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Résumé La confusion est fréquente et grave chez le sujet âgé hospitalisé, alors qu'elle est souvent évitable. Plusieurs études sur les connaissances des infirmier(e)s et des médecins sur la confusion révèlent un manque de formation. En France, l'interne est souvent le prescripteur de première ligne en hospitalisation. Cette enquête nationale réalisée entre juin et décembre 2019 avait pour but d'évaluer les connaissances des internes sur la confusion et la prise en charge de sa forme hyperactive chez le sujet âgé.Pour cela, un auto-questionnaire a été élaboré à partir des recommandations de la Haute Autorité de santé (HAS) sur la confusion puis transmis via les réseaux sociaux aux internes. Ils sont 182 internes de 23 spécialités et de 18 villes différentes à y avoir répondu. Ils déclaraient être impliqués dans 97% des prises en charge alors que 45 % d'entre eux n'avaient pas connaissance des recommandations. La thérapeutique semblait être l'étape la plus difficile et les internes passés par une formation pratique en gériatrie obtenaient de meilleurs résultats.Les enjeux liés à la confusion et les recommandations de prise en charge thérapeutique sont mal connus des internes. La formation théorique mais surtout pratique en stage semble améliorer le niveau de connaissance. Abstract Delirium is frequent and serious, while it is often avoidable. Previous studies revealed a caregivers lack of knowledge about this syndrome concerning diagnosis and therapeutic management. In France, residents are often in first line to manage delirium patients. The purpose of this study is therefore to assess residents' level of knowledge about delirium and its therapeutic management in the elderly.Our study is a national survey carried out between June and December 2019 using a self-administrated survey derived from the 2009 Haute Autorité de santé (HAS) recommendations about delirium. The primary endpoint was the global score obtained by residents. The secondary endpoints were the score in different fields of competence (general knowledge, diagnostic, therapeutic) and the comparison of the resident's score according to their formation. One hundred eighty-two residents from 23 specialties and 18 different cities were represented. Residents were involved in more than 97% of the cases, while 45% of them were unaware of the HAS recommendations. Mean score to the survey was 68/100, and therapeutic management seemed the most difficult step, especially when the symptoms of delirium were severe. Our study highlights the benefit of practical training during internship to improve the level of knowledge on delirium.This study suggests the need for specific teaching on delirium. Training both theoretical and practical seems to be the most effective method. Development of a national educational program about delirium and its management could be proposed to improve residents awareness and develop their skill. Increasing the number of mobile geriatric teams and strengthen their action could also be a concrete option to improve delirium management. Finally, we could imagine the development of a pocket tool to offer a practical bedside help for clinicians. The development of such a tool would require further studies to evaluate its relevance and effectiveness.

The elderly represent a large percentage of patients seen in departments of vascular surgery. Delirium is a frequent perioperative complication in this population and contributes to increased morbidity and mortality. Prevention of problems associated with mental confusion rests in identifying comorbidities, their severity, and the risk factors associated with delirium syndrome. The aging of our population implies management of increasing numbers of older patients who often have concomitant pathologies and, consequently, polypharmacy. Optimization of their management rests on collaboration between surgeons, anesthetists, and geriatrists., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: The aim of this prospective study was to determine incidence, duration, and risk factors for postoperative delirium (PD) in elderly patients undergoing major abdominal surgery., Summary Background Data: The incidence and risk factors of PD after major abdominal surgery in elderly patients are not well documented., Methods: From May 2006 to May 2008, 118 patients aged 75 years or more without severe preoperative cognitive dysfunction (mini mental state examination score >10/30) and undergoing major elective abdominal surgery were included. The preoperative geriatric assessment battery consisted of 4 tests evaluating physical (instrumental activities of daily living and timed get up and go test score) and cognitive function (mini mental state examination score), and detecting the presence of an underlying depression (Short-GDS). After the operation, geriatric patients were assessed for PD by the Confusion Assessment Method. Univariate and multivariate analyses were used to determine risk factors for PD., Results: Overall, PD occurred in 28 patients (24%). Multivariate analysis showed that an American Society of Anesthesiologists status of 3-4 (P = 0.02), impaired mobility (timed get up and go test score >20 seconds) (P = 0.009) and postoperative tramadol administration (P = 0.0009) were risk factors for PD. The mortality rate was 14% in 28 patients with PD and 3.3% in 90 patients without PD (P = 0.051). The morbidity rate was 35.5% in 28 patients with PD and 32% in 90 patients without PD (NS). The mean hospital stay was 19 +/- 11 days for patients with PD and 14 +/- 8 for patients without PD (P = 0.01). Fifteen of 24 (62.5%) surviving patients with PD and 28 of 87 (32%) surviving patients without PD were discharged to geriatric rehabilitation unit (P = 0.007)., Conclusions: PD is a frequent and severe postoperative event in elderly patients after major abdominal surgery. A perioperative geriatric assessment should be recommended to patients with an American Society of Anesthesiologists status of 3-4 and preoperative impaired mobility to facilitate the management of PD. In these patients, the postoperative administration of tramadol should be avoided.