Journal articles: 'Delirium in old age Japan'

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Igarashi, Masakazu, Kotoba Okuyama, Naoya Ueda, Hideki Sano, Kanae Takahashi, Zaina P Qureshi, Shigeru Tokita, Asao Ogawa, Yasuyuki Okumura, and Shoki Okuda. "Incremental medical cost of delirium in elderly patients with cognitive impairment: analysis of a nationwide administrative database in Japan." BMJ Open 12, no. 12 (December 2022): e062141. http://dx.doi.org/10.1136/bmjopen-2022-062141.

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ObjectivesDelirium is a neuropsychiatric disorder that commonly occurs in elderly patients with cognitive impairment. The economic burden of delirium in Japan has not been well characterised. In this study, we assessed incremental medical costs of delirium in hospitalised elderly Japanese patients with cognitive impairment.DesignRetrospective, cross-sectional, observational study.SettingAdministrative data collected from acute care hospitals in Japan between April 2012 and September 2020.ParticipantsHospitalised patients ≥65 years old with cognitive impairment were categorised into groups—with and without delirium. Delirium was identified using a delirium identification algorithm based on the International Classification of Diseases 10thRevision codes or antipsychotic prescriptions.Outcome measuresTotal medical costs during hospitalisation were compared between the groups using a generalised linear model.ResultsThe study identified 297 600 hospitalised patients ≥65 years of age with cognitive impairment: 39 836 had delirium and 257 764 did not. Patient characteristics such as age, sex, inpatient department and comorbidities were similar between groups. Mean (SD) unadjusted total medical cost during hospitalisation was 979 907.7 (871 366.4) yen for patients with delirium and 816 137.0 (794 745.9) yen for patients without delirium. Adjusted total medical cost was significantly greater for patients with delirium compared with those without delirium (cost ratio=1.09, 95% CI: 1.09 to 1.10; p<0.001). Subgroup analyses revealed significantly higher total medical costs for patients with delirium compared with those without delirium in most subgroups except patients with hemiplegia or paraplegia.ConclusionsMedical costs during hospitalisation were significantly higher for patients with delirium compared with those without delirium in elderly Japanese patients with cognitive impairment, regardless of patient subgroups such as age, sex, intensive care unit admission and most comorbidities. These findings suggest that delirium prevention strategies are critical to reducing the economic burden as well as psychological/physiological burden in cognitively impaired elderly patients in Japan.

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Kimura, Yutaka, Osamu Shiraishi, Hisato Kawakami, Hiroto Ueda, Mitsuru Iwama, Hiroaki Kato, Tatsuya Okuno, et al. "PS02.112: A RETROSPECTIVE STUDY OF NEOADJUVANT 5-FU, DOCETAXEL, AND NEDAPLATIN (UDON) COMBINATION CHEMOTHERAPY FOR ADVANCED ESOPHAGEAL CANCER." Diseases of the Esophagus 31, Supplement_1 (September 1, 2018): 152–53. http://dx.doi.org/10.1093/dote/doy089.ps02.112.

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Abstract Background In Japan, pre-operative5-FU and cisplatin (CDDP) (FP) combination therapy has been the standard neoadjuvant chemotherapy (NAC) for advanced resectable esophageal cancer (EC), whereas the efficacy of docetaxel (DTX)-containing triplet regimen, FP plus DTX has been reported (Yamasaki M, et al, Ann Oncol 2017). However, for frail patients, such as patients with old age, chronic renal failure, poor performance status, severe commodities or malnutrition, high dose CDDP is not generally recommended in terms of toxicity. We have been developing non-CDDP-containing triplet regimen, 5-FU, DTX, and nedaplatin (NED) (UDON) on a phase I/II trial basis. This retrospective study aimed to investigate the safety and efficacy of NAC with UDON combination for advanced EC. Methods Eleven patients with advanced resectable EC who were unsuitable for the administration of high dose CDDP were enrolled in this study. Patients received two cycles of NAC with UDON (5-FU, 640 or 800 mg/m2, day1–5, DTX, 28 or 35 mg/m2, day1 and 15 and NED, 72 or 90 mg/m2, day1, q28) followed by esophagectomy. Primary endpoint was response rate and secondary endpoint was adverse event (AE). Results The median age was 73 years (range: 58–80) with eight patients being aged 70 or older. ECOG PS was 1/2: 7/4. The main location of the tumor was Ce/Ut/Mt/Lt/Ae: 1/1/7/1/1 and cStage was IIA/IIB/IIIA/IIIB/IIIC/IV: 2/2/4/0/2/1. The RR (CR + PR) was 82% (CR/PR/SD/PD: 1/8/2/0). The pathological response was grade 0/1a/1b/2/3: 2/3/3/2/1. Major grade 3 or 4 adverse events included neutropenia (27%), febrile neutropenia (27%), diarrhea (18%), enteritis (9%) and hyponatremia (27%). The postoperative morbidity included recurrent nerve palsy (36%), aspiration (27%), pneumonia (18%), anastomotic leakage (9%) and delirium (36%). There was no treatment-related death and no reoperation. Conclusion NAC with UDON for advanced resectable EC unsuitable for the administration of high dose CDDP might be feasible and effective. We are planning a phase II clinical study based on the present results. Disclosure All authors have declared no conflicts of interest.

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Bostwick, John Michael. "Delirium in old age." Clinical Neurophysiology 115, no. 6 (June 2004): 1487–88. http://dx.doi.org/10.1016/j.clinph.2004.01.024.

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Jellinger, K. A. "Delirium in old age." European Journal of Neurology 10, no. 2 (March 2003): 194–95. http://dx.doi.org/10.1046/j.1468-1331.2003.05484.x.

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DaPonte, G., M. Lobo, S. Fernandes, V. VilaNova, and A. Paiva. "P-1020 - Delirium in old age." European Psychiatry 27 (January 2012): 1. http://dx.doi.org/10.1016/s0924-9338(12)75187-8.

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J, Dr Nimitha K., and Dr Jini Thomas. "A Study of Old Age Delirium and Quality of Life of Family Caregivers." SAR Journal of Psychiatry and Neuroscience 3, no. 3 (October 15, 2022): 45–54. http://dx.doi.org/10.36346/sarjpn.2022.v03i03.004.

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Objectives: To study the aetiology of patients of delirium in old age, to study the severity of delirium in old age and to study the quality of life of family caregivers of delirium patients. Design: Prospective, observational, and cross sectional. Setting: Inpatient tertiary care hospital setting. Participants: Subjects with the diagnosis of Delirium qualifying according to ICD-10 (international classification of disease-10) and confirmed with CAM scale aged >60 years and Patient or patient’s family members willing to give consent. Measurements: Socio-demographic questionnaire, Confusion assessment method, Delirium index, Delirium aetiology check list, ICD -10 DCR, WHO QOL BREF and the Barthel index. Results: There is no significant association between delirium severity and WHOQoL. There is no significant association between Barthel index and WHOQoL. There is no significant association between WHOQoL and delirium aetiologies. There is no significant association between gender and WHOQoL. There is no significant association between marital status and WHOQoL. There is no significant association between religion and WHOQoL. There is no significant association between WHOQol and education. There is significant association between WHOQoL and occupation. Emloyed subjects have better quality of life than unemployed. There is no significant association between WHO QoL and residence. There is no significant association between WHOQoL and duration of delirium. There is no significant association between WHOQoL and medical comorbidities. There is no significant association between WHOQoL and substance use. There is no significant association between medical comorbidities and delirium aetiology. There is significant association between delirium severity and duration of delirium. As duration of delirium increases severity of delirium increases. There is no significant association between duration of delirium and delirium aetiology. There is no significant association between delirium severity and medical comorbidities. Conclusions: In this study results showed that there is significant association between delirium is an acute illness with sudden onset with maximum percentage of duration 2-4 weeks, delirium is more in males than females, majority of the care givers are spouses and parents, multiple aetiologies, diminished psychological QoL are associated with increased care giver burden. Family history of delirium is associated with better care giver burden. Employed subjects with delirium have better overall QoL. As duration of delirium increases, delirium severity increases.

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Singler, K., U. Thiem, M. Christ, P. Zenk, R. Biber, C. C. Sieber, and H. J. Heppner. "Aspects and assessment of delirium in old age." Zeitschrift für Gerontologie und Geriatrie 47, no. 8 (April 13, 2014): 680–85. http://dx.doi.org/10.1007/s00391-014-0615-z.

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Cole, Martin G. "Subsyndromal delirium in old age: conceptual and methodological issues." International Psychogeriatrics 25, no. 6 (April 11, 2013): 863–66. http://dx.doi.org/10.1017/s1041610213000434.

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Delirium is a cognitive disorder characterized by acute onset, fluctuating course, altered level of consciousness, inattention, disorganized thinking, disorientation, memory impairment, and perceptual and motor disturbances (American Psychiatric Association, 2000; World Health Organization, 2010). It occurs in hyperactive, hypoactive, or mixed forms in up to 42% of older hospital inpatients (Siddiqi et al., 2006) and 70% of older long-term care residents (McCusker et al., 2011). In both settings, delirium is independently associated with poor outcomes (Siddiqi et al., 2006; McCusker et al., 2010; Witlox et al., 2010).

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Gondo, Yasuyuki. "Technology and old age in Japan." Angewandte GERONTOLOGIE Appliquée 1, no. 1 (January 2016): 28–30. http://dx.doi.org/10.1024/2297-5160/a000017.

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Abstract. The population of older people has been increasing in the last few decades in Japan. This larger demographical shift provided new business opportunities to companies. Innovative technologies and services for older people have been developing. Some of these are already at work; further technological revolution seems to promise “successful” aging for the future super-aging society. This report provides an overview of technologies currently applied with older people and introduces some examples of new technologies developing in Japan.

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Han, Jin H., Candace D. McNaughton, William B. Stubblefield, Peter S. Pang, Phillip D. Levy, Karen F. Miller, Sarah Meram, et al. "Delirium and its association with short-term outcomes in younger and older patients with acute heart failure." PLOS ONE 17, no. 7 (July 26, 2022): e0270889. http://dx.doi.org/10.1371/journal.pone.0270889.

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Younger patients (18 to 65 years old) are often excluded from delirium outcome studies. We sought to determine if delirium was associated with short-term adverse outcomes in a diverse cohort of younger and older patients with acute heart failure (AHF). We conducted a multi-center prospective cohort study that included adult emergency department patients with confirmed AHF. Delirium was ascertained using the Brief Confusion Assessment Method (bCAM). The primary outcome was a composite outcome of 30-day all-cause death, 30-day all-cause rehospitalization, and prolonged index hospital length of stay. Multivariable logistic regression was performed, adjusting for demographics, cognitive impairment without delirium, and HF risk factors. Older age (≥ 65 years old)*delirium interaction was also incorporated into the model. Odds ratios (OR) with their 95% confidence intervals (95%CI) were reported. A total of 1044 patients with AHF were enrolled; 617 AHF patients were < 65 years old and 427 AHF patients were ≥ 65 years old, and 47 (7.6%) and 40 (9.4%) patients were delirious at enrollment, respectively. Delirium was significantly associated with the composite outcome (adjusted OR = 1.64, 95%CI: 1.02 to 2.64). The older age*delirium interaction p-value was 0.47. In conclusion, delirium was common in both younger and older patients with AHF and was associated with poorer short-term outcomes in both cohorts. Younger patients with acute heart failure should be included in future delirium outcome studies.

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Lilford, Philippa, and Julian C. Hughes. "Epidemiology and mental illness in old age." BJPsych Advances 26, no. 2 (February 24, 2020): 92–103. http://dx.doi.org/10.1192/bja.2019.56.

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SUMMARYThis is an overview of epidemiology relevant to mental health problems in old age. We start by reviewing some basic terminology: the definitions of prevalence and incidence; the difference between descriptive and analytical epidemiology; the differences between study designs, including cross-sectional, case–control and cohort studies. We then cover the main epidemiological features of the major psychiatric diseases that affect older people (dementia and its different types, depression, late-onset schizophrenia, bipolar affective disorder, delirium, anxiety-related disorders, eating disorders, alcohol and substance misuse, personality disorders) and suicide.We end with some descriptive statistics regarding quality of life in older people.

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Jabbar, Faiza, Maeve Leonard, Karena Meehan, Margaret O'Connor, Con Cronin, Paul Reynolds, Anna Maria Meaney, and David Meagher. "Neuropsychiatric and cognitive profile of patients with DSM-IV delirium referred to an old age psychiatry consultation-liaison service." International Psychogeriatrics 23, no. 7 (January 21, 2011): 1167–74. http://dx.doi.org/10.1017/s1041610210002383.

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ABSTRACTBackground: The phenomenology of delirium is understudied, including how the symptom profile varies across populations. The aim of this study was to explore phenomenology occurring in patients with delirium referred to an old age psychiatry consultation-liaison setting and compare with delirium occurring in palliative care patients.Methods: Consecutive cases of DSM-IV delirium were assessed with the Delirium Rating scale Revised-98 (DRS-R98) and Cognitive Test for Delirium (CTD).Results: Eighty patients (mean age 79.3±7.7 years; mean DRS-R98 total score 21.7±4.9 and total CTD score 10.2±6.3) were included. Forty patients (50%) with comorbid dementia were older, had a longer duration of symptoms at referral, and more severe delirium due to greater cognitive impairments. Inattention (100%) was the most prominent cognitive disturbance, while sleep-wake cycle disturbance (98%), altered motor activity (97%), and thought process abnormality (96%) were the most frequent DRS-R98 non-cognitive features. Inattention was associated with severity of other cognitive disturbances on both the DRS-R98 and CTD, but not with DRS-R98 non-cognitive items. The phenomenological profile was similar to palliative care but with more severe delirium due to greater cognitive and non-cognitive disturbance.Conclusion: Delirium is a complex neuropsychiatric syndrome with generalized cognitive impairment and disproportionate inattention. Sleep-wake cycle and motor-activity disturbances are also common. Comorbid dementia results in a similar phenomenological pattern but with greater cognitive impairment and later referral.

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Haugen, Christine E., Alexandra Mountford, Fatima Warsame, Rachel Berkowitz, Sunjae Bae, Alvin G. Thomas, Charles H. Brown, et al. "Incidence, Risk Factors, and Sequelae of Post-kidney Transplant Delirium." Journal of the American Society of Nephrology 29, no. 6 (April 23, 2018): 1752–59. http://dx.doi.org/10.1681/asn.2018010064.

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Background Frail kidney transplant (KT) recipients may be particularly vulnerable to surgical stressors, resulting in delirium and subsequent adverse outcomes. We sought to identify the incidence, risk factors, and sequelae of post-KT delirium.Methods We studied 125,304 adult KT recipients (1999–2014) to estimate delirium incidence in national registry claims. Additionally, we used a validated chart abstraction algorithm to identify post-KT delirium in 893 adult recipients (2009–2017) from a cohort study of frailty. Delirium sequelae were identified using adjusted logistic regression (length of stay ≥2 weeks and institutional discharge [skilled nursing or rehabilitation facility]) and adjusted Cox regression (death-censored graft loss and mortality).Results Only 0.8% of KT recipients had a delirium claim. In the cohort study, delirium incidence increased with age (18–49 years old: 2.0%; 50–64 years old: 4.6%; 65–75 years old: 9.2%; and ≥75 years old: 13.8%) and frailty (9.0% versus 3.9%); 20.0% of frail recipients aged ≥75 years old experienced delirium. Frailty was independently associated with delirium (odds ratio [OR], 2.05; 95% confidence interval [95% CI], 1.02 to 4.13; P=0.04), but premorbid global cognitive function was not. Recipients with delirium had increased risks of ≥2-week length of stay (OR, 5.42; 95% CI, 2.76 to 10.66; P<0.001), institutional discharge (OR, 22.41; 95% CI, 7.85 to 63.98; P<0.001), graft loss (hazard ratio [HR], 2.73; 95% CI, 1.14 to 6.53; P=0.03), and mortality (HR, 3.12; 95% CI, 1.76 to 5.54; P<0.001).Conclusions Post-KT delirium is a strong risk factor for subsequent adverse outcomes, yet it is a clinical entity that is often missed.

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Méndez-Martínez, Carlos, María Nélida Fernández-Martínez, Mario García-Suárez, Santiago Martínez-Isasi, Jesús Antonio Fernández-Fernández, and Daniel Fernández-García. "Related Factors and Treatment of Postoperative Delirium in Old Adult Patients: An Integrative Review." Healthcare 9, no. 9 (August 26, 2021): 1103. http://dx.doi.org/10.3390/healthcare9091103.

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“Postoperative delirium” is defined as delirium occurring in the hospital up to one week after a procedure or before discharge (whichever occurs first) that meets the DSM-5 diagnostic criteria. Objectives: To describe the risk factors related to this pathology and identify effective non-pharmacological forms of treatment. An integrative review of the available literature was performed. The search results considered included all quantitative studies published between 2011 and 2019 in both English and Spanish. A total of 117 studies were selected. Advanced age was identified as the principal risk factor for postoperative delirium. Nursing interventions appear to be the key to preventing or reducing the seriousness of delirium after an anaesthetic episode. The aetiology of postoperative delirium remains unknown, and no treatment exists to eliminate this pathology. The role of nursing staff is fundamental in the prevention, diagnosis, and management of the pathology.

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Traphagan, John W. "Contesting the Transition to Old Age in Japan." Ethnology 37, no. 4 (1998): 333. http://dx.doi.org/10.2307/3773786.

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Tobin, J. J. "The American Idealization Of Old Age In Japan." Gerontologist 27, no. 1 (February 1, 1987): 53–58. http://dx.doi.org/10.1093/geront/27.1.53.

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Fujishiro, Hiroshige, Ito Kawakami, Kenichi Oshima, Kazuhiro Niizato, and Shuji Iritani. "Delirium prior to dementia as a clinical phenotype of Lewy body disease: an autopsied case report." International Psychogeriatrics 29, no. 4 (August 16, 2016): 687–89. http://dx.doi.org/10.1017/s1041610216001265.

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ABSTRACTAlthough delirium shares clinical characteristics with dementia with Lewy bodies (DLB), there is limited information regarding the relationship between delirium and Lewy body pathology. Here, we report an 89-year-old Japanese woman with an episode of delirium who was pathologically confirmed to have limbic-type Lewy body disease (LBD). Although she exhibited transient visual hallucinations during the delirium, she had no overt dementia. She developed no core clinical features of DLB and died of pneumonia at the age of 90 years. This autopsied case suggests that delirium may be one of the clinical phenotypes of LBD prior to the onset of dementia.

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Abdelrahman, Islam, Rosa Vieweg, Stefan Irschik, Ingrid Steinvall, Folke Sjöberg, and Moustafa Elmasry. "Development of delirium: Association with old age, severe burns, and intensive care." Burns 46, no. 4 (June 2020): 797–803. http://dx.doi.org/10.1016/j.burns.2020.02.013.

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Iglseder, Bernhard, Thomas Frühwald, and Christian Jagsch. "Delirium in geriatric patients." Wiener Medizinische Wochenschrift 172, no. 5-6 (January 10, 2022): 114–21. http://dx.doi.org/10.1007/s10354-021-00904-z.

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SummaryDelirium is the most common acute disorder of cognitive function in older patients. Delirium is life threatening, often under-recognized, serious, and costly. The causes are multifactorial, with old age and neurocognitive disorders as the main risk factors. Etiologies are various and multifactorial, and often related to acute medical illness, adverse drug reactions, or medical complications. To date, diagnosis is clinically based, depending on the presence or absence of certain features. In view of the multifactorial etiology, multicomponent approaches seem most promising for facing patients’ needs. Pharmacological intervention, neither for prevention nor for treatment, has been proven effective unanimously. This article reviews the current clinical practice for delirium in geriatric patients, including etiology, pathophysiology, diagnosis, prognosis, treatment, prevention, and outcomes.

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Hori, Shigeo. "BEGINNING OF OLD AGE IN JAPAN AND AGE NORMS IN ADULTHOOD." Educational Gerontology 20, no. 5 (January 1994): 439–51. http://dx.doi.org/10.1080/0360127940200502.

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Wang, Zhi, Yong Yang, Yang Chen, Kai Lu, and Bing Chen. "Emergence Delirium in a 29-Year-Old Man following an Uneventful Appendectomy." Case Reports in Medicine 2021 (September 25, 2021): 1–4. http://dx.doi.org/10.1155/2021/1338823.

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Emergence delirium (ED) is defined as the delirium that occurs during the transition from the sleep state to full consciousness. ED increases the risk for injury, self-extubation, hemorrhages, and prolonged hospitalization and occurs in patients of any age but most often in children and elderly patients. However, ED in young adults is rarely reported. We presented a case of typical ED occurring in a young healthy man following an uneventful appendectomy. The causes of ED can be classified as either predisposing or precipitating factors. In this case, the unnoticeable mental stress may be the predisposing factor and the sevoflurane maintenance of anesthesia may be the precipitating factor. ED occurs at any age of patient and in any minor surgery, and anesthesiologists should do some work to prevent it from happening.

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Gual, Neus, Alessandro Morandi, Laura Monica Pérez, Laura Brítez, Pamela Burbano, Flor Man, and Marco Inzitari. "Risk Factors and Outcomes of Delirium in Older Patients Admitted to Postacute Care with and without Dementia." Dementia and Geriatric Cognitive Disorders 45, no. 1-2 (2018): 121–29. http://dx.doi.org/10.1159/000485794.

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Background: Delirium research is poorly studied in postacute care, a growing setting due to aging populations, as well as in dementia, a critical risk factor for delirium and particularly prevalent in postacute care. We investigated risk factors for delirium and its outcomes in older adults with and without dementia admitted to a subacute care unit (SCU) after exacerbated chronic conditions. Methods: This is a prospective cohort study including patients ≥65 years old admitted to an SCU for 12 months. We collected demographics, comprehensive geriatric assessments, and presence of dementia and delirium at admission. Outcomes included discharge to previous living situation, mortality, and functional evolution. Due to the high prevalence of dementia, a subgroup analysis was performed to investigate specific risk factors for delirium and related outcomes. Results: Of 909 patients (mean age [±SD] 85.8 ± 6.7; 60% women, 47.5% with dementia), 352 (38.7%) developed delirium. The main risk factor for delirium was dementia (HR [95% CI] 5.2 [3.5–7.7]); age, functional status, and urinary tract infections were also independently associated with delirium. In dementia patients, only age (HR [95% CI] 1.0 [1.004–1.1]) and being male (HR [95% CI] 1.7 [1.04–2.6]) were associated with delirium. Delirium was associated with greater mortality (10.8 vs. 3.9%; p < 0.001) and greater functional decline in the entire sample (–12.3 vs. –6.4 Barthel index points; p < 0.001). In the dementia subgroup, patients with delirium experienced greater functional loss (p = 0.013) and less functional recovery (p = 0.025). Conclusions: In older patients admitted to postacute care, dementia is the main risk factor for delirium, and delirium carries worse clinical and functional outcomes. In patients with dementia, delirium is also relevant, since it entails a functional loss at admission and lower functional recovery.

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Matsumoto, Koutarou, Yasunobu Nohara, Mikako Sakaguchi, Yohei Takayama, Shota Fukushige, Hidehisa Soejima, and Naoki Nakashima. "Delirium Prediction Using Machine Learning Interpretation Method and Its Incorporation into a Clinical Workflow." Applied Sciences 13, no. 3 (January 25, 2023): 1564. http://dx.doi.org/10.3390/app13031564.

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Delirium in hospitalized patients is a worldwide problem, causing a burden on healthcare professionals and impacting patient prognosis. A machine learning interpretation method (ML interpretation method) presents the results of machine learning predictions and promotes guided decisions. This study focuses on visualizing the predictors of delirium using a ML interpretation method and implementing the analysis results in clinical practice. Retrospective data of 55,389 patients hospitalized in a single acute care center in Japan between December 2017 and February 2022 were collected. Patients were categorized into three analysis populations, according to inclusion and exclusion criteria, to develop delirium prediction models. The predictors were then visualized using Shapley additive explanation (SHAP) and fed back to clinical practice. The machine learning-based prediction of delirium in each population exhibited excellent predictive performance. SHAP was used to visualize the body mass index and albumin levels as critical contributors to delirium prediction. In addition, the cutoff value for age, which was previously unknown, was visualized, and the risk threshold for age was raised. By using the SHAP method, we demonstrated that data-driven decision support is possible using electronic medical record data.

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Danely, Jason. "Japanese Ingredients for a Good Old Age." Current History 118, no. 809 (September 1, 2019): 244–46. http://dx.doi.org/10.1525/curh.2019.118.809.244.

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Osugi, Yasuhiro. "Increased Mortality of “Died of Old Age” in Japan." Gerontology and Geriatric Medicine 8, no. 3 (July 19, 2022): 1–4. http://dx.doi.org/10.24966/ggm-8662/100135.

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The aim of this study was to inform the significance of the mortality of “Died of old age” in older people. These categories of death (ICD R54 in Japanese modification in 2013) have rapidly increased (sixfold increase compared to 20 years before) and become the third most frequent cause of death in Japan where older people (≥65 years) are 28.6% of whole populations.

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Squires, Amanda. "Public Policy and the Old Age Revolution in Japan." Physiotherapy 83, no. 9 (September 1997): 499. http://dx.doi.org/10.1016/s0031-9406(05)65650-7.

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Nakano, Tadasumi, and Hideki Ito. "Epidemiology of diabetes mellitus in old age in Japan." Diabetes Research and Clinical Practice 77, no. 3 (September 2007): S76—S81. http://dx.doi.org/10.1016/j.diabres.2007.01.070.

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Kajitani, Shinya. "Working in old age and health outcomes in Japan." Japan and the World Economy 23, no. 3 (August 2011): 153–62. http://dx.doi.org/10.1016/j.japwor.2011.06.001.

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Glynn, Kevin, Frank McKenna, Kevin Lally, Muireann O’Donnell, Sandeep Grover, Subho Chakrabarti, Ajit Avasthi, et al. "How do delirium motor subtypes differ in phenomenology and contributory aetiology? a cross-sectional, multisite study of liaison psychiatry and palliative care patients." BMJ Open 11, no. 4 (April 2021): e041214. http://dx.doi.org/10.1136/bmjopen-2020-041214.

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ObjectivesTo investigate whether delirium motor subtypes differ in terms of phenomenology and contributory aetiology.DesignCross-sectional study.SettingInternational study incorporating data from Ireland and India across palliative care, old age liaison psychiatry and general adult liaison psychiatry settings.Participants1757 patients diagnosed with delirium using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM IV).Primary and secondary outcome measuresHyperactive, mixed and hypoactive delirium subtypes were identified using the abbreviated version of the Delirium Motor Subtype Scale. Phenomenology was assessed using the Delirium Rating Scale Revised. Contributory aetiologies were assessed using the Delirium Aetiology Checklist (DEC), with a score >2 indicating that the aetiology was likely or definitely contributory.ResultsHypoactive delirium was associated with dementia, cerebrovascular and systemic infection aetiologies (p<0.001) and had a lower overall burden of delirium symptoms than the other motor subtypes. Hyperactive delirium was associated with younger age, drug withdrawal and the DEC category other systemic aetiologies (p<0.001). Mixed delirium showed the greatest symptom burden and was more often associated with drug intoxication and metabolic disturbance (p<0.001). All three delirium motor subtypes had similar levels of impairment in attention and visuospatial functioning but differed significantly when compared with no subtype (p<0.001).ConclusionsThis study indicates a pattern of aetiology and symptomatology of delirium motor subtypes across a large international sample that had previously been lacking. It serves to improve our understanding of this complex condition and has implications in terms of early detection and management of delirium.

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Draper, Brian, and Lee-Fay Low. "What is the effectiveness of acute hospital treatment of older people with mental disorders?" International Psychogeriatrics 17, no. 4 (September 27, 2005): 539–55. http://dx.doi.org/10.1017/s1041610205001663.

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Aim: To appraise the effectiveness of acute hospital service delivery in old age psychiatry.Method: A systematic literature search of the Medline, PsycINFO, CINAHL, EMBASE and Cochrane Collaboration databases was undertaken to obtain articles published in English from 1966 to May 2004 about old age psychiatry services. Articles were excluded if they did not focus on subjects over 60 years of age, did not include quantitative data on outcomes, or if the intervention was purely pharmacological or a specific non-pharmacological technique. The two authors independently assessed data quality. The overall quality of the evidence for the effectiveness of old age mental health service delivery was rated on an evidence hierarchy that has four levels of evidence.Results: Forty-six studies were identified that met our criteria. The only randomized controlled trials (RCTs) were of consultation/liaison service provision and delirium prevention and hence the best quality evidence is for interventions to prevent delirium, reduce costs and length of stay (LOS) in medical wards (level II). There is lower quality (level III/IV), albeit consistently positive, evidence that acute hospital treatment by old age psychiatry services is effective. By contrast, there is no evidence (level I) that non-psychiatric hospital medical services improve mental health outcomes.Conclusion: There are gaps in our knowledge regarding the effectiveness of acute hospital treatment of mental disorders in old age. Multicenter studies involving comparisons of day hospitals, multidisciplinary community teams and acute hospital settings (old age mental health and adult mental health, with and without post-discharge community care) are required.

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Diniari, Ni Ketut Sri, and Luh Nyoman Alit Aryani. "Characteristics and pharmacological treatment options of delirium patients treated at Sanglah Central General Hospital." International journal of health & medical sciences 5, no. 1 (January 13, 2022): 37–43. http://dx.doi.org/10.21744/ijhms.v5n1.1835.

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Delirium is a syndrome characterized by disturbances of consciousness and cognition that occur acutely and fluctuate. Delirium can be caused by general medical conditions, drug users, sensory disturbances, polypharmacy, etc. The etiology of delirium is diverse and non-specific. The preference of pharmacological therapy in delirium is still a debate. Descriptive research with the retrospective cross-sectional method, using secondary data in medical records at the Sanglah Central General Hospital Denpasar for the period January 1, 2020, to December 31, 2020. Patients who were consulted were 166 people, with sex 57 people (34.3%) and 109 women (65.7%). The incidence of delirium in adults (20-59 years old) and elderly (age 60 years) is the highest with 51.2% and 45.1% respectively. One-third of 45 people (37.2%) had overlapping dementia. Most of the 142 people (85.5%) were experiencing significant life stress. The most common type of delirium was hyperactive delirium (74%). The underlying disease of delirium varies such as the cause of infection (24.1%), intracranial process (19%), malignancy 18.1%, cardiovascular (10.1%), endocrine disorders,(7.8%), kidney disorders (6%), and others in small percentages.

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Gorzoni, Milton Luiz, and Ronaldo Fernandes Rosa. "Beers AGS 2019 criteria in very old hospitalized patients." Revista da Associação Médica Brasileira 66, no. 7 (July 2020): 918–23. http://dx.doi.org/10.1590/1806-9282.66.7.918.

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SUMMARY OBJECTIVE To define the rates and types of potentially inappropriate medications (PIMs) for older adults according to the Beers AGS 2019 criteria in oldest-old patients (aged ≥80 years) hospitalized in an Internal Medicine ward. METHODS A retrospective analysis of prescriptions from medical records of oldest-old patients hospitalized in an Internal Medicine Teaching-Hospital ward using the Beers AGS 2019 criteria was performed. Data was also collected for gender, mean age, days of hospitalization, presence of feeding tube, delirium, and polypharmacy (≥5 drugs/day). The drugs listed in Table 2 of the Beers criteria were considered PIMs. RESULTS The series comprised 39 very old patients (22 men, 17 women), with a mean age of 86.3±4.7 years and hospitalization of 22.8±21.3 days. All patients were admitted via the Emergency Room. Feeding tube placement and polypharmacy occurred in 84.6% of cases and delirium in 71.8%. The prescription of a total of 16 drugs considered PIM was detected by the Beers AGS 2019 criteria (mean 1.8 ± 1.0 PIM per patient). Main prescribed PIMs were Metoclopramide “if necessary” [IN] (41.0% of cases), Omeprazole (38.5%), Regular Insulin [IN] (23.1%), Haloperidol [IN] (18.0%), Quetiapine and Amiodarone (10% each). CONCLUSION In the present series of oldest-old hospitalized patients, significant rates of PIM were found, especially for drugs prescribed as “If Necessary”, thereby increasing the risk of side-effects to that of the common polypharmacy in this age group.

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Silver, Gabrielle, Julia Kearney, Chani Traube, Thomas M. Atkinson, Katarzyna E. Wyka, and John Walkup. "Pediatric delirium: Evaluating the gold standard." Palliative and Supportive Care 13, no. 3 (April 24, 2014): 513–16. http://dx.doi.org/10.1017/s1478951514000212.

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AbstractObjective:Our aim was to evaluate interrater reliability for the diagnosis of pediatric delirium by child psychiatrists.Method:Critically ill patients (N = 17), 0–21 years old, including 7 infants, 5 children with developmental delay, and 7 intubated children, were assessed for delirium using the Diagnostic and Statistical Manual–IV (DSM–IV) (comparable to DSM–V) criteria. Delirium assessments were completed by two psychiatrists, each blinded to the other's diagnosis, and interrater reliability was measured using Cohen's κ coefficient along with its 95% confidence interval.Results:Interrater reliability for the psychiatric assessment was high (Cohen's κ = 0.94, CI [0.83, 1.00]). Delirium diagnosis showed excellent interrater reliability regardless of age, developmental delay, or intubation status (Cohen's κ range 0.81–1.00).Significance of results:In our study cohort, the psychiatric interview and exam, long considered the “gold standard” in the diagnosis of delirium, was highly reliable, even in extremely young, critically ill, and developmentally delayed children. A developmental approach to diagnosing delirium in this challenging population is recommended.

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Milstein, Asher, Ayala Pollack, Guy Kleinman, and Yoram Barak. "Confusion/Delirium Following Cataract Surgery: An Incidence Study of 1-Year Duration." International Psychogeriatrics 14, no. 3 (September 2002): 301–6. http://dx.doi.org/10.1017/s1041610202008499.

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Background: Delirium is frequently observed in clinical practice, particularly in medical and surgical wards and more so among patients at risk, especially elderly with pre-existing central nervous system impairments. Objective: Despite the severe consequences of delirium, epidemiological data relating to incidence of delirium following “minor” surgery are lacking. The aim of the present study was to evaluate the incidence of delirium following cataract surgery in community-dwelling patients. Outcome: For purposes of the present study, the Confusion Rating Scale was used. Results: Of 296 patients fulfilling the inclusion criteria, 13 (4.4%) had had immediate postoperative delirium. The two variables that significantly differentiated between delirious and nondelirious patients were older age (82.1 vs. 73.06 years; p < .001) and more frequent use of benzodiazepine premedication (69% vs. 39.9%; p < .002). Conclusion: These findings suggest that the incidence of delirium following cataract surgery requires greater awareness, possibly changes in premedication, and a longer observation period in the very old.

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Ueda, Naoya, Masakazu Igarashi, Kotoba Okuyama, Hideki Sano, Kanae Takahashi, Zaina P Qureshi, Shigeru Tokita, Asao Ogawa, Yasuyuki Okumura, and Shoki Okuda. "Demographic and clinical characteristics of patients with delirium: analysis of a nationwide Japanese medical database." BMJ Open 12, no. 9 (September 2022): e060630. http://dx.doi.org/10.1136/bmjopen-2021-060630.

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ObjectivesDelirium commonly occurs during hospitalisation and is associated with increased mortality, especially in elderly patients. This study aimed to determine the demographic and clinical characteristics of patients with delirium in the Japanese real-world clinical setting using a nationwide database comprising claims and discharge abstract data.DesignThis was an observational, cross-sectional, retrospective study in hospitalised patients with an incident delirium identified by a diagnosis based on International Classification of Diseases, 10th Revision codes or initiating antipsychotics recommended for delirium treatment in Japan during their hospitalisation.SettingPatients from the Medical Data Vision database including more than 400 acute care hospitals in Japan were evaluated from admission to discharge.ParticipantsOf the 32 910 227 patients who were included in the database between April 2012 and September 2020, a total of 145 219 patients met the criteria for delirium.Primary and secondary outcome measuresDemographic and baseline characteristics, comorbidities, clinical profiles and pharmacological treatments were evaluated in patients with delirium.ResultsThe mean (SD) patient age was 76.5 (13.8) years. More than half of the patients (n=82 159; 56.6%) were male. The most frequent comorbidities were circulatory system diseases, observed in 81 954 (56.4%) patients. Potentially inappropriate medications (PIMs) with risk of delirium including benzodiazepines and opioids were prescribed to 76 798 (52.9%) patients. Approximately three-fourths of these patients (56 949; 74.2%) were prescribed ≥4 PIMs. The most prescribed treatment for delirium was injectable haloperidol (n=82 490; 56.8%). Mean (SD) length of hospitalisation was 16.0 (12.1) days.ConclusionsThe study results provide comprehensive details of the clinical characteristics of patients with delirium and treatment patterns with antipsychotics in the Japanese acute care setting. In this patient population, the prescription rate of injectable haloperidol and PIMs was high, suggesting the need for improved understanding among healthcare providers about the appropriate management of delirium, which may benefit patients.

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Murayama, Hiroshi, Yu Shibui, Yoshiharu Fukuda, and Sachiyo Murashima. "A New Crisis in Japan-Social Isolation in Old Age." Journal of the American Geriatrics Society 59, no. 11 (November 2011): 2160–62. http://dx.doi.org/10.1111/j.1532-5415.2011.03640.x.

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Wang, Tao, Junfei Guo, Zhiyong Hou, and Yingze Zhang. "Risk Factors of Postoperative Delirium in Elderly Patients With Intertrochanteric Fracture: An Age-Stratified Retrospective Analysis of 2307 Patients." Geriatric Orthopaedic Surgery & Rehabilitation 13 (January 2022): 215145932210817. http://dx.doi.org/10.1177/21514593221081779.

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Background Postoperative delirium (POD) is a serious and common complication of intertrochanteric fracture (IF). However, the risk factors for POD remain debated. The purpose of this study was to explore risk factors for POD after IF surgery in elderly patients by age-stratified analysis. Methods A total of 2307 patients who underwent IF surgery in our hospital between Jan. 2017 and Nov. 2020 were included. 128 patients suffering from POD were regarded as the delirium group (DG) and the other patients as the normal group (NG). Univariate and multivariate analyses were conducted. Results In our study, the occurrence of POD after IF surgery in elderly patients was 5.55% (128 of 2307). The results of univariate and multivariate analysis showed that advanced age and patients with a history of dementia were identified as the risk factors for POD. Age-stratified analysis showed different comorbidities influencing POD at different stages of age. Additionally, POD markedly increased along with age. Moreover, compared with younger than 70 years in male patients and younger than 80 years in female patients, patients over the age of 70 for males and over the age of 80 for females had a higher rate of POD. Conclusions Advanced age and patients with a history of dementia were independent risks of delirium after IF surgery in both univariate and multivariate analyses. 70 years old in male patients and 80 years old in female patients may be the cut-off values for a significantly increased rate of POD. Preoperative measures should be taken to lower the incidence of POD. Level of Evidence Prognostic Level III.

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Guerra, C., J. Azevedo, J. Massano, and L. Fernandes. "Delirium and parkinsonic syndrome in elderly." European Psychiatry 26, S2 (March 2011): 835. http://dx.doi.org/10.1016/s0924-9338(11)72540-8.

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Delirium is an acute or subacute syndrome characterized by a fluctuating global disorder of cognition, impairment of attention and awareness, disorganization of thought and speech, perceptual disturbances, hallucinations, as well as hypo or hyperactivity.We present a case report of a 76-year-old woman who developed disorientation, lack of familiar recognition and functional impairment, three days before admission. She was admitted to a Medicine Department and submitted to several laboratory and imaging studies.During this period she presented attention, consciousness fluctuations and agitation that required several treatments, including neuroleptics. Like these symptoms were linked to an important life even that triggered reactive depression, she was transferred to a psychiatric ward. Progressively her clinical state worsened, she became permanently bedridden and was observed by Neurology. She presented moderate to severe parkinsonian signs, namely akinesia and rigidity, predominantly on her left side. Reviewing her clinical past, she had suffered these symptoms during the two years before this episode (apathy, small stepped gait, flexed posture, and left hand rest tremor). Treatment with antiparkinsonic drugs produced a dramatic improvement in the patient’s mental and physical status. A I-Ioflupane-SPECT (DaTscan) confirmed striatal presynaptic dopaminergic degeneration, more on the right side, which was the proof of the presence of a degenerative parkinsonian syndrome.The present clinical case shows Delirium with degenerative Parkinsonism comorbidity, worsened by the use of neuroleptics. We emphasize the importance previously undiagnosed Parkinsonism in old age which is highlighted by usefulness of dopamine transporter imaging in this scenery.

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Lin, Chien-ho, Wan-Lin Cheng, Szu-Hsien Chiang, and Pei-Chi Liu. "Psychiatry engagement in the management of delirium in general hospital patients." Jurnal Psikiatri Surabaya 11, no. 1 (May 30, 2022): 7–13. http://dx.doi.org/10.20473/jps.v11i1.33263.

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Background: Delirium is a common and serious problem in patients with medical illness. The overall prevalence rate of delirium was 10~31% in hospital general medical in-patient settings. The purpose of this study is to examine the characteristics of patients with delirium encountered during the consultation of psychiatric departments in other departments of general hospitals, the benefit of consultation. Methods: We reviewed the medical records to collect relevant information. The Confusion Assessment Method-Short (CAM-Short) scale was used to evaluate the severities. Results: Twenty patients were recruited. The average age was 73.9-year-old. All the participants presented with hyperactive delirium. The average initial CAM score was 4.5 and then decreased to 2 after the follow-up. Almost all teams applying for consultation arranged treatment (19 in 20) or examinations (18 in 20) as the suggestion.. Conclusion: In our study, the psychiatric department's consultation services have specific assistance to patients with delirium. The consulting physician should still track the follow-up status of the case and discuss the treatment of delirium with other physicians at an appropriate time. Keywords: Delirium, psychiatric consultation, CAM-S

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Kobayashi, Kazuyoshi, Shiro Imagama, Kei Ando, Naoki Ishiguro, Masaomi Yamashita, Yawara Eguchi, Morio Matsumoto, et al. "Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature: Japan Association of Spine Surgeons with Ambition Multicenter Study." Global Spine Journal 7, no. 6 (April 11, 2017): 560–66. http://dx.doi.org/10.1177/2192568217700115.

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Study Design: Retrospective database analysis. Objective: Spine surgeries in elderly patients have increased in recent years due to aging of society and recent advances in surgical techniques, and postoperative complications have become more of a concern. Postoperative delirium is a common complication in elderly patients that impairs recovery and increases morbidity and mortality. The objective of the study was to analyze postoperative delirium associated with spine surgery in patients aged 80 years or older with cervical, thoracic, and lumbar lesions. Methods: A retrospective multicenter study was performed in 262 patients 80 years of age or older who underwent spine surgeries at 35 facilities. Postoperative complications, incidence of postoperative delirium, and hazard ratios of patient-specific and surgical risk factors were examined. Results: Postoperative complications occurred in 59 of the 262 spine surgeries (23%). Postoperative delirium was the most frequent complication, occurring in 15 of 262 patients (5.7%), and was significantly associated with hypertension, cerebrovascular disease, cervical lesion surgery, and greater estimated blood loss ( P < .05). In multivariate logistic regression using perioperative factors, cervical lesion surgery (odds ratio = 4.27, P < .05) and estimated blood loss ≥300 mL (odds ratio = 4.52, P < .05) were significantly associated with postoperative delirium. Conclusions: Cervical lesion surgery and greater blood loss were perioperative risk factors for delirium in extremely elderly patients after spine surgery. Hypertension and cerebrovascular disease were significant risk factors for postoperative delirium, and careful management is required for patients with such risk factors.

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Wong, Alfred, and Kimberley Boyle. "Old age liaison psychiatry: audit assessing adherence to referral pathway and referral characteristics including indications, interventions and outcomes." BJPsych Open 7, S1 (June 2021): S112—S113. http://dx.doi.org/10.1192/bjo.2021.330.

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AimsThis audit covered 3 hospitals in Glasgow City which has 1221 beds providing inpatient healthcare for the north east region of the city. To improve the referral process,we aimed to verify adherence to existing referral pathway and adequacy of information provided by referrals. Referral characteristics including referral indication, intervention and outcomes were accounted for to identify area interest that may help improve the referral process.MethodOur referral pathway involves completion of a Microsoft Word referral template subsequently sent electronically to an internal electronic mail.Referrals in a 2 month period were included in the audit. Each referral was reviewed for adherence to the referral template, adequacy of provided information and referral indications. Intervention in the form of staff input, Mental Health Act status, psychotropic medication prescribed and given diagnosis was ascertained via staff electronic entry records.Result139 referrals were included. 114 referrals (82%) adhered to the referral template. 72 referrals (52%) contained adequate information. Common referral indications were delirium (23%), agitation (20%), low mood (18%) and cognitive decline queries (18%). Staff input ranged from psychiatrist input (46%), liaison nurses (40%), clinical psychology (1%) and shared input (13%). 16 referrals (12%) resulted in subsequent detention under the Mental Health Act. Psychotropic medications prior to liaison assessment included antidepressants (49%), antipsychotics (29%) and benzodiazepines (16%). Liaison assessment resulted in increase use of antipsychotic (55%) and reduction of antidepressants (29%) and benzodiazepines (10%), Delirium (34%), dementia (21%), Mood & Anxiety related disorders (18%) and Query of Cognitive Impairment (14%) were recorded as the most discussed diagnosis.ConclusionReferrals with inadequate details affect the service's ability to efficiently assess for clinical urgency and matching of appropriate interventions to suit clinical needs. The percentage difference in delirium between referral indication and diagnosis highlights that delirium can be under-recognised, resulting in potentially delayed treatment. Identifying common given diagnosis and differences in psychotropic medication prescribing pattern points to the need for training and support of acute medical ward staff in utilising therapeutics for management of acute mental health disorder.A pending electronic referral pathway with mandatory entries and linked relevant online resources can encourage early recognition of acute mental health disorder and prompt early management including the use of appropriate therapeutics. An additional feature allowing direct referrals by acute ward staff to community mental health team would support continuity of care for discharged patients needing ongoing mental health assessment.

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Durmayüksel, Esra, Fadime Çinar, Bulent Baris Guven, and Fatma Eti Aslan. "Risk factors for the development of delirium in elderly patients undergoing orthopaedic surgery: A systematic review and metaanalysis." Journal of Clinical and Investigative Surgery 6, no. 2 (November 15, 2021): 94–103. http://dx.doi.org/10.25083/2559.5555/6.2.3.

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Objective. Delirium is a temporary neuropsychiatric syndrome characterized by fluctuations in cognition and attention. Delirium is one of the most common complications seen in old individuals after orthopaedic surgery. With a high incidence, the clinical picture of delirium increases the length of hospital stay and increases healthcare-related costs. This study has aimed to systematically review the national and international studies that investigated the risk factors leading to delirium in geriatric patients after orthopaedic surgery and to perform a meta-analysis using the data reported by those studies. Materials and Methods. A preliminary literature review was performed on six databases. The following English keyword combinations were used including 'Orthopaedic Surgery', 'Geriatrics', 'Elderly', and 'Delirium'. The results of trials were evaluated with random or fixed effect model according to the heterogeneity. Statistical evaluation was performed by using Comprehensive Meta Analysis version 3 programme. Results. The total sample size of the studies included in the analysis was 892. In geriatric patients; who had undergone orthopaedic surgery and developed delirium, the random-effects model revealed a high-level, in the positive direction, and statistically significant (p<0.05) overall effect size of 5.21 (CI; 1.33-20.33) for gender, 1.33 (CI; 0.58-2.06) for age, 11.30 (CI; 4.70-27.12 for polypharmacy, and a low-level, in the positive direction, and statistically significant (p<0.05) overall effect size of 0.12 (CI; 0.05-0.27) for mini-mental state examination as the risk factors leading to the development of delirium. Conclusions. Advanced age, female gender, polypharmacy, and a mini-mental state examination score of 17-23 are major risk factors for the development of delirium after orthopaedic surgery.

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Liang, J., J. Bennett, N. Krause, E. Kobayashi, H. Kim, J. W. Brown, H. Akiyama, H. Sugisawa, and A. Jain. "Old Age Mortality in Japan: Does the Socioeconomic Gradient Interact With Gender and Age?" Journals of Gerontology Series B: Psychological Sciences and Social Sciences 57, no. 5 (September 1, 2002): S294—S307. http://dx.doi.org/10.1093/geronb/57.5.s294.

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Kojima, Yuki, Kiichi Furuse, Takeshi Murouchi, Kazuya Hirabayashi, Motoi Kato, and Tatsuhiro Oka. "Ultrasound-Guided Local Anesthetic Nerve Blocks in a Forehead Flap Reconstructive Maxillofacial Procedure." Anesthesia Progress 67, no. 3 (September 1, 2020): 164–69. http://dx.doi.org/10.2344/anpr-67-02-04.

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Head and neck reconstructive surgery involving tissue flaps is often complex requiring the development of an individualized anesthetic plan. The following case report describes the anesthetic management of an 87-year-old man considered at high risk for postoperative delirium due to advanced age and blindness undergoing general anesthesia for resection of squamous cell carcinoma of the right side of the nose and reconstructive surgery with a scalping forehead flap. Ultrasound-guided local anesthetic maxillary and supraorbital nerve blocks were successfully used perioperatively to reduce the need for alternative analgesics associated with higher risks of complications such as postoperative nausea, vomiting, and delirium.

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Kim, Heekyoung. "Changing Images of Old Age and Politics of Representation in Japan." Comparative Japanese Studies 45 (June 30, 2019): 1–30. http://dx.doi.org/10.31634/cjs.2019.45.001.

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Cooper, Michael, Sepp Linhart, and Fleur Woss. "Old Age in Japan: An Annotated Bibliography of Western-Language Materials." Monumenta Nipponica 40, no. 2 (1985): 243. http://dx.doi.org/10.2307/2384731.

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Schoeni, Robert F., Jersey Liang, Joan Bennett, Hidehiro Sugisawa, Taro Fukaya, and Erika Kobayashi. "Trends in old-age functioning and disability in Japan, 1993–2002." Population Studies 60, no. 1 (March 2006): 39–53. http://dx.doi.org/10.1080/00324720500462280.

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Daoust, R., J. Paquet, J. Lee, E. Gouin, P. Voyer, M. Pelletier, A. Nadeau, V. Boucher, and M. Emond. "LO91: Relationship between pain, opioid treatment, and delirium in emergency department elderly patients." CJEM 20, S1 (May 2018): S39. http://dx.doi.org/10.1017/cem.2018.153.

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Introduction: Emergency department (ED) stay and its associated conditions (immobility, inadequate hydration and nutrition, lack of stimulation) favor the development of delirium in vulnerable elderly patients. Poorly controlled pain, and paradoxically opioid pain treatment, has also been identified as a trigger for delirium. The aim of this study was to assess the relationship between pain, opioid treatment, and delirium in elderly ED patients. Methods: A multicenter prospective cohort study was conducted in four hospitals across the province of Québec (Canada). Patients aged 65 years old, waiting for care unit admission between February and May 2016, who were non-delirious upon ED arrival, independent or semi-independent for their activities of daily living, and had an ED stay of at least 8 hours were included. Delirium assessments were made twice a day for their entire ED stay and for the first 24 hours in the hospital ward using the Confusion Assessment Method (CAM). Pain intensity was evaluated using a visual analog scale (0-100) during the initial interview, and all opioid treatments were documented. Results: A total of 338 patients were included; 51% were female, mean age was 77 years (SD: 8). Forty-one patients (12%) experienced delirium during their hospital stay occurring within a mean delay of 47 hours (SD: 19) after ED admission. Among patients with pain intensity 60, 22% experienced delirium compared to 10.7% for patients with pain <60 (p<0.05). No significant association was found between opioid consumption and delirium (p=0.22). Logistic regression controlling for age, sex, ED stay duration, and opioids intake showed that patients with pain intensity 60 are 2.6 (95%CI: 1.2-5.9) more likely to develop delirium than patients who had pain <60. Conclusion: Severe pain, not opioids, is associated with the development of delirium during ED stay. Adequate pain control during the hospital stay may contribute to the decrease of delirium episodes.

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Nguyen, Trinh H., Rabia S. Atayee, Katrina L. Derry, Jeremy Hirst, Anthony Biondo, and Kyle P. Edmonds. "Characteristics of Hospitalized Patients Screening Positive for Delirium." American Journal of Hospice and Palliative Medicine® 37, no. 2 (July 30, 2019): 142–48. http://dx.doi.org/10.1177/1049909119867046.

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Background: Delirium in the hospitals leads to worse outcomes for patients. There were no previous studies that characterize patients with delirium from multiple hospital locations. Objective: To describe patient characteristics screening positive for delirium and identify any correlations with hospital location and medication use. Design, Settings, Patients: Retrospective chart review of 227 hospitalized patients from a large, academic, tertiary referral, 2-campus health system. Patients were ≥18 years old and had delirium for at least ≥24 hours. Validated delirium screening tools were utilized. Measurements: Patients’ demographics, inpatient stay information, delirium episodes characteristics, drugs, and palliative and psychiatry teams’ involvement. Results: Most patients were older with a mean age of 64.1 years. The most common primary diagnoses were infection, cardiac, and pulmonary. Average length of delirium was 7.2 days (standard deviation [SD] = 8.2), and average length of stay (LOS) was 18.7 days (median = 10.5, SD = 35.1, 95% confidence interval = 14.1-23). Thirty-day readmission rate was 24.8% (65/262 hospitalizations); 12.8% of patients died in the hospital (29/227). Around one-third of hospitalizations had involvement of palliative care, palliative psychiatry, or general psychiatry team. There was a decrease in the number of medications administered 24 hours after the first recording of delirium compared to the immediate preceding 48 hours. Those hospitalizations where delirium first occurred in the intensive care unit (ICU) did have a longer LOS (average = 22.9, SD = 45.7) than those where delirium first occurred outside the ICU (average = 14.8, SD = 20.5). Patients were likely to have received an opioid within 48 hours in 51% of hospitalizations and to have received benzodiazepines in 16% of hospitalizations. Conclusion: In our study, we found that delirium significantly impacted length of delirium episode, number of episodes of delirium, length of hospital admission, and mortality. The population most sensitive to the impacts of delirium were elderly patients.

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Sivolap, Y., I. Damulin, and S. Mendelevich. "Mental Disorders Following Delirium Tremens: Preliminary Data." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70691-1.

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Symptoms of states following delirium tremens have not been adequately studied until now. We observed 24 alcoholic males aged from 29 to 62 years old (mean age 44 ± 11 years) in early period after delirium tremens. Post-psychotic period in nineteen cases was characterized by severe brain organic symptoms, including emotional disorders, cognitive dysfunction and alcoholic anosognosia. Emotional disorders included the prevalence of euphoric affect with light-heartedness in evaluation of their own health. Cognitive dysfunction included deceleration of thought, decrease of abstraction ability and logic thinking, difficulties in counting. Eleven patients had disturbances of short memory, which in 8 cases reach degree of fixative amnesia. Alcoholic anosognosia was closely related to emotional and cognitive disorders, including the loss of light-minded attitude to their disease and to the consequences of the psychosis. The severity of post-delirious disorders positively correlated with age of patients and the duration of alcohol abuse. Brain organic symptoms were more severe in patients with repeated psychosis. Post-delirious disorders gradually reduced in 11-28 (mean 18 ± 4) days after complete reduction of psychosis. Our findings suggest that these disturbances can be a benign equivalent of acute transient forms of Korsakoff disease. Development of post-psychotic brain organic symptoms, including euphoria, loss of critics and anosognosia, suggests adverse influence of delirium tremens on the clinical course and prognosis of the disease, but this assumption requires corroboration during further studies.

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Journal articles on the topic 'Delirium in old age Japan'

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