Parental Education and Delirium Risk after Surgery in Older Adults

ABSTRACT

Objectives

Efforts to conceptualize risk factors for postoperative delirium in older adults have focused on the time proximate to the episode, but how early-life exposures influence delirium risk is poorly understood.

Methods

An observational cohort of 547 patients aged 70+undergoing major non-cardiac surgery at two academic medical centers in Boston. Demographic characteristics, cognition, parental education, health, and participation in cognitively stimulating activities were assessed prior to surgery. Delirium incidence and severity were measured daily during hospitalization.

Results

Higher paternal education was associated with significantly lower incidence of delirium (X²(1, N =547)=8.35, p <.001; odds ratio OR=.93, 95% CI, .87 to .98) and inversely associated with delirium severity (r(545)=−.13, p <.001). Higher maternal education was associated with lower delirium incidence but did not reach statistical significance. The effect of paternal education on delirium incidence was independent of the patient’s education, estimated premorbid intelligence, medical comorbidities, neighborhood disadvantage, and participation in cognitively stimulating activities (X²(2, N =547)=31.22, p <.001).

Conclusions

Examining early-life exposures may yield unique insights into the risks and pathogenesis of delirium.

Clinical Implications

Evaluating long-term factors that increase vulnerability to delirium may improve our ability to calculate risk. It may guide clinical decision-making and inform pre- and post-operative recommendations.

KEYWORDS:

• Childhood socioeconomic status
• delirium
• social determinants of health

Acknowledgments

This work is dedicated to the memory of Joshua Bryan Inouye Helfand. The authors gratefully acknowledge the contributions of the patients, family members, nurses, physicians, research team, and members of the Executive Committee who participated in the Successful Aging after Elective Surgery (SAGES) study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability of statement

Dataset supporting this project is available to researchers subject to a non-disclosure agreement. For details on how to access the data, please, visit: The Aging Brain Center at the Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, https://www.marcusinstituteforaging.org/research/aging-brain-center/team.

Additional information

Funding

This work was funded in part by grants no. [P01AG031720] (SKI) and [R24AG054259] (SKI) from the National Institute on Aging. Dr. Marcantonio’s time in part by [K24AG035075]; Dr. Franchesca Arias’ time was supported in part by grant no. [2019-AARFD-644816]of the Alzheimer’s Association; Dr. Inouye holds the Milton and Shirley F. Levy Family Chair at Hebrew SeniorLife/Harvard Medical School. The funding sources had no involvement in the design, analysis, or reporting of the result; Alzheimer’s Association.