TY - JOUR
T1 - Physical Activity and Risk of Postoperative Delirium
AU - Lee, Susie S.
AU - Lo, Yungtai
AU - Verghese, Joe
N1 - Funding Information:
Financial Disclosure: Dr Lee was supported by the National Institutes of Health/National Center for Advancing Translational Science through Einstein‐Montefiore Institute for Clinical and Translational Science Award grant UL1TR001073. Dr Verghese receives funding from National Institute of Aging grants 1RO1 AGO44829‐01A1, R01 AG050448‐01, and 1UG3NS105565‐01.
Funding Information:
Special thanks to Amanda Tow for sharing her data for this analysis, the Clinical Research Training Program program for support and insight, and Drs Joe Verghese and Ellise Delphin for their mentorship. Financial Disclosure: Dr Lee was supported by the National Institutes of Health/National Center for Advancing Translational Science through Einstein-Montefiore Institute for Clinical and Translational Science Award grant UL1TR001073. Dr Verghese receives funding from National Institute of Aging grants 1RO1 AGO44829-01A1, R01 AG050448-01, and 1UG3NS105565-01. Conflict of Interest: Dr Verghese is a member of the editorial board at Journal of the American Geriatrics Society. Author Contributions: Under the direction of J.V., S.L. constructed the research question, conducted the analyses, and wrote the manuscript. Y.L. supervised the analysis and guided interpretation. J.V. and Y.L. revised the manuscript. All authors read and approved of the final manuscript. Sponsor's Role: The funding sources had no role in the design, conduct, or reporting of this study.
Publisher Copyright:
© 2019 The American Geriatrics Society
PY - 2019/11/1
Y1 - 2019/11/1
N2 - BACKGROUND/OBJECTIVE: Regular physical activity (PA) has been associated with improved cognitive function, but its effect on postoperative delirium (POD) has not been established. Our objectives were to determine the effect of baseline PA on the incidence of POD in older patients undergoing elective orthopedic surgery and to determine whether these effects were independent of cognitive reserve. We hypothesize that PA protects against POD by bolstering physiologic reserve needed to withstand the stressors of surgery. DESIGN: Secondary analysis of a prospective, single-center, cohort study. SETTING: Urban academic hospital. PARTICIPANTS: A total of 132 nondemented, English-speaking adults older than 60 years undergoing elective orthopedic surgery. MEASUREMENTS: Subjects were screened for POD and delirium severity using the Confusion Assessment Method and the Memorial Delirium Assessment Scale. Baseline cognitive activities and PAs were assessed with a validated Leisure Activity Scale. Regular PA was categorized as 6 to 7 days per week. The association of regular PA with incidence of POD was assessed using multivariable logistic regression, adjusting for age, sex, Charlson Comorbidity Index, cognitive reserve, and cognitive function. Linear regression was used to assess the association of delirium severity with regular PA. RESULTS: Of 132 patients, 41 (31.1%) developed POD. Regular PA was associated with a 74% lower odds of developing POD (odds ratio [OR] = 0.26; 95% confidence interval [CI] = 0.08-0.82). There was no significant interaction between PA and cognitive reserve (P =.70). Of 85 women, 25 (29.4%), and of 47 men, 16 (34.0%) developed POD. In stratified analysis, women who engaged in regular PA had dramatically lower odds of POD (OR = 0.08; 95% CI = 0.01-0.63) compared with men (OR = 0.93; 95% CI = 0.18-4.97). CONCLUSIONS: Regular PA is associated with decreased incidence of POD, especially among women. Future studies should address the basis of sex differences in PA benefits on delirium. J Am Geriatr Soc 67:2260–2266, 2019.
AB - BACKGROUND/OBJECTIVE: Regular physical activity (PA) has been associated with improved cognitive function, but its effect on postoperative delirium (POD) has not been established. Our objectives were to determine the effect of baseline PA on the incidence of POD in older patients undergoing elective orthopedic surgery and to determine whether these effects were independent of cognitive reserve. We hypothesize that PA protects against POD by bolstering physiologic reserve needed to withstand the stressors of surgery. DESIGN: Secondary analysis of a prospective, single-center, cohort study. SETTING: Urban academic hospital. PARTICIPANTS: A total of 132 nondemented, English-speaking adults older than 60 years undergoing elective orthopedic surgery. MEASUREMENTS: Subjects were screened for POD and delirium severity using the Confusion Assessment Method and the Memorial Delirium Assessment Scale. Baseline cognitive activities and PAs were assessed with a validated Leisure Activity Scale. Regular PA was categorized as 6 to 7 days per week. The association of regular PA with incidence of POD was assessed using multivariable logistic regression, adjusting for age, sex, Charlson Comorbidity Index, cognitive reserve, and cognitive function. Linear regression was used to assess the association of delirium severity with regular PA. RESULTS: Of 132 patients, 41 (31.1%) developed POD. Regular PA was associated with a 74% lower odds of developing POD (odds ratio [OR] = 0.26; 95% confidence interval [CI] = 0.08-0.82). There was no significant interaction between PA and cognitive reserve (P =.70). Of 85 women, 25 (29.4%), and of 47 men, 16 (34.0%) developed POD. In stratified analysis, women who engaged in regular PA had dramatically lower odds of POD (OR = 0.08; 95% CI = 0.01-0.63) compared with men (OR = 0.93; 95% CI = 0.18-4.97). CONCLUSIONS: Regular PA is associated with decreased incidence of POD, especially among women. Future studies should address the basis of sex differences in PA benefits on delirium. J Am Geriatr Soc 67:2260–2266, 2019.
KW - cognitive reserve
KW - physical activity
KW - postoperative delirium
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U2 - 10.1111/jgs.16083
DO - 10.1111/jgs.16083
M3 - Article
C2 - 31368511
AN - SCOPUS:85075098306
SN - 0002-8614
VL - 67
SP - 2260
EP - 2266
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 11
ER -