Intranasal insulin for prevention of perioperative delirium in femoral fracture surgery

Delirium is a transient and fluctuating cause of cerebral dysfunction and manifests with a wide range of cognitive and behavioural abnormalities. Delirium is associated with both increased morbidity and mortality and is a medical emergency. The sequelae of delirium are multiple and significant and extend well beyond the acute hospital stay. Delirium is associated with higher rates of death, medical complications, longer hospital stays, functional and cognitive decline and admission to residential aged care facilities. There are no registered pharmacological agents for the prevention or management of delirium. Pharmacological management is currently focused on symptomatic control with antipsychotics, as thus far, the cerebral abnormalities causing delirium have been poorly elucidated. We hypothesise that intranasal insulin, via its neuromodulatory effects, will reduce the rate of delirium leading to improved outcomes for patients and decreased costs of patient care in hospital. This RCT aims to evaluate the use of short-acting intranasal insulin in the prevention of delirium in patients undergoing orthopaedic surgery for femoral fractures. We will also assess the effect of intranasal insulin on duration and severity of delirium, acute and total hospital length of stay, complications, new residential aged care facility placement, cognitive decline, new onset of dementia, mortality, function, cost of care, quality of life (QoL) and emotional/mental impact on patients and caregivers.