1111/j.1532-5415.2005.53120.x
Deeken F, Sánchez A, Rapp MA, et al. Outcomes of a delirium prevention program in older persons after elective surgery: a stepped-wedge cluster randomized clinical trial. JAMA Surg. 2022;157(2):e216370. doi:10.1001/jamasurg.2021.6370
Pais R, Ruano L, Carvalho PO, Barros H Global cognitive impairment prevalence and incidence in community dwelling older adults-a. Systematic Review Geriatrics (Basel). 2020;5(4):84. doi:10.3390/geriatrics5040084
Wang Y-Y, Yue J-R, Xie D-M, et al. Effect of the tailored, family-involved hospital elder life program on postoperative delirium and function in older adults: a randomized clinical trial. JAMA Intern Med. 2020;180(1):17-25. doi:10.1001/jamainternmed.2019.4446
Cohen M, Brom D, Dasberg H. Child survivors of the holocaust: symptoms and coping after fifty years. Isr J Psychiatry Relat Sci. 2001;38(1):3-12.
Shrira A, Palgi Y, Ben-Ezra M, Shmotkin D. Do holocaust survivors show increased vulnerability or resilience to post-holocaust cumulative adversity? J Trauma Stress. 2010;23(3):367-375. doi:10.1002/jts.20524
Petersen N, König H-H, Hajek A. The link between falls, social isolation and loneliness: a systematic review. Arch Gerontol Geriatr. 2020;88:104020. doi:10.1016/j.archger.2020.104020
Gani F, Canner JK, Pawlik TM. Use of the modified frailty index in the american college of surgeons national surgical improvement program database: highlighting the problem of missing data. JAMA Surg. 2017;152(2):205-207. doi:10.1001/jamasurg.2016.3479