The edition · Geriatrics
Intraoperative dexmedetomidine was linked to less postoperative delirium in a small randomised analysis
In 96 patients having major head and neck surgery, delirium was less common after dexmedetomidine than placebo, though numbers are small. Also: multimorbidity clusters and mortality in 16,095 older adults, hospital fall sensors that showed no consistent benefit, and what an Indian deprescribing trial has learned about stopping fall-risk drugs.
The edition in brief
A delirium-focused secondary analysis of a single-centre double-blind trial in 96 adults having head and neck cancer surgery with free-flap reconstruction found delirium in 14.9% (7 of 47) given intraoperative dexmedetomidine against 34.7% (17 of 49) given placebo, adjusted OR 0.31 (95% CI 0.10 to 0.92); the study was small and secondary. In 16,095 community-dwelling Australians aged 70 or over, five multimorbidity clusters were identified, and a cluster of frailty, depressive symptoms and osteoporosis carried higher mortality in both sexes (adjusted HR 1.56 in men, 1.68 in women). A meta-analysis of seven studies found no consistent effect of hospital sensor-based fall prevention on fall rate, fallers or fall injuries, with low certainty. A narrative review drawing on the DeFRID trial in India describes ethical, operational, methodological and context-specific barriers to deprescribing fall-risk drugs.
Dexmedetomidine during surgery: less delirium in a small randomised analysis
Dexmedetomidine is worth discussing with the anaesthetist for high-risk surgery, but non-drug prevention remains the foundation.
Multimorbidity clusters: frailty with depression and osteoporosis carried the highest mortality signal
Consider reviewing older patients with co-occurring frailty, low mood and osteoporosis as a higher-risk group.
Hospital fall-prevention sensors showed no consistent benefit in pooled data
Do not rely on sensor alarms alone to prevent hospital falls; maintain basic multicomponent prevention.
Ask about hearing and vision whenever mood or cognition is in question
Check and correct hearing and vision before diagnosing cognitive or mood problems in older adults.
Deprescribing fall-risk drugs in India: ethical, operational and context barriers to plan for
Consider building a deprescribing routine with prescriber engagement and clear follow-up, rather than relying on one-off advice.
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