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.

Figure 1.. Association between Paternal Education and Delirium Incidence in the Sample (N=547)

The graph illustrates results from a logistic regression model (black line) and 95% confidence intervals (grey area), which were calculated using a standard formula (mean ±1.96 * SE). The X-axis reflects paternal education in years, with black lines along the X-axis reflecting the number of cases on each year of education reported. The Y-axis reflects the probability of delirium risk (N=547). *

Figure 2.. Association between Paternal Education and Delirium Severity in the Sample (N=547)

The graph illustrates results from a linear regression model (black line) and 95% confidence intervals (grey area), which were calculated using a standard formula (mean ±1.96 * SE). The X-axis reflects paternal education in years, with black lines along the X-axis reflecting the number of cases on each year of education reported. The Y-axis reflects delirium severity (N=547).