Cognitive Reserve and Postoperative Delirium in Older Adults
Open accessAbstract
Objectives: To examine the role of cognitive reserve in reducing delirium incidence and severity in older adults undergoing surgery. Design: Prospective cohort study. Setting: Hospital. Participants: Older adults (mean age 71.2, 65% women) undergoing elective orthopedic surgery (N = 142). Measurements: Incidence (Confusion Assessment Method) and severity (Memorial Delirium Assessment Scale) of postoperative delirium were the primary outcomes. Predictors included early‐ (literacy) and late‐life (cognitive activities) proxies for cognitive reserve. Results: Forty‐five participants (32%) developed delirium. Greater participation in cognitive activity was associated with lower incidence (odds ratio = 0.92 corresponding to increase of 1 activity per week, 95% confidence interval ( CI ) = 0.86–0.98, P = .006) and severity (B = −0.06, 95% CI = −0.11 to −0.01, P = .02) of delirium after adjustment for age, sex, medical illnesses, and baseline cognition. Greater literacy was not associated with lower delirium incidence or severity. Of individual leisure activities, reading books, using electronic mail, singing, and computer games were associated with lower dementia incidence and severity. Conclusion: Greater late‐life cognitive reserve was associated with lower delirium incidence and severity in older adults undergoing surgery. Interventions to enhance cognitive reserve by initiating or increasing participation in cognitive activities may be explored as a delirium prophylaxis strategy.
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In the United States, risks of loneliness, depression, delirium, and falls are greatest among patients with limited English comprehension, low health literacy, and socioeconomic disadvantage.
“In the United States, all of these risks are greatest among patients with limited English comprehension, low health literacy, and socioeconomic disadvantage [15].”
From A Protocol-Driven, Bedside Digital Conversational Agent to Support Nurse Teams and Mitigate Risks of Hospitalization in Older Adults: Case Control Pre-Post Study (2019) · cites this paper as [15]
The Results (Study Population; page unavailable) report that older surgical patients who developed postoperative delirium had lower literacy. But literacy did not significantly predict delirium after adjustment, and the paper measures reading-test literacy rather than health literacy. It does not establish that loneliness, depression, delirium, and falls are greatest among patients with limited English comprehension or socioeconomic disadvantage. (LLM, conf=0.86)
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Fernández‐Gonzalo, S., Navarra‐Ventura, G., Bacardit, N., Gomà, G., de Haro, C., Subirá, C., López‐Aguilar, J., Magrans, R., Sarlabous, L., Aquino‐Esperanza, J., et al. (2020) · Figshare · doi:10.6084/m9.figshare.13126478
Johnson, H., Monnin, C., Patel, R., Choukou, M.-A., & El-Gabalawy, R. M. (2026) · Psychology Health & Medicine · doi:10.1080/13548506.2026.2682563
- Authors
- Tow, A., Holtzer, R., Wang, C., Sharan, A., Kim, S. J., Gladstein, A., Blum, Y., & Verghese, J.
- Affiliations
- Albert Einstein College of Medicine (US)
- Corresponding author
- Verghese, Joe
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2016-06
- Volume
- 64
- Issue
- 6
- Pages
- 1341-1346
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC4916859
- OpenAlex
- W2425756612
- Cited by
- 60
- References
- 32
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 6 · 2023: 3 · 2022: 7 · 2021: 5 · 2020: 8 · 2019: 10 · 2018: 3 · 2017: 4 · 2016: 3
- FWCI
- 6.05
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R01 AG039330, RO1AGO44007, AGO44829, R01AG036921)
- National Institute of General Medical Sciences (T32‐GM007288)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Developmental Neuroscience › Anesthesia and Neurotoxicity Research
- Keywords
- cognitive reserve, postoperative delirium, older adults, elective orthopaedic surgery, cognitive activity, literacy, delirium severity, delirium incidence, dementia, delirium prevention, leisure
- MeSH terms
- Aged, Aged, 80 and over, Delirium, Female, Humans, Male, Postoperative Complications, Prospective Studies, Risk Factors, Incidence, Orthopedic Procedures, Cognitive Reserve
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