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Kawaura, Takayuki, and Yasuyuki Sugatani. "Clinical Nurses’ Awareness Structure of Delirium – An Analysis of Spontaneous Utterances in a Group Interview by DEMATEL Method –." Journal of Advanced Computational Intelligence and Intelligent Informatics 18, no. 6 (November 20, 2014): 1013–19. http://dx.doi.org/10.20965/jaciii.2014.p1013.
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In the 1990s, the Japanese population aged 65 and over increased to more than 14%, and Japan became an “aging society.” Now, one in five people are 65 or over (23.4%, and one in ten people are 75 or over (1.6%, meaning that Japanese society is aging substantially. The serious problems that acute hospitals now face involve complications of diseases that are typified by deliriu, and their prevention. Patients with delirium have a higher risk of falling and dying, and delirium has a negative influence on treatment and nursing as well as on a patient’s vital prognosis. However, delirium is a mental state that is often overlooked. Thus, it is very important to develop the observation skills of staff and establish a nursing care system that does not overlook delirium. In this study, we conducted group interviews involving the clinical nurses who care for patients with delirium on a routine basis at Kansai Medical University Takii Hospital, Japan. Their spontaneous utterances about delirium were analyzed using the DEMATEL method, and these utterances were divided into two groups: “causes of delirium” and “delirious patients’ behavior.” From each group, keywords and phrases were chosen and analyzed. Consequently, this study will demonstrate how these clinical nurses feel about delirium and delirious patients.
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Emond, M., A. Nadeau, V. Boucher, P. Voyer, M. Pelletier, E. Gouin, R. Daoust, et al. "MP11: Underreport of incident delirium in elderly patients treated in the emergency department." CJEM 20, S1 (May 2018): S44. http://dx.doi.org/10.1017/cem.2018.165.
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Introduction: It is documented that physicians and nurses fail to detect delirium in more than half of cases from various clinical settings, which could have serious consequences for seniors and for our health care system. The present study aimed to describe the rate of documented incident delirium in 5 Canadian Emergency departments (ED) by health professionals (HP). Methods: This study is part of the multicenter prospective cohort INDEED study. Patients aged 65 years old, initially free of delirium with an ED stay 8hours were followed up to 24h after ward admission. Delirium status was assessed twice daily using the Confusion Assessment Method (CAM) by trained research assistants (RA). HP reviewed patient charts to assess detection of delirium. HP had no specific routine detection of delirious ED patients. Inter-observer agreement was realized among RA. Comparison of detection between RA and HP was realized with univariate analyses. Results: Among the 652 included patients, 66 developed a delirium as evaluated with the CAM by the RA. Among those 66 patients, only 10 deliriums (15.2%) were documented in the patients medical file by the HP. 54 (81.8%) patients with a CAM positive for delirium by the RA were not recorded by the HP, 2 had incomplete charts. The delirium index was significantly higher in the HP reported group compared to the HP not reported, respectively 7.1 and 4.5 (p<0.05). Other predictive delirium variables, such as cognitive status, functional status, comorbidities, physiological status, and ED and hospital length of stay were similar between groups. Conclusion: It seems that health professionals missed 81.8% of the potential delirious ED patients in comparison to routine structured screening of delirium. HP could identify patients with a greater severity of symptoms. Our study points out the need to better identify elders at risk to develop delirium and the need for fast and reliable tools to improve the screening of this disorder.
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Falsini, Giovanni, Simone Grotti, Italo Porto, Giulio Toccafondi, Aureliano Fraticelli, Paolo Angioli, Kenneth Ducci, et al. "Long-term prognostic value of delirium in elderly patients with acute cardiac diseases admitted to two cardiac intensive care units: a prospective study (DELIRIUM CORDIS)." European Heart Journal: Acute Cardiovascular Care 7, no. 7 (March 16, 2017): 661–70. http://dx.doi.org/10.1177/2048872617695235.
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Background: Delirium is a frequent in-hospital complication in elderly patients, and is associated with poor clinical outcome. Its clinical impact, however, has not yet been fully addressed in the setting of the cardiac intensive care unit (CICU). The present study is a prospective, two-centre registry aimed at assessing the incidence, prevalence and significance of delirium in elderly patients with acute cardiac diseases. Methods: Between January 2014 and March 2015, all consecutive patients aged 65 years or older admitted to the CICU of our institutions were enrolled and followed for 6 months. Delirium was defined according to the confusion assessment method. Results: During the study period, 726 patients were screened for delirium. The mean age was 79.1±7.8 years. A total of 111 individuals (15.3%) were diagnosed with delirium; of them, 46 (41.4%) showed prevalent delirium (PD), while 65 (58.6%) developed incident delirium (ID). Patients 85 years or older showed a delirium rate of 52.3%. Hospital stay was longer in delirious versus non-delirious patients. Patients with delirium showed higher in-hospital, 30-day and 6-month mortality compared to non-delirious patients, irrespective of the onset time (overall, ID or PD). Six-month re-hospitalisation was significantly higher in overall delirium and the PD group, as compared to non-delirious patients. Kaplan–Meier analysis showed a significant reduction of 6-month survival in patients with delirium compared to those without, irrespective of delirium onset time (i.e. ID or PD). A positive confusion assessment method was an independent predictor of short and long-term mortality. Conclusions: Delirium is a common complication in elderly CICU patients, and is associated with a longer and more complicated hospital stay and increased short and long-term mortality. Our findings suggest the usefulness of a protocol for the early identification of delirium in the CICU. Clinicaltrials.gov: NCT02004665
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Rood, Paul J. T., Dharmanand Ramnarain, Annemarie W. Oldenbeuving, Brenda L. den Oudsten, Sjaak Pouwels, Lex M. van Loon, Steven Teerenstra, Peter Pickkers, Jolanda de Vries, and Mark van den Boogaard. "The Impact of Non-Pharmacological Interventions on Delirium in Neurological Intensive Care Unit Patients: A Single-Center Interrupted Time Series Trial." Journal of Clinical Medicine 12, no. 18 (September 7, 2023): 5820. http://dx.doi.org/10.3390/jcm12185820.
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Background: Delirium is a pathobiological brain process that is frequently observed in Intensive Care Unit (ICU) patients, and is associated with longer hospitalization as well as long-term cognitive impairment. In neurological ICU patients, delirium may be more treatment-resistant due to the initial brain injury. This study examined the effects of a multicomponent non-pharmacological nursing intervention program on delirium in neurological ICU patients. Methods: A single-center interrupted time series trial was conducted in adult neurological ICU patients at high risk for developing delirium who were non-delirious at admission. A multicomponent nursing intervention program focusing on modifiable risk factors for delirium, including the optimalization of vision, hearing, orientation and cognition, sleep and mobilization, was implemented as the standard of care, and its effects were studied. The primary outcome was the number of delirium-free and coma-free days alive at 28 days after ICU admission. The secondary outcomes included delirium incidence and duration, ICU and hospital length-of-stay and duration of mechanical ventilation. Results: Of 289 eligible patients admitted to the ICU, 130 patients were included, with a mean age of 68 ± 11 years, a mean APACHE-IV score of 79 ± 25 and a median predicted delirium risk (E-PRE-DELIRIC) score of 42 [IQR 38–50]). Of these, 73 were included in the intervention period and 57 in the control period. The median delirium- and coma-free days alive were 15 days [IQR 0–26] in the intervention group and 10 days [IQR 0–24] in the control group (level change −0.48 days, 95% confidence interval (95%CI) −7 to 6 days, p = 0.87; slope change −0.95 days, 95%CI −2.41 to 0.52 days, p = 0.18). Conclusions: In neurological ICU patients, our multicomponent non-pharmacological nursing intervention program did not change the number of delirium-free and coma-free days alive after 28 days.
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Heymann, A., M. Sander, D. Krahne, M. Deja, S. Weber-Carstens, M. MacGuill, M. Kastrup, KD Wernecke, I. Nachtigall, and CD Spies. "Hyperactive Delirium and Blood Glucose Control in Critically Ill Patients." Journal of International Medical Research 35, no. 5 (September 2007): 666–77. http://dx.doi.org/10.1177/147323000703500511.
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Delirium is a common complication of critically ill patients and is often associated with metabolic disorders. One of the most frequent metabolic disorders in intensive care unit (ICU) patients is hyperglycaemia. The aim of this retrospective study of 196 adult ICU patients was to determine if there is an association between hyperactive delirium and blood glucose levels in ICU patients. Hyperactive delirium was diagnosed using the delirium detection score. Blood glucose levels were monitored by blood gas analysis every 4 h. Hyperactive delirium was detected in 55 (28%) patients. Delirious patients showed significantly higher blood glucose levels than non-delirious patients Higher overall complication rates, length of ventilation, ICU stay and mortality rates were seen in the delirium group. In a multivariate analysis, glucose level, alcohol abuse, APACHE II score, complication by hospital-acquired pneumonia and a diagnosis of polytrauma on-admission all significantly influenced the appearance of delirium.
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Ren, Quan, Ya-zhou Wen, Jin Wang, Jing Yuan, Xu-hui Chen, Yubaraj Thapa, Meng-shuang Qiang, and Fei Xu. "Elevated Level of Serum C-reactive Protein Predicts Postoperative Delirium among Patients Receiving Cervical or Lumbar Surgery." BioMed Research International 2020 (August 10, 2020): 1–8. http://dx.doi.org/10.1155/2020/5480148.
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Objective. To explore the relationship between elevated serum C-reactive protein (CRP) level and postoperative delirium (POD). Methods. 206 patients scheduled to receive cervical or lumbar vertebra surgery under general anesthesia for more than 2 hours in a single medical center were observed and analyzed. Patients’ serum CRP, delirious status (using the confusion assessment method (CAM)), and delirious score (using the memorial delirium assessment scale (MDAS)) were examined before surgery and 1-2 days after surgery. The association of a serum CRP elevation value from before to after surgery (D-CRP) with delirium occurrence within 2 days after surgery was assessed with a binary logistic regression model, while the association of D-CRP with the postoperative delirious score was assessed with a linear regression model. The effect of D-CRP on predicting delirium occurrence was evaluated with the area under the receiver operating characteristic (ROC) curve (AUC). Results. D-CRP was significantly positively associated with postoperative delirium occurrence (OR=1.047, 95%CI=1.013, 1.082), and D-CRP was also significantly linearly associated with the postoperative delirious score (β=0.014, 95%CI=0.006, 0.023). AUC of ROC was 0.711 (P=0.014), suggesting that D-CRP had moderate efficacy on predicting postoperative delirium occurrence (P<0.05). Conclusions. Elevated serum CRP after surgery may be a risk factor for and a predictor of postoperative delirium.
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Adamis, D., J. Williams, K. Finn, V. Melvin, D. Meagher, and G. McCarthy. "Brain-derived Neurotrophic Factor (BDNF) Levels and Delirium." European Psychiatry 41, S1 (April 2017): s237. http://dx.doi.org/10.1016/j.eurpsy.2017.01.2263.
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IntroductionStudies of the association between blood BDNF levels and delirium are very few and have yielded mixed results.ObjectivesTo investigate the blood BDNF levels in the occurrence and recovery of delirium.MethodsProspective, longitudinal study. Participants were assessed twice weekly with MoCA, DRS-R98, APACHE-II. BDNF levels of the same were estimated with ELISA method. Delirium has been define as per DRS-98R (cut-off > 16) and recovery of delirium as at least two consequently assessments without delirium prior to discharge.ResultsNo differences in the levels of BDNF between those with delirium and those who never developed it. Excluding those who never developed delirium (n = 140), we analysed the effects of BDNF and the other variables on delirium resolution and recovery. Of the 58 remained with delirium in the subsequently observations (max = 8) some of them continue to be delirious until discharge or death (n = 39) while others recovered (n = 19). BDNF levels and MoCA scores were significantly associated with both delirium cases who became non-delirious (resolution) during the assessments and with overall recovery. BDNF (Wald χ2 = 11.652, df: 1 P = .001), for resolution. For recovery Wald χ2 = 7.155; df: 1, P = .007. No significant association was found for the other variables (APACHE-II, history of dementia, age or gender)ConclusionsBDNF do not have a direct effect in the occurrence of delirium but for those delirious of whom the levels are increased during the hospitalisation they are more likely to recover from delirium.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Sullinger, Danine, Alexander Gilmer, Lesly Jurado, Lisa Hall Zimmerman, Joshua Steelman, Ann Gallagher, Tiffany Dupre, and Elizabeth Acquista. "Development, Implementation, and Outcomes of a Delirium Protocol in the Surgical Trauma Intensive Care Unit." Annals of Pharmacotherapy 51, no. 1 (October 1, 2016): 5–12. http://dx.doi.org/10.1177/1060028016668627.
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Background: Delirium in the critically ill is associated with increased mortality, length of stay (LOS), and prolonged cognitive dysfunction. Existing guidelines provide no recommendation for use of combination nonpharmacological and pharmacological prevention protocols or use of antipsychotic medications for the prevention or treatment of delirium. Objective: This study evaluated the impact of implementing a delirium treatment protocol on the number of delirium-free days experienced by acutely delirious patients in the surgical trauma intensive care unit (STICU). Methods: This retrospective, institutional review board–approved, pre-implementation (PRE) versus post-implementation (POST) cohort evaluated delirious patients admitted to the STICU. Patients were evaluated based on the duration of delirium. Secondary end points included ICU LOS, amount of atypical and typical antipsychotic medication used, amount of analgesia and sedation used, and adverse drug events associated with antipsychotics. Results: Of the 593 evaluated, 89 patients were included (38 PRE vs 51 POST). Implementation of a delirium protocol reduced the number of delirious days, 8.2 ± 5.7 days PRE versus 4.5 ± 4.4 days POST; P = 0.001. ICU LOS in surviving patients and use of concomitant medications, intravenous morphine equivalents, and propofol were significantly reduced in the POST group. Conclusion: The implementation of a delirium protocol with nonpharmacological and pharmacological interventions had an impact on STICU patients experiencing acute delirium by significantly increasing delirium-free days and reducing the ICU LOS, in addition to decreased administration of concomitant medications.
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Kok Kendirlioglu, Burcu, Esma Corekli Kaymakci, Suat Kucukgoncu, Bugra Cetin, and Hidayet Ece Arat Celik Ece Arat Celik. "DELIRIOUS MANIA OR HYPERACTIVE DELIRIUM? A CASE REPORT." PSYCHIATRIA DANUBINA 35, no. 3 (October 23, 2023): 433–35. http://dx.doi.org/10.24869/psyd.2023.433.
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Suleman, A., J. Krakovsky, and P. Joo. "LO15: Treatment of asymptomatic bacteriuria in elderly patients with delirium: a systematic review." CJEM 20, S1 (May 2018): S11—S12. http://dx.doi.org/10.1017/cem.2018.77.
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Introduction: It is typical to look for UTI in delirious elderly patients, despite a high prevalence of asymptomatic bacteriuria (ASB) in this population. A common presentation of infection is delirium, which often has a non-specific and multifactorial etiology. Therefore, when bacteriuria is present with delirium in the absence of urinary symptoms, physicians prescribe antibiotics for the suspected UTI-induced delirium. We set to determine whether antibiotic treatment in the elderly presenting with delirium in the presence of ASB resulted in resolution of delirium. Methods: Literature searches were performed in MEDLINE, EMBASE, CINAHL and Cochrane Library. Abstracts were independently reviewed by two authors for decision to include for full-text review. Inclusion criteria included female gender, >65 years of age, presenting in an acute care setting with delirium and ASB. The primary outcome was resolution of delirium. The secondary outcomes were mortality, frequency of side effects from antibiotics, length of hospital stay and readmission for delirium. Results: 930 abstracts published from 1946-2017 were screened, and 42 were included for full text review. No studies were eligible for inclusion in the systematic review, as none addressed the primary outcome. One study addressed the outcomes of poor functional recovery after delirium and the rate of improvement of delirium symptoms after presentation of delirium with ASB. Conclusion: Even though current guidelines recommend against treatment of ASB, no guideline states whether ASB should be treated in elderly patients with delirium. Little evidence exists to elucidate whether treating delirious patients with ASB results in improvement in outcomes. Future studies should focus on demonstrating the relationship between resolution of delirium with antibiotic treatment. This will clarify whether delirium is a true symptom of ASB and whether treatment results in faster resolution of delirium.
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Woodward, Jennifer, and Tru Byrnes. "A Delirium Risk Stratification Tool and Interdisciplinary Rounds to Prevent Delirium in Hospitalized Older Adults." Innovation in Aging 5, Supplement_1 (December 1, 2021): 593. http://dx.doi.org/10.1093/geroni/igab046.2279.
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Abstract Delirium is a disturbance of attention accompanied by a change in baseline cognition that is commonly seen in acute care settings, and effects up to 80% of ICU patients. The development of delirium has adverse effects on patient outcomes and high health care costs. Of patients aged 65+ admitted to our hospital in 2019, non-delirious patients had a five-day length of stay (LOS) compared to a 10-14 days LOS in delirious patients. A five days LOS increase adds an additional $ 8,325 per patient for an extra annual cost of 15 million dollars. Additionally, delirium is often not recognized. A prior retrospective study showed that 31% of older adults seen by a Geriatrics provider were diagnosed with delirium, while only 11% were detected by nurse’s CAM screen. Given the need to improve delirium detection and management, a QI project was undertaken with a goal to recruit an interdisciplinary team, create a risk stratification tool to identify patients at substantial risk for developing delirium, and develop a delirium prevention protocol. Patients with a score of ≥ 4 were initiated on a nurse driven delirium protocol that included a delirium precaution sign and caregiver education. 6 months data has shown increased delirium detection of 33%, a reduction in 7.7 days LOS, reduced SNF discharge by 27%, and a significant LOS saving of 231 days. The results were statistically significant, p < 0.04 for LOS reduction. The cost avoidance in LOS alone were $384,615 for delirium patients.
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Maldeniya, Pramudith M., and Akshya Vasudev. "Is the Concept of Delirious Mania Valid in the Elderly? A Case Report and a Review of the Literature." Case Reports in Psychiatry 2013 (2013): 1–5. http://dx.doi.org/10.1155/2013/432568.
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Delirious mania has been well recognized in the published literature and in the clinic. Over the years there has been refinement of understanding of its clinical features, course, and treatment. The literature suggests that delirious mania should be considered in individuals who present with a constellation of sudden onset delirium, mania, and psychosis. However, delirious mania is not recognized under a formal classification system nor are there any formal guidelines for its treatment. We, as such, question if the concept of delirious mania in the elderly is valid. We present a case of an elderly man with marked features of delirium with minimal manic or psychotic features who had a previous diagnosis of bipolar I disorder. On thorough clinical assessments no identifiable cause of his delirium was found. We therefore considered his presentation to be more likely due to delirious mania. Electroconvulsive therapy was considered and offered to which he responded very well. We invite the reader to consider whether delirious mania is a valid concept in the elderly, where features of delirium may be more prominent than manic or psychotic features.
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Jiang, Shixie, Philip A. Efron, Esther S. Oh, and Steven T. DeKosky. "Optical Neuroimaging in Delirium." Photonics 10, no. 12 (December 1, 2023): 1334. http://dx.doi.org/10.3390/photonics10121334.
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Delirium persists as the most common neuropsychiatric syndrome among medically ill hospitalized patients, yet its neural mechanisms remain poorly understood. The development of neuroimaging biomarkers has been difficult primarily due to the complexities of imaging patients experiencing delirium. Optical imaging techniques, including near-infrared spectroscopy (NIRS) and diffuse optical tomography (DOT), offer promising avenues for investigating delirium’s pathophysiology. These modalities uniquely stand out for delirium exploration due to their blend of spatiotemporal resolution, bedside applicability, cost-effectiveness, and potential for real-time monitoring. In this review, we examine the emergence of optical imaging modalities and their pioneering utility in delirium research. With further investment and research efforts, they will become instrumental in our understanding of delirium’s pathophysiology and the development of preventive, predictive, and therapeutic strategies.
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Sánchez Caraballo, ´Álvaro, Jorge Herrera Herrera, Néider Cárdenas Díaz, and Edison Oyola López. "Delirio en pacientes con síndrome coronario agudo en una unidad de cuidados intensivos." Revista avances en salud 3, no. 1 (June 24, 2019): 26–33. http://dx.doi.org/10.21897/25394622.1763.
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El Delirio es una variación aguda del estado de conciencia, frecuente en la unidad de cuidados intensivos (UCI). Su incidencia varía ampliamente, presentando diferentes características clínicas correlacionadas. Objetivo. Determinar la incidencia de delirium en pacientes con síndrome coronario agudo (SCA) en la UCI, e identificar sus características clínicas asociadas, así como la correlación del delirio (CAM-ICU) y el grado de severidad de la enfermedad (APACHE-II). Materiales y métodos. Estudio descriptivo, prospectivo, cuantitativo. Realizado durante el cuarto bimestre del 2015. A los pacientes bajo los criterios de inclusión, se les aplicó la herramienta diagnóstica CAM-ICU, para detectar la presencia de delirium, así como una revisión de la historia clínica, y operacionalización de variables. Luego de un análisis estadístico multivariado de tipo descriptivo y correlacional se obtuvieron los objetivos planteados. Resultados. La incidencia de delirio en el grupo clínico estudiado fue del 37,5%, con promedio de edad para pacientes con delirium de 67 años vs 64 años para los que no presentaron. El grado de asociación entre el delirium y las características clínicas operacionalizadas presenta una significancia mayor a 0,05%, al igual que la relación entre el delirium y el porcentaje de mortalidad según APACHE-II (Phi 283). Conclusiones. La incidencia del delirio en pacientes con SCA en la UCI fue del 37,5%, evidenciando una asociación estadística no significativa entre el delirium y las características clínicas identificadas. El índice de mortalidad se comportó de forma independiente a la aparición de delirium.
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Slor, Chantal J., Joost Witlox, Dimitrios Adamis, David J. Meagher, Tjeerd van der Ploeg, Rene W. M. M. Jansen, Mireille F. M. van Stijn, et al. "Predicting Delirium Duration in Elderly Hip-Surgery Patients: Does Early Symptom Profile Matter?" Current Gerontology and Geriatrics Research 2013 (2013): 1–9. http://dx.doi.org/10.1155/2013/962321.
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Background. Features that may allow early identification of patients at risk of prolonged delirium, and therefore of poorer outcomes, are not well understood. The aim of this study was to determine if preoperative delirium risk factors and delirium symptoms (at onset and clinical symptomatology during the course of delirium) are associated with delirium duration.Methods. This study was conducted in prospectively identified cases of incident delirium. We compared patients experiencing delirium of short duration (1 or 2 days) with patients who had more prolonged delirium (≥3 days) with regard to DRS-R-98 (Delirium Rating Scale Revised-98) symptoms on the first delirious day. Delirium symptom profile was evaluated daily during the delirium course.Results. In a homogenous population of 51 elderly hip-surgery patients, we found that the severity of individual delirium symptoms on the first day of delirium was not associated with duration of delirium. Preexisting cognitive decline was associated with prolonged delirium. Longitudinal analysis using the generalised estimating equations method (GEE) identified that more severe impairment of long-term memory across the whole delirium episode was associated with longer duration of delirium.Conclusion. Preexisting cognitive decline rather than severity of individual delirium symptoms at onset is strongly associated with delirium duration.
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Martínez-Velilla, Nicolas, José G. Franco, and Clara Marina Molina Amaya. "Delirio frente a delirium." Medicina Clínica 147, no. 6 (September 2016): 274–75. http://dx.doi.org/10.1016/j.medcli.2016.04.005.
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Cheston, H., E. Miller, and S. Mufti. "120 Improving Delirium Recognition and Management Through In-Situ Simulation." Age and Ageing 50, Supplement_1 (March 2021): i12—i42. http://dx.doi.org/10.1093/ageing/afab030.81.
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Abstract Introduction Delirium is a common condition that is often associated with increased morbidity and mortality, longer hospital admission, and discharge to a residential or nursing home. By improving our ability to recognise and manage these patients we can intervene early to help reduce the likelihood of these outcomes. Method We organised several in-situ simulation scenarios with junior staff working on the Elderly Care Unit. The research team designed a scenario to re-create a typical delirious patient on the ward. Participants had to recognise the patient was delirious and instigate a management plan. Participants completed a pre and post-intervention questionnaire to ascertain whether they felt the simulation had improved their confidence. Additionally we performed an audit to investigate whether our intervention led to an improvement in the recognition and management of delirium in patients on the ward. Results The questionnaires showed an increase in participants’ confidence and knowledge when managing a delirious patient on the ward. From reviewing patient notes pre-intervention we identified that 24 patients were delirious during admission,14 of which were accurately diagnosed with delirium. The remaining 10 patients were diagnosed with “Acute Confusion”. On reviewing these 10 patients’ notes, they were all likely to have a diagnosis of delirium. Post-intervention there were 14 patients identified as delirious during their admission. All these patients were correctly documented as having delirium with no inaccurate use of terminology. The data also showed increasing use of tools such as AMTS and 4AT to diagnose delirium. Conclusions From the data gathered, we can see participants are better at recognising and diagnosing delirium. However, our sample sizes are too small to test statistical significance between data points. To improve the project we would include a larger sample size to determine whether the simulation produces a statistically significant improvement in confidence levels.
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Azhar, Gohar, Shakshi Sharma, Regina Gibson, Amanda Pangle, Robert Wolfe, and Jeanne Wei. "EVALUATION OF AMINO ACIDS LEVELS OF HOSPITALIZED PATIENTS WITH DELIRIUM." Innovation in Aging 7, Supplement_1 (December 1, 2023): 452–53. http://dx.doi.org/10.1093/geroni/igad104.1488.
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Abstract Delirium is an acute and often fluctuating change in cognitive status characterized by disorientation, disorganized thought processes and changes in perceptual and psychomotor function. The common precipitating etiologies of delirium include any acute illnesses, infections, hospitalizations, fluid or electrolyte imbalance, or medications. Neurotransmitters are synthesized from amino acids. We hypothesized that regardless of the clinical reason for delirium, a sudden imbalance of plasma amino acids might alter the level of neurotransmitters and contribute to delirium. We measured amino acids in hospitalized patients 60 or older, both genders, with delirium secondary to any infection (n=13) for a period of 3 days and compared them with healthy control, non-delirious group (n=13). Delirium was evaluated twice daily using the Confusion Assessment Method (CAM) test. Plasma amino acids were analyzed using LC-MS. Our results showed that level of isoleucine was significantly higher in delirious patients on day 1 (64.26 %) as compared to healthy control (43.25%, p < 0.01). The level of tryptophan was slightly lower on day 1 as compared to control (31.13 % vs 36.80%, p=NS). However, the tryptophan/isoleucine ratio on day 1 was significantly lower in delirious compared to healthy controls (49.96% vs 85.54 %, p < 0.01). The tryptophan/isoleucine rose on day 2 of delirium but was still significantly lower compared to the healthy control (59.0% vs 85.54%, p < 0.01). Our results suggest that significant alterations in the levels and ratios of amino acids, in particular, tryptophan and isoleucine might disrupt the synthesis of neurotransmitters and hence contribute to delirium.
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Émond, M., P. Voyer, R. Daoust, M. Pelletier, E. Gouin, S. Berthelot, V. Boucher, et al. "LO022: Incidence and impact measurement of delirium induced by ED stay - INDEED." CJEM 18, S1 (May 2016): S37—S38. http://dx.doi.org/10.1017/cem.2016.59.
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Introduction: Delirium is a dreadful complication in seniors’ acute care. Many studies are available on the incidence of delirium, however ED-induced delirium is far less studied. We aim to evaluate the incidence and impact of ED-induced delirium among older non-delirious admitted ED patients who have prolonged ED stays (≥ 8 hours). Methods: This prospective INDEED study phase 1 included patients recruited from 4 Canadian EDs. Inclusion criteria: 1) Patients aged 65 and over; 2) ED stay ≥ 8 hours; 3) Patient is admitted to the hospital; 4) Patient is non-delirious upon arrival and at the end of the first 8 hours; 5) Independent or semi-independent patient. Eligible patients were assessed by a research assistant after an 8 hour exposition to the ED and evaluated twice a day up to 24h after ward admission. Patients’ functional and cognitive status were assessed using validated OARS and TICS-m tools. The Confusion Assessment Method was used to detect incident delirium. Hospital length of stays (LOS) were obtained. Univariate and multivariate analyses were conducted to evaluate outcomes. Results: Of the 380 patients prospectively followed, mean age was 76.5 (± 8.9), male represent 50% and 16.5% very old seniors (> 85 y.o.). The overall incidence of ED-induced delirium was 8.4%. Distribution by the 4 sites was: 10%, 13.8%, 5.5% & 13.4%. The mean ED LOS varied from 29 to 48 hours. The mean hospital LOS was increase by 6.1 days in the delirious patients compared to non-delirious patient (p<0.05). Increase mean hospital LOS distribution by site was by: 6.9, 8.5, 4.3 and 5.2 days for the ED-induced delirium patients. Conclusion: ED-induced delirium was recorded in nearly one senior out of ten after a minimal 8 hour exposure in the ED environment. An episode of delirium increases hospital LOS by about a week and therefore could contribute to ED overcrowding.
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SARI, Neslihan, and Meryem YAVUZ VAN GİERSBERGEN. "SAĞLIK ÇALIŞANLARININ YOĞUN BAKIMLARDA DELİRYUM YÖNETİMLERİNİN İNCELENMESİ." Yoğun Bakım Hemşireliği Dergisi 27, no. 3 (December 31, 2023): 128–37. http://dx.doi.org/10.62111/ybhd.1264698.
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Özet
Amaç: Yoğun bakımlardaki sağlık çalışanları deliryumu tanılamada ve önlemede önemli rollere sahiptir. Bu araştırma; Yoğun bakımda çalışan hemşire ve hekimlerin deliryum yönetimleri konusunda bilgi, tutum ve uygulamalarını incelemek amacıyla tanımlayıcı tipte yapılmıştır.
Yöntem: Araştırma İzmir ilinde bulunan 3 üniversite hastanesinde yürütüldü. Araştırmanın örneklemini, araştırmanın yapıldığı hastanelerin yoğun bakım ünitelerinde görev yapan ve araştırmaya katılmayı kabul eden 175 sağlık çalışanı oluşturdu. Veriler sosyodemografik özelliklerine ilişkin soru formu, deliryum ile ilgili bilgi, tutum ve uygulamalar soru formu olmak üzere toplam dört bölüm, 47 sorudan oluşan ve uzman görüşü alınan veri toplama formu ile toplandı.
Bulgular: Araştırmaya katılan sağlık çalışanlarının yaş ortalamasının 30.81±3.88, %66.9’unun deliryum ile ilgili eğitim aldığını ve 151'i (%86.3) tanılama yapmadıklarını ifade etmişlerdir. Bilgi ve uygulama puanları arasında istatiksel olarak anlam bulunmuştur. Bilgi puanı hekimlerin daha fazla, uygulama puanı ise hemşirelerin daha fazla bulunmuştur. Bilgi puanında ise eğitim durumu ile arasında anlamlı fark bulunmuştur. Eğitim durumu arttıkça bilgi puanı artmıştır. Araştırmada bulunan sonuca göre deliryum tanılaması yapma oranı oldukça düşük saptandı.
Sonuç: Araştırma sonucunda yoğun bakım sağlık çalışanlarının bilgi puanı arttıkça, uygulama puanının arttığı, uygulama puanı arttıkça da tutum puanının arttığı saptandı.
Anahtar kelimeler: Deliryum, Sağlık Çalışanı, Bilgi, Tutum, Uygulama.
Abstract
Background: Healthcare workers in intensive care units have important roles in diagnosing and preventing delirium. This research; It was conducted to examine the knowledge, attitudes and practices of nurses and physicians working in the intensive care unit about delirium management.
Methods: The research was carried out in 3 university hospitals in Izmir between November 2014 and February 2015. The sample of the study consisted of 175 healthcare professionals working in the intensive care units of the hospitals where the study was conducted and who agreed to participate in the study. A questionnaire form consisting of 47 questions and expert opinion was used.
Results: It was determined that the mean age of the health workers participating in the study was 30.81±3.88 years, and 66.9% of them received training on delirium. 151 (86.3%) stated that they did not make a diagnosis. A statistical significance was found between knowledge and practice scores. The knowledge score was higher for the physicians, and the practice score was higher for the nurses. A significant difference was found between the knowledge score and the education level. As the education level increased, the knowledge score increased. According to the results found in the study, the rate of making a diagnosis of delirium was found to be quite low.
Conclusion: As a result of the research, it was determined that as the knowledge score of the intensive care health workers increased, the application score increased, and as the practice score increased, the attitude score increased.
Keywords: Delirium, Health Professional, Knowledge, Attitude, Practice.
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Hamidović, J., L. Dostović Hamidović, S. Haskic, E. Prljača, A. Brigić, and M. Mešanović. "Etiology and pharmacological treatment of delirious syndrome." European Psychiatry 66, S1 (March 2023): S380. http://dx.doi.org/10.1192/j.eurpsy.2023.822.
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IntroductionPatients in psychiatric department, especially in the intensive care unit, often develop delirium syndrome, which leads to a high risk of morbidity and mortality. The etiology is multifactorial. The most common causes are alcoholism and dementia. Pharmacological treatment of delirious syndrome is the most important part of the treatment, which includes various psychopharmaceuticals that are effective both in the treatment of delirium and in improving cognitive functions. Haloperidol is the drug of first choice and from atypical antipsychotics, the most commonly used are risperidone and olanzapine. Benzodiazepines are used in the treatment of delirium tremens.ObjectivesThe objective of the work is to determine the most common cause of delirious syndrome and the treatment of those patients.MethodsWe analyzed 52 patients who were treated for delirious syndrome at the Department of Psychiatry , University Clinical Center Tuzla, Bosnia and Herzegovina in the period from January 1, 2019. until June 1, 2022. Data were taken from medical records and the hospital information system.ResultsThe total number of patients was 52 and 23 (44.23%) were treated for delirium tremens, and the rest were treated for delirium syndrome of another cause. The most common other causes were dementia in 21 (40.38%) patients, followed by sepsis, infectious syndrome and tumors in 6 (11.53%) patients, and cerebrovascular cause in 2 (3,84%) patient. In a therapeutic approach of delirious syndrome, all patients with delirium tremens were treated with benzodiazepines: 11 (47.82%) patients with diazepam monotherapy, then diazepam and promazine 7 (30.43%) patients, diazepam and haloperidol 3 (13,04%) patients, and diazepam, olanzapine and haloperidol 2 (8.69%). In the therapy of other delirious syndromes, 11 (37.93%) patients were treated with risperidone, haloperidol 8 (27.58%), promazine 3 (10.34%), quetiapine 4 (13.79%), and olanzapine, clozapine and aripiprazole 1 patient each (3.44%). It is important to point out that there was no fatal outcome in the processed sample of patients.ConclusionsThe most common etiological cause of delirious syndrome is the consequence of alcohol withdrawal. Delirium superimposed on dementia is the second most common. The priority of treatment is focused on pharmacological treatment. Atypical antipsychotics (risperidone) are most often used. Haloperidol is the second most common. Benzodiazepine (diazepam) was most often used in the treatment of delirium tremens.Disclosure of InterestNone Declared
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Emond, M., A. Nadeau, V. Boucher, P. Voyer, M. Pelletier, E. Gouin, R. Daoust, et al. "MP09: Incidence of emergency department induced delirium: a Canadian two years prospective study." CJEM 20, S1 (May 2018): S43. http://dx.doi.org/10.1017/cem.2018.163.
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Introduction: Prevalence and incidence of delirium in older patients admitted to acute and long-term care facilities ranges between 9.6% and 89% but little is known in the context of emergency department (ED) incident delirium. Literature regarding the incidence of delirium in the ED and its potential impacts on hospital length of stay (LOS), functional status and unplanned ED readmissions is scant, its consequences have yet to be clearly identified in order to orient modern acute medical care. Methods: This study is part of the multicenter prospective cohort INDEED study. Three Canadian EDs completed the two years prospective study (March-July 2015 and Feb-May 2016). Patients aged 65 years old, initially free of delirium with an ED stay 8hours were followed up to 24h after ward admission. Patients were assessed 2x/day during their entire ED stay and up to 24 hours on hospital ward by research assistants (RA). The primary outcome of this study was incident delirium in the ED or within 24 h of ward admission. Functional and cognitive status were assessed using validated Older Americans’ Resources and Services and the Telephone Interview for Cognitive Status- modified tools. The Confusion Assessment Method (CAM) was used to detect incident delirium. ED and hospital administrative data were collected. Inter-observer agreement was realized among RA. Results: Incident delirium was not different between sites, nor between phases, nor between times from one site to another. All phases confounded, there is between 7 to 11% of ED related incident delirious episodes. Differences were seen in ED LOS between sites in non-delirious patients, but also between some sites for delirious participants (p<0.05). Only one site had a difference in ED LOS between their delirious and non-delirious patients, respectively of 52.1 and 40.1 hours (p<0.05). There is also a difference between sites in the time between arrival to the ED and the incidence of delirium (p=0.003). Kappa statistics were computed to measure inter-rater reliability of the CAM. Based on an alpha of 5%, 138 patients would allow 80% power for an estimated overall incidence proportion of 15 % with 5% precision.. Other predictive delirium variables, such as cognitive status, environmental factors, functional status, comorbidities, physiological status, and ED and hospital length of stay were similar between sites and phases. Conclusion: The fact that incidence of delirium was the same for all sites, despite the differences of ED LOS and different time periods suggest that many other modifiable and non-modifiable factors along LOS influenced the incidence of ED induced delirium. Emergency physician should concentrate on improving senior-friendly environment for the ED.
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Bergus, Katherine, Tran Bourgeois, Kelli Patterson, Dana Schwartz, Rajan Thakkar, and Renata Fabia. "68 Using the Cornell Assessment of Pediatric Delirium Score to Identify Delirium in Pediatric Burn Patients." Journal of Burn Care & Research 44, Supplement_2 (May 1, 2023): S34. http://dx.doi.org/10.1093/jbcr/irad045.042.
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Abstract Introduction Delirium rates in pediatric critical care range from 18-40% and its development is associated with baseline cognitive dysfunction, primary diagnosis, and mechanical ventilation. The Cornell Assessment of Pediatric Delirium (CAPD) is a tool used to detect delirium in children of all ages, but has not been validated in burn patients. Our study aimed to use CAPD score to determine the frequency of delirium in pediatric burn patients and assess the association of delirium with burn demographics. Methods We conducted a retrospective review of patients aged 2.5 weeks to 18 years who were admitted to our ABA-verified pediatric burn center from 2018-2021 and who underwent delirium screening with the CAPD tool (CAPD ≥9 indicates a diagnosis of delirium). Injury mechanism, patient demographics, hospitalization details, and CAPD score were collected and χ2, Fisher’s exact test, and univariate analyses performed. Results 389 patients with documented CAPD scores were included in our cohort, with median age of 2 years at the time of burn injury. Delirium was identified in 42 (10.8%) patients. Delirious patients were generally older compared to non-delirious patients (4 years (IQR 2, 11) vs 2 years (IQR 1, 6), P < 0.0005) and had higher TBSA burned (21.63% (IQR 9, 42) vs 3.5% (IQR 1.75, 6), P < 0.0001). Odds of developing delirium with increasing age was 1.08 (95% CI: 1.02-1.15, P = 0.0068) and 1.16 (95% CI: 1.11-1.20, P = < 0.0001) for each percent increase in TBSA burned. Delirium diagnosis did not vary significantly with gender or race/ethnicity. Though it did not reach statistical significance, percent probability of developing delirium was highest among fire burns (26.53% (95% CI: 17.79-35.27)), and lowest among chemical burns (1.49% (95%CI: 0-4.40), P > 0.05). Patients who underwent 6 or more Anesthesia Events (AE) were 74.43 times more likely to develop delirium than patients who underwent 0 AEs (P < 0.001). Compared to non-delirious patients, patients with delirium were 81.02 times more likely to have an ICU admission (95% CI: 38.79-169.22, P < 0.0001) and 11.37 times more likely to have a longer hospital admission (95% CI: 7.74-16.72, P < 0.0001). Conclusions Screening with the CAPD tool identified delirium in pediatric burn patients with known risk factors for delirium including higher TBSA burned, greater number of AEs, and longer ICU course or hospital admission. Delirium increased with age in our study group. There are few validated tools for measuring delirium in pediatric burn patients, and further studies are needed determine whether CAPD accurately captures delirium in younger burn patients. Applicability of Research to Practice Knowing associations between clinical burn characteristics and delirium can help predict which patients are at highest risk. Early identification of these patients can enable extra precautions to prevent delirium and to treat it early if it develops.
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Boettger, Soenke, Steven Passik, and William Breitbart. "Delirium superimposed on dementia versus delirium in the absence of dementia: Phenomenological differences." Palliative and Supportive Care 7, no. 4 (November 26, 2009): 495–500. http://dx.doi.org/10.1017/s1478951509990502.
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AbstractObjective:To examine differences in the phenomenological characteristics of delirium superimposed on dementia compared to those observed in delirious patients without dementia, based on the rating items of the Memorial Delirium Assessment Scale (MDAS).Methods:We conducted an analysis of a prospectively collected clinical delirium database utilized to record and monitor the care of delirious patients treated at Memorial Sloan-Kettering Cancer Center (MSKCC). Sociodemographic, medical variables, and MDAS total score and individual item ratings were analyzed in respect to differences between delirium in the demented (DD) versus delirium in the nondemented (ND).Results:We were able to examine data collected on 100 delirious patients: 82 ND patients and 18 DD patients. Patients in the DD group, compared to the ND group, had significantly greater levels of disturbance of consciousness and impairments in all cognitive domains (i.e., orientation, short term memory, concentration, organization of thought process). Severe symptoms were more common in the DD group compared to the ND group on all the MDAS cognitive items as well as in disturbance of consciousness. There were no significant differences between the DD and ND groups in terms of presence or severity of hallucinations, delusions, psychomotor behavior, and sleep–wake cycle disturbance.Significance of results:Delirium superimposed on dementia has phenomenological differences compared to delirium in the absence of dementia. There are no significant differences in the severity of hallucinations, delusions, psychomotor behavior, or sleep–wake cycle disturbances. However, level of disturbance in consciousness (arousal and awareness) and impairments in multiple cognitive domains are significantly more severe in patients with delirium superimposed on dementia.
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Maybrier, Hannah R., Angela M. Mickle, Krisztina E. Escallier, Nan Lin, Eva M. Schmitt, Ravi T. Upadhyayula, Troy S. Wildes, et al. "Reliability and accuracy of delirium assessments among investigators at multiple international centres." BMJ Open 8, no. 11 (November 2018): e023137. http://dx.doi.org/10.1136/bmjopen-2018-023137.
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IntroductionDelirium is a common, serious postoperative complication. For clinical studies to generate valid findings, delirium assessments must be standardised and administered accurately by independent researchers. The Confusion Assessment Method (CAM) is a widely used delirium assessment tool. The objective was to determine whether implementing a standardised CAM training protocol for researchers at multiple international sites yields reliable inter-rater assessment and accurate delirium diagnosis.MethodsPatients consented to video recordings of CAM delirium assessments for research purposes. Raters underwent structured training in CAM administration. Training entailed didactic education, role-playing with intensive feedback, apprenticeship with experienced researchers and group discussions of complex cases. Raters independently viewed and scored nine video-recorded CAM interviews. Inter-rater reliability was determined using Fleiss kappa. Accuracy was judged by comparing raters’ scores with those of an expert delirium researcher.ResultsTwenty-seven raters from eight international research centres completed the study and achieved almost perfect agreement for overall delirium diagnosis, kappa=0.88 (95% CI 0.85 to 0.92). Agreement of the four core CAM features ranged from fair to substantial. The sensitivity and specificity for identifying delirium were 72% (95% CI 60% to 81%) and 99% (95% CI 96% to 100%), considering an expert rater’s scores as the reference standard (delirious, n=3; non-delirious, n=6). Delirium severity ratings were tightly clustered, with most scores within 5% of the median.ConclusionOur results demonstrate that, with appropriate training and ongoing scoring discussions, researchers at multiple sites can reliably detect delirium in postsurgical patients. These results support the premise that methodologically rigorous multi-centre studies can yield standardised and accurate determinations of delirium.
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Schwartz, Thomas L., Mantosh J. Dewan, and Wendy A. Armenta. "Sustained Manic Delirium." Journal of Pharmacy Technology 16, no. 4 (July 2000): 147–50. http://dx.doi.org/10.1177/875512250001600409.
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Objective: To report a case of bipolar I disorder with psychotic features that resembled a sustained episode of delirium. Case Summary: A 54-year-old white woman with bipolar I disorder developed severe, sustained psychosis resembling delirium. These symptoms resolved following several pharmacologic interventions. Discussion: Manic delirium is an extreme manifestation of bipolar disorder. The primary symptoms of manic delirium are confusion, agitation, altered levels of consciousness, and perceptual disturbances. Our patient developed typical symptoms of manic delirium; however, this case differed in terms of increased duration of symptoms and decreased treatment efficacy. Conclusions: Bipolar disorder with psychotic features may present as a delirious episode. Combination therapy may be an appropriate intervention when pharmacologic monotherapy fails.
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LaHue, Sara, Joy Youn, Matias Fuentealba, Vanja Douglas, David Furman, Julio Rojas, Lawren VandeVrede, and John Newman. "ACCELERATED BIOLOGICAL AGE IS ASSOCIATED WITH DELIRIUM AND PLASMA NEUROFILAMENT LIGHT IN GERIATRIC HIP FRACTURE." Innovation in Aging 7, Supplement_1 (December 1, 2023): 119. http://dx.doi.org/10.1093/geroni/igad104.0387.
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Abstract Background Biological age may be distinct from chronological age. Epigenetic clocks (e.g., PhenoAge) estimate biological age by quantifying changes in DNA methylation (DNAm). Biological age is “accelerated” (AgeAccel) when epigenetic>chronological age. AgeAccel predicts age-related diseases but its association with delirium or neuronal injury markers (e.g., neurofilament light “NfL”) is unknown. Methods Adults age 65+ hospitalized for acute hip fracture underwent daily delirium screening with the Confusion Assessment Method Long Form. DNAm status of 850,000 CpG sites was measured in triplicate from pre-op peripheral blood mononuclear cells using Illumina MethylationEPIC arrays. AgeAccel represented the residual of the linear regression model of PhenoAge regressed on chronological age. Plasma NfL was measured in duplicate using Simoa immunoassays. Group differences calculated by T-test. Results Of 12 subjects (enrollment ongoing): mean age 79±8, 75% women, 42% with dementia, 33% were delirious on pre-op blood collection day. Mean AgeAccel was 4.4 years (p=0.02) in delirious vs non-delirious subjects (Fig1A). Those with positive (vs negative) AgeAccel had higher mean NfL (Fig1B, p=0.002). Delirious (vs non-delirious) subjects had higher mean NfL (p=0.004). We found no difference in either AgeAccel or NfL by dementia status. Conclusions In this geriatric hip fracture pilot, accelerated biological age was associated with higher delirium prevalence and NfL. Delirium was also associated with higher NfL. This pilot demonstrates feasibility and utility of measuring biological aging in delirium that warrants study in a larger cohort.
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Banerdt, Justin K., Kondwelani Mateyo, Li Wang, Christopher J. Lindsell, Elisabeth D. Riviello, Deanna Saylor, Douglas C. Heimburger, and E. Wesley Ely. "Delirium as a predictor of mortality and disability among hospitalized patients in Zambia." PLOS ONE 16, no. 2 (February 11, 2021): e0246330. http://dx.doi.org/10.1371/journal.pone.0246330.
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Objective To study the epidemiology and outcomes of delirium among hospitalized patients in Zambia. Methods We conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. The primary exposure was delirium duration over the initial 3 days of hospitalization, assessed daily using the Brief Confusion Assessment Method. The primary outcome was 6-month mortality. Secondary outcomes included 6-month disability, evaluated using the World Health Organization Disability Assessment Schedule 2.0. Findings 711 adults were included (median age, 39 years; 461 men; 459 medical, 252 surgical; 323 with HIV). Delirium prevalence was 48.5% (95% CI, 44.8%-52.3%). 6-month mortality was higher for delirious participants (44.6% [39.3%-50.1%]) versus non-delirious participants (20.0% [15.4%-25.2%]; P < .001). After adjusting for covariates, delirium duration independently predicted 6-month mortality and disability with a significant dose-response association between number of days with delirium and odds of worse clinical outcome. Compared to no delirium, presence of 1, 2 or 3 days of delirium resulted in odds ratios for 6-month mortality of 1.43 (95% CI, 0.73–2.80), 2.20 (1.07–4.51), and 3.92 (2.24–6.87), respectively (P < .001). Odds of 6-month disability were 1.20 (0.70–2.05), 1.73 (0.95–3.17), and 2.80 (1.78–4.43), respectively (P < .001). Conclusion Among hospitalized medical and surgical patients in Zambia, delirium prevalence was high and delirium duration independently predicted mortality and disability at 6 months. This work lays the foundation for prevention, detection, and management of delirium in low-income countries. Long-term follow up of outcomes of critical illness in resource-limited settings appears feasible using the WHO Disability Assessment Schedule.
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Linkaitė, Gabrielė, Mantas Riauka, Ignė Bunevičiūtė, and Saulius Vosylius. "Evaluation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for the patients in the intensive care unit." Acta medica Lituanica 25, no. 1 (May 14, 2018): 14–22. http://dx.doi.org/10.6001/actamedica.v25i1.3699.
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Introduction. Delirium not only compromises patient care, but is also associated with poorer outcomes: increased duration of mechanical ventilation, higher mortality, and greater long-term cognitive dysfunction. The PRE-DELIRIC model is a tool used to calculate the risk of the development of delirium. The classification of the patients into groups by risk allows efficient initiation of preventive measures. The goal of this study was to validate the PRE-DELIRIC model using the CAM-ICU (The Confusion Assessment Method for the Intensive Care Unit) method for the diagnosis of delirium. Materials and methods. Patients admitted to the University Hospital of Vilnius during February 2015 were enrolled. Every day, data were collected for APACHE-II and PRE-DELIRIC scores. Out of 167 patients, 38 (23%) were included and screened using the CAM-ICU method within 24 hours of admission to the ICU. We defined patients as having delirium when they had at least one positive CAM-ICU screening or haloperidol administration due to sedation. To validate the PRE-DELIRIC model, we calculated the area under receiver operating characteristic curve. Results. The mean age of the patients was 69.2 ± 17.2 years, 19 (50%) were male, APACHE-II mean score 18.0 ± 7.4 points. Delirium was diagnosed in 22 (58%) of 38 patients. Data used for validation of the PRE-DELIRIC model resulted in an area under the curve of 0.713 (p < 0.05, 95% CI 0.539–0.887); sensitivity and specificity for the patients with 20% risk were, accordingly, 77.3% and 50%; 40% risk – 45.5% and 81.3%, 60% – 36.4%, and 87.5%. Conclusions. The PRE-DELIRIC model predicted delirium in the patients within 24 hours of admission to the ICU. Preventive therapy could be efficiently targeted at high-risk patients if both of the methods are to be implemented.
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Bode, Leonie, Florian Isler, Simon Fuchs, Justus Marquetand, Heidi Petry, Jutta Ernst, Maria Schubert, David Garcia Nuñez, Roland von Känel, and Soenke Boettger. "The utility of nursing instruments for daily screening for delirium: Delirium causes substantial functional impairment." Palliative and Supportive Care 18, no. 3 (November 27, 2019): 293–300. http://dx.doi.org/10.1017/s1478951519001019.
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AbstractObjectiveNursing assessments have been recommended for the daily screening for delirium; however, the utility of individual items have not yet been tested. In a first step in establishing the potential of the electronic Patient Assessment-Acute Care (ePA-AC) as such, the impact of delirium on the functional domains was assessed.MethodIn this prospective observational cohort study, 277 patients were assessed and 118 patients were delirious. The impact of delirium on functional domains of the ePA-AC related to self-initiated activity, nutrition, and elimination was determined with simple logistic regressions.ResultsPatients with delirium were older, sicker, were more commonly sedated during the assessment, stayed longer in the intensive care unit (ICU) and floors, and less commonly discharged home. A general pattern was the loss of abilities and full functioning equivalent to global impairment. For self-initiated mobility, in and out of the bed sizable limitations were noted and substantial inability to transfer caused friction and shearing. Similarly, any exhaustion and fatigue were associated with delirium. For self-initiated grooming and dressing, the impairment was greater in the upper body. Within the nutritional domain, delirium affected self-initiated eating and drinking, the amount of food and fluids, energy and nutrient, as well as parenteral nutrition requirement. In delirious patients, the fluid demand was rather increased than decreased, tube feeding more often required and dysphagia occurred. For the elimination domain, urination was not affected — of note, most patients were catheterized, whereas abilities to initiate or control defecation were affected.Significance of resultsDelirium was associated with sizable impairment in the level of functioning. These impairments could guide supportive interventions for delirious patients and perspectively implement nursing instruments for delirium screening.
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Grover, Sandeep, Sanjana Kathiravan, and Devakshi Dua. "Delirium Research in India: A Systematic Review." Journal of Neurosciences in Rural Practice 12, no. 02 (April 2021): 236–66. http://dx.doi.org/10.1055/s-0041-1725211.
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AbstractDelirium is the most common psychiatric diagnoses encountered in patients with various medical-surgical illnesses, in all the treatment set-ups, with relatively higher incidence and prevalence in the intensive care units. As delirium is encountered in multiple specialties, it is important to understand the research on this diagnosis. This study aims to assess the research output involving patients of delirium from India. A comprehensive search was undertaken using Medline (PubMed) and other databases. Search words included were “delirium,” “delirious,” “delirium tremens” AND “India.” No filters were used. Internet and hand searches yielded 305 articles. Out of these articles, 151 had the terms “delirium,” “delirious,” “delirium tremens” in the title and these were included for the review. Additionally, 14 articles were included for the review, although these did not have these terms in the title, but delirium was one of the major outcome parameters in these studies. Majority of the papers were original articles (n = 81), and these were followed by, case reports (n = 58), review articles (n = 10), letter to the editor (not as case reports but as a communication; n = 13), editorials (n = 2) and one clinical practice guideline. Most of the original papers have either focused on epidemiology (incidence, prevalence, outcome, etc.), symptom profile, with occasional studies focusing on effectiveness of various pharmacological interventions. There is a dearth of research in the field of delirium from India. There is a lack of studies on biomarkers, evaluation of nonpharmacological interventions, and evaluation of prevention strategies. It is the need of the hour to carry out more studies to further our understanding of delirium in the Indian context.
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Williams, John, Karen Finn, Vincent Melvin, David Meagher, Geraldine McCarthy, and Dimitrios Adamis. "The Association of Serum Levels of Brain-Derived Neurotrophic Factor with the Occurrence of and Recovery from Delirium in Older Medical Inpatients." BioMed Research International 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/5271395.
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Limited studies of the association between BDNF levels and delirium have given inconclusive results. This prospective, longitudinal study examined the relationship between BDNF levels and the occurrence of and recovery from delirium. Participants were assessed twice weekly using MoCA, DRS-R98, and APACHE II scales. BDNF levels were estimated using an ELISA method. Delirium was defined with DRS-R98 (score > 16) and recovery from delirium as ≥2 consecutive assessments without delirium prior to discharge. We identified no difference in BDNF levels between those with and without delirium. Excluding those who never developed delirium (n=140), we examined the association of BDNF levels and other variables with delirium recovery. Of 58 who experienced delirium, 39 remained delirious while 19 recovered. Using Generalized Estimating Equations models we found that BDNF levels (Wald χ2=7.155; df: 1, p=0.007) and MoCA (Wald χ2=4.933; df: 1, p=0.026) were associated with recovery. No significant association was found for APACHE II, dementia, age, or gender. BDNF levels do not appear to be directly linked to the occurrence of delirium but recovery was less likely in those with continuously lower levels. No previous study has investigated the role of BDNF in delirium recovery and these findings warrant replication in other populations.
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Rudolph, James L., Viken L. Babikian, Patrick Treanor, Val E. Pochay, Jeremy B. Wigginton, Michael D. Crittenden, and Edward R. Marcantonio. "Microemboli are not associated with delirium after coronary artery bypass graft surgery." Perfusion 24, no. 6 (November 2009): 409–15. http://dx.doi.org/10.1177/0267659109358207.
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Delirium is an acute change in cognition which occurs frequently after coronary artery bypass graft (CABG) surgery. Cerebral microemboli, from plaque, air, or thrombus, have been hypothesized to contribute to delirium and cognitive decline after CABG. The purpose of this study was to determine if there was an association between cerebral microemboli and delirium after cardiac surgery. Non-delirious patients (n=68) were prospectively enrolled and underwent intraoperative monitoring of the middle cerebral arteries with transcranial Doppler (TCD). TCD signals were saved and analyzed postoperatively for microemboli manually, according to established criteria. Postoperatively, patients were assessed for delirium with a standardized battery. Thirty-three patients (48.5%) developed delirium after surgery. Microemboli counts (mean ± SD) were not significantly different in those with and without delirium (303 ± 449 vs. 299 ± 350; p=0.97). While intraoperative microemboli were not associated with delirium after CABG, further investigation into the source and composition of microemboli can further elucidate the long-term clinical impact of microemboli.
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Ragheb, Jacqueline, Amy McKinney, Mackenzie Zierau, Joseph Brooks, Maria Hill-Caruthers, Mina Iskander, Yusuf Ahmed, Remy Lobo, Graciela Mentz, and Phillip E. Vlisides. "Delirium and neuropsychological outcomes in critically Ill patients with COVID-19: a cohort study." BMJ Open 11, no. 9 (September 2021): e050045. http://dx.doi.org/10.1136/bmjopen-2021-050045.
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ObjectiveTo characterise the clinical course of delirium for patients with COVID-19 in the intensive care unit, including postdischarge neuropsychological outcomes.DesignRetrospective chart review and prospective survey study.SettingIntensive care units, large academic tertiary-care centre (USA).ParticipantsPatients (n=148) with COVID-19 admitted to an intensive care unit at Michigan Medicine between 1 March 2020 and 31 May 2020 were eligible for inclusion.Primary and secondary outcome measuresDelirium was the primary outcome, assessed via validated chart review method. Secondary outcomes included measures related to delirium, such as delirium duration, antipsychotic use, length of hospital and intensive care unit stay, inflammatory markers and final disposition. Neuroimaging data were also collected. Finally, a telephone survey was conducted between 1 and 2 months after discharge to determine neuropsychological function via the following tests: Family Confusion Assessment Method, Short Blessed Test, Patient-Reported Outcomes Measurement Information System Cognitive Abilities 4a and Patient-Health Questionnaire-9.ResultsDelirium was identified in 108/148 (73%) patients, with median (IQR) duration lasting 10 (4–17) days. In the delirium cohort, 50% (54/108) of patients were African American and delirious patients were more likely to be female (76/108, 70%) (absolute standardised differences >0.30). Sedation regimens, inflammation, delirium prevention protocol deviations and hypoxic-ischaemic injury were likely contributing factors, and the most common disposition for delirious patients was a skilled care facility (41/108, 38%). Among patients who were delirious during hospitalisation, 4/17 (24%) later screened positive for delirium at home based on caretaker assessment, 5/22 (23%) demonstrated signs of questionable cognitive impairment or cognitive impairment consistent with dementia and 3/25 (12%) screened positive for depression within 2 months after discharge.ConclusionPatients with COVID-19 commonly experience a prolonged course of delirium in the intensive care unit, likely with multiple contributing factors. Furthermore, neuropsychological impairment may persist after discharge.
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Brown, Charles H., Julia Probert, Ryan Healy, Michelle Parish, Yohei Nomura, Atsushi Yamaguchi, Jing Tian, et al. "Cognitive Decline after Delirium in Patients Undergoing Cardiac Surgery." Anesthesiology 129, no. 3 (September 1, 2018): 406–16. http://dx.doi.org/10.1097/aln.0000000000002253.
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Abstract What We Already Know about This Topic What This Article Tells Us That Is New Background Delirium is common after cardiac surgery and has been associated with morbidity, mortality, and cognitive decline. However, there are conflicting reports on the magnitude, trajectory, and domains of cognitive change that might be affected. The authors hypothesized that patients with delirium would experience greater cognitive decline at 1 month and 1 yr after cardiac surgery compared to those without delirium. Methods Patients who underwent coronary artery bypass and/or valve surgery with cardiopulmonary bypass were eligible for this cohort study. Delirium was assessed with the Confusion Assessment Method. A neuropsychologic battery was administered before surgery, at 1 month, and at 1 yr later. Linear regression was used to examine the association between delirium and change in composite cognitive Z score from baseline to 1 month (primary outcome). Secondary outcomes were domain-specific changes at 1 month and composite and domain-specific changes at 1 yr. Results The incidence of delirium in 142 patients was 53.5%. Patients with delirium had greater decline in composite cognitive Z score at 1 month (greater decline by −0.29; 95% CI, −0.54 to −0.05; P = 0.020) and in the domains of visuoconstruction and processing speed. From baseline to 1 yr, there was no difference between delirious and nondelirious patients with respect to change in composite cognitive Z score, although greater decline in processing speed persisted among the delirious patients. Conclusions Patients who developed delirium had greater decline in a composite measure of cognition and in visuoconstruction and processing speed domains at 1 month. The differences in cognitive change by delirium were not significant at 1 yr, with the exception of processing speed.
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Denke, Claudia, Felix Balzer, Mario Menk, Sebastian Szur, Georg Brosinsky, Sascha Tafelski, Klaus-Dieter Wernecke, and Maria Deja. "Long-term sequelae of acute respiratory distress syndrome caused by severe community-acquired pneumonia: Delirium-associated cognitive impairment and post-traumatic stress disorder." Journal of International Medical Research 46, no. 6 (April 2, 2018): 2265–83. http://dx.doi.org/10.1177/0300060518762040.
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Objective Delirium in critically ill patients is considered a risk factor for various long-term consequences. We evaluated delirium and associated long-term outcomes in patients with acute respiratory distress syndrome with non-H1N1 and H1N1- associated severe community-acquired pneumonia (sCAP) who had been recommended to take antiviral drugs associated with delirious symptoms as adverse effects. Methods Of 64 patients, 42 survivors (H1N1, 15; non-H1N1, 27) were analyzed regarding the relationship between medication and the duration of delirium in the intensive care unit. During follow-up (n = 23), we assessed cognitive abilities, post-traumatic stress disorder (PTSD), physical capacity, and health-related quality of life (HRQoL). Results The incidence of delirium was 88%. There was no difference in the incidence and duration of delirium between patients with H1N1 and non-H1N1 infection. The haloperidol and opioid doses were associated with a longer delirium duration. The delirium duration was correlated with reduced cognitive performance in motor skills, memory function, and learning efficiency. Patients with PTSD (16%) had a significantly longer delirium duration and low mental HRQoL. Conclusions H1N1 infection and corresponding antiviral medication had no impact on delirium. The duration of delirium in these patients was associated with impairments in various outcome parameters, illustrating the burden of sCAP.
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Cyr, Monica, S. Casey Laizure, and Carl M. daCunha. "Methazolamide‐Induced Delirium." Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 17, no. 2 (March 4, 1997): 387–89. http://dx.doi.org/10.1002/j.1875-9114.1997.tb03726.x.
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A 74‐year‐old man became delirious 2 days after beginning oral therapy with methazolamide. The delirium was manifested by intermittent psychosis, incontinence of bowel and bladder, lethargy, and disorientation. These symptoms continued for 25 days despite many changes in his drug regimen, and complete laboratory, urologic, and neurologic work‐ups. The symptoms resolved completely within 1 week of discontinuing methazolamide. This is the first case reported of delirium associated with methazolamide not accompanied by a metabolic imbalance.
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Wood, MD, D. Maslove, J. Muscedere, and JG Boyd. "E.04 Coma and delirium are associated with low levels of brain tissue oxygen in critically ill patients." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 43, S2 (June 2016): S17. http://dx.doi.org/10.1017/cjn.2016.88.
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Background: The cause of ICU delirium is unknown. We used near infrared spectroscopy (NIRS) to measure brain tissue oxygenation (BtO2) in critically ill patients, to test the hypothesis that poor cerebral oxygen delivery contributes to ICU delirium. Methods: Adult patients were enrolled if they required mechanical ventilation for >24 hours, and/or vasoactive agents. Patients were excluded if they had previous cognitive dysfunction, brain injury on admission, or a life expectancy <24 hours. BtO2 was measured for the first 24 hours of ICU admission. The confusion assessment method-ICU (CAM-ICU) was used to screen for delirium. Participants were designated to one of three groups on the basis of their predominant neurological status (comatose, delirious, or intact). Results: To date, 47 patients have been recruited. Both delirious and comatose patients’ had significantly lower BtO2 levels compared to intact patients (P<0.001). There was a significant correlation between hemoglobin and BtO2 (R2=0.347, P<0.01). However, when correlation analysis was conducted separately amongst the three groups, the delirious patients (R2=0.485, P<0.05) were the strongest contributors to this positive correlation. Conclusions: Delirious patients exhibited the lowest BtO2 recordings and demonstrated a significant association between Hb and BtO2. This study offers potential insight into the pathophysiology of ICU delirium.
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Rahkonen, Terhi, Helena Mäkelä, Satu Paanila, Pirjo Halonen, Juhani Sivenius, and Raimo Sulkava. "Delirium in Elderly People Without Severe Predisposing Disorders: Etiology and 1-Year Prognosis After Discharge." International Psychogeriatrics 12, no. 4 (December 2000): 473–81. http://dx.doi.org/10.1017/s1041610200006591.
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Background: The etiologic factors of delirium have been frequently studied in hospitalized elderly patients who usually have an underlying disorder, i.e., hip fracture or dementia predisposing to delirium. The etiologic factors of delirium and prognosis in healthy elderly remain unstudied. The aim of our study was to detect the primary and additional etiologic factors contributing to delirium among community-dwelling healthy elderly people without predisposing disorders to delirium and to evaluate 1-year prognosis after discharge to home. Method: The study subjects consisted of 51 community-dwelling people over 65 years of age, without severe underlying disorders predisposing to delirium, admitted consecutively to the hospital because of a delirious state. The diagnosis of delirium was based on the DSM-III-R criteria. After discharge to home, the subjects were followed up for 1 year. Results: The most important primary causes of delirium were infections in 22 cases (43%) and cerebrovascular attacks in 13 cases (25%). After the 1-year follow-up period, 10 patients (20%) had been taken into long-term care and 5 patients (10%) had died. Discussion: The plausible etiologic factor of delirium was detected in all cases. Among healthy elderly people, infections and cerebrovascular attacks were the most important etiologic factors for delirium. After discharge to home, 30% of the patients had to be taken into long-term care or had died within 1 year of the delirium.
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Stevens, Lee E., Gregory M. de Moore, and Judy M. Simpson. "Delirium in Hospital: Does it Increase Length of Stay?" Australian & New Zealand Journal of Psychiatry 32, no. 6 (December 1998): 805–8. http://dx.doi.org/10.3109/00048679809073869.
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Objective: To determine the effect of delirium, as a comorbid diagnosis in hospitalised patients, on patient length of stay (LOS). Method: Prospective study comparing LOS of delirious patients with controls matched by age, gender, principal diagnosis and date of admission. Medical and surgical inpatients of Westmead Hospital with delirium were identified from a Consultation Liaison (CL) psychiatry database and were matched with controls from the hospital medical records. Results: Delirious patient LOS was found to be significantly longer (2.2-fold; 95% confidence interval 1.5-3.3) than matched controls. Conclusions: Delirium, as a comorbid diagnosis in general hospital patients, is associated with an increased use of resources. Its early diagnosis may limit this and morbidity.
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Reznik, Michael E., Scott Moody, Kayleigh Murray, Samantha Costa, Brian Mac Grory, Tracy E. Madsen, Ali Mahta, et al. "The impact of delirium on withdrawal of life-sustaining treatment after intracerebral hemorrhage." Neurology 95, no. 20 (September 10, 2020): e2727-e2735. http://dx.doi.org/10.1212/wnl.0000000000010738.
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ObjectiveTo determine the impact of delirium on withdrawal of life-sustaining treatment (WLST) after intracerebral hemorrhage (ICH) in the context of established predictors of poor outcome, using data from an institutional ICH registry.MethodsWe performed a single-center cohort study on consecutive patients with ICH admitted over 12 months. ICH features were prospectively adjudicated, and WLST and corresponding hospital day were recorded retrospectively. Patients were categorized using DSM-5 criteria as never delirious, ever delirious (either on admission or later during hospitalization), or persistently comatose. We determined the impact of delirium on WLST using Cox regression models adjusted for demographics and ICH predictors (including Glasgow Coma Scale score), then used logistic regression with receiver operating characteristic curve analysis to compare the accuracy of ICH score–based models with and without delirium category in predicting WLST.ResultsOf 311 patients (mean age 70.6 ± 15.6, median ICH score 1 [interquartile range 1–2]), 50% had delirium. WLST occurred in 26%, and median time to WLST was 1 day (0–6). WLST was more frequent in patients who developed delirium (adjusted hazard ratio 8.9 [95% confidence interval (CI) 2.1–37.6]), with high rates of WLST in both early (occurring ≤24 hours from admission) and later delirium groups. An ICH score-based model was strongly predictive of WLST (area under the curve [AUC] 0.902 [95% CI 0.863–0.941]), and the addition of delirium category further improved the model's accuracy (AUC 0.936 [95% CI 0.909–0.962], p = 0.004).ConclusionDelirium is associated with WLST after ICH regardless of when it occurs. Further study on the impact of delirium on clinician and surrogate decision-making is warranted.
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Aitken, Sarah Joy, Fiona M. Blyth, and Vasi Naganathan. "Incidence, prognostic factors and impact of postoperative delirium after major vascular surgery: A meta-analysis and systematic review." Vascular Medicine 22, no. 5 (August 7, 2017): 387–97. http://dx.doi.org/10.1177/1358863x17721639.
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Although postoperative delirium is a common complication and increases patient care needs, little is known about the predictors and outcomes of delirium in patients having vascular surgery. This review aimed to determine the incidence, prognostic factors and impact of postoperative delirium in vascular surgical patients. MEDLINE and EMBASE were systematically searched for articles published between January 2000 and January 2016 on delirium after vascular surgery. The primary outcome was the incidence of delirium. Secondary outcomes were contributing prognostic factors and impact of delirium. Study quality and risk of bias was assessed using the QUIPS tool for systematic reviews of prognostic studies, and MOOSE guidelines for reviews of observational studies. Quantitative analyses of extracted data were conducted using meta-analysis where possible to determine incidence of delirium and prognostic factors. A qualitative review of outcomes was performed. Fifteen articles were eligible for inclusion. Delirium incidence ranged between 5% and 39%. Meta-analysis found that patients with delirium were older than those without delirium (OR 3.6, p<0.001). Prognostic factors predicting delirium included increased age (OR 1.04, p<0.001), pre-existing cognitive impairment (OR 9.8, p=0.01), hypertension, pre-existing depression and open aortic surgery. Delirious patients remained in hospital 6 days longer ( p<0.001) and had more complications than patients without delirium. Data were limited on the impact of procedure complexity, endovascular compared to open surgery or type of anaesthetic. Postoperative delirium occurs frequently, resulting in major morbidity for vascular patients. Improved quality of prognostic studies may identify modifiable peri-operative factors to improve quality of care for vascular surgical patients.
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Kotfis, Katarzyna, Wojciech Witkiewicz, Aleksandra Szylińska, Karina Witkiewicz, Magdalena Nalewajska, Wiktoria Feret, Łukasz Wojczyński, Łukasz Duda, and Eugene Wesley Ely. "Delirium Severely Worsens Outcome in Patients with COVID-19—A Retrospective Cohort Study from Temporary Critical Care Hospitals." Journal of Clinical Medicine 10, no. 13 (July 2, 2021): 2974. http://dx.doi.org/10.3390/jcm10132974.
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Delirium is a sign of deterioration of homeostasis and worse prognosis. The aim of this study was to investigate the frequency, risk factors and prognosis of delirium in patients with COVID-19 in a temporary acute setting hospital. A retrospective cohort analysis of data collected between October 2020 and February 2021 from two temporary acute care hospitals was performed. All consecutive hospitalized patients ≥18 years old with COVID-19 were included. An assessment of consciousness was carried out at least two times a day, including neurological examination. Delirium was identified through retrospective chart review according to DSM-5 criteria if present at least once during hospitalization. Analysis included 201 patients, 39 diagnosed with delirium (19.4%). Delirious patients were older (p < 0.001), frailer (p < 0.001) and the majority were male (p = 0.002). Respiratory parameters were worse in this group with higher oxygen flow (p = 0.013), lower PaO2 (p = 0.043) and higher FiO2 (p = 0.006). The mortality rate was significantly higher in patients with delirium (46.15% vs 3.70%, p < 0.001) with OR 17.212 (p < 0.001) corrected for age and gender. Delirious patients experienced significantly more complications: cardiovascular (OR 7.72, p < 0.001), pulmonary (OR 8.79, p < 0.001) or septic (OR 3.99, p = 0.029). The odds of mortality in patients with COVID-19 presenting with delirium at any point of hospitalization were seventeen times higher.
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Landreville, Philippe, Philippe Voyer, and Pierre-Hugues Carmichael. "Relationship between delirium and behavioral symptoms of dementia." International Psychogeriatrics 25, no. 4 (December 20, 2012): 635–43. http://dx.doi.org/10.1017/s1041610212002232.
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ABSTRACTBackground: Persons with dementia frequently present behavioral and psychological symptoms as well as delirium. However, the association between these has received little attention from researchers and current knowledge in this area is limited. The purpose of this study was to examine the relation between delirium and behavioral symptoms of dementia (BSD).Methods: Participants were 155 persons with a diagnosis of dementia, 109 (70.3%) of whom were found delirious according to the Confusion Assessment Method. BSD were assessed using the Nursing Home Behavior Problem Scale.Results: Participants with delirium presented significantly more BSD than participants without delirium. More specifically, they presented more wandering/trying to leave, sleep problems, and irrational behavior after controlling for cognitive problems and use of antipsychotics and benzodiazepines. Most relationships between participant characteristics and BSD did not differ according to the presence or absence of delirium, but some variables, notably sleep problems, were more strongly associated to BSD in persons with delirium.Conclusions: Although correlates of BSD in persons with delirium superimposed on dementia are generally similar to those in persons with dementia alone, delirium is associated with a higher level of BSD. Results of this study have practical implications for the detection of delirium superimposed on dementia, the management of behavioral disturbances in patients with delirium, and caregiver burden.
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Eriksson, Irene, Yngve Gustafson, Lisbeth Fagerström, and Birgitta Olofsson. "Urinary tract infection in very old women is associated with delirium." International Psychogeriatrics 23, no. 3 (August 18, 2010): 496–502. http://dx.doi.org/10.1017/s1041610210001456.
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ABSTRACTBackground: The aim of the study was to investigate whether urinary tract infection (UTI) in a representative sample of 85-, 90- and ≥95-year-old women is associated with delirium.Methods: In 504 out of 643 women (78.4%) it was possible to evaluate UTI and delirium. Assessments such as the Organic Brain Syndrome (OBS) Scale, the Geriatric Depression Scale-15 (GDS-15) and the Mini-mental State Examination (MMSE) were performed during home visits. Delirium, dementia and depression were diagnosed according to the DSM-IV criteria. A diagnosed, symptomatic UTI with or without ongoing treatment, documented in medical records or detected in association with the assessments, was registered.Results: Eighty-seven of 504 women (17.2%), were diagnosed as having a UTI with or without ongoing treatment when they were assessed, and almost half of them (44.8%) were diagnosed to be delirious or having had episodes of delirium during the past month. One hundred and thirty-seven of the 504 women (27.2%) were delirious or had had episodes of delirium during the past month and 39 (28.5%) of them were diagnosed to have a UTI. In a multivariate logistic regression model, delirium was significantly associated with Alzheimer's disease (OR = 5.8), multi-infarct dementia (OR = 5.4), depression (OR = 3.1), heart failure (OR = 2.3) and urinary tract infection (OR = 1.9).Conclusions: A large proportion of very old women with UTI suffered from delirium which might indicate that UTI is a common cause of delirium. There should be more focus on detecting, preventing and treating UTI to avoid unnecessary suffering among old women.
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Kajawo, S., D. Flynn, and M. Buckley. "221 PREVALENCE AND DOCUMENTATION OF DELIRIUM IN A UNIVERSITY HOSPITAL." Age and Ageing 50, Supplement_3 (November 2021): ii9—ii41. http://dx.doi.org/10.1093/ageing/afab219.221.
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Abstract Background Delirium can complicate approximately 10% of all medical admissions and prevalence increases in those with cognitive impairment, increasing age and medical complexity. Delirium is associated with increased morbidity and mortality as well as increased length of stay. Prompt recognition and treatment is essential. The National Delirium Care Bundle suggests assessment and recognition at the earliest opportunity and documentation of delirium if patients screen positive. Methods We carried out an audit among patients admitted in all medical wards to identify delirium and assess if it was documented and a care bundle opened. All patients were screened using the 4AT tool at least once over the space of one week. Medical notes were also screened to assess for documentation of delirium. Results 95 patients were screened and 32 (33%) of these screened positive. Of these only 11 patients had a diagnosis of delirium documented in medical/nursing notes and a delirium care bundle opened. 50% of CCU patients were delirious. The Geriatric Medicine Ward had a lower prevalence of 19% with 66% identified in medical notes. Conclusion These results are disappointing with only 34% of patients identified as having a delirium. This audit is part of a quality improvement project with education sessions ongoing and roll out of the national delirium/dementia pathways across the medical wards. We hope to present our interventions and completed audit loop shortly.
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Babine, Rhonda L., Kristiina E. Hyrkäs, Christin Scott, and Heidi R. Wierman. "Individuals Who Developed Delirium While Enrolled in the Hospital Elder Life Program: An Exploratory Study." Journal of Gerontological Nursing 49, no. 5 (May 2023): 19–29. http://dx.doi.org/10.3928/00989134-20230414-02.
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Delirium prevention in hospitalized older adults is important due to delirium's high prevalence and negative impact on outcomes. Today, there are evidence-based programs with well-documented effectiveness aimed at preventing delirium, such as the Hospital Elder Life Program (HELP); however, approximately 4% to 5% of patients develop delirium regardless of implemented prevention interventions. It remains unknown why some patients develop delirium. The current retrospective exploratory chart review analyzed 98 records for clinical risk factors and outcomes of patients who developed delirium while enrolled in the HELP. On admission, immobility (86.7%) was the most common risk factor. Patients developed delirium approximately 70 hours after admission. Average length of stay was 8 days. Approximately one half (44.9%) of patients died within 1 year. Immobility (97.7% vs. 77.8%, p = 0.005) and renal disease (52.3% vs. 24.1%, p = 0.008) were more often found in patients who died. This study identifies risk factors that seem to require heightened attention during hospitalization to prevent the negative outcomes associated with delirium in older adults. [ Journal of Gerontological Nursing, 49 (5), 19–29.]
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Gaudreau, Jean-David, Pierre Gagnon, François Harel, Marc-André Roy, and Annie Tremblay. "Psychoactive Medications and Risk of Delirium in Hospitalized Cancer Patients." Journal of Clinical Oncology 23, no. 27 (September 20, 2005): 6712–18. http://dx.doi.org/10.1200/jco.2005.05.140.
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Purpose Psychoactive medications are biologically plausible and potentially modifiable risk factors of delirium. To date, however, research findings are inconsistent regarding their association with delirium. The association between exposure to anticholinergics, benzodiazepines, corticosteroids, and opioids and the risk of delirium was studied. Patients and Methods A total of 261 hospitalized cancer patients were followed up with repeated assessments by using the Nursing Delirium Screening Scale for up to 4 weeks for incident delirium. Detailed exposure to psychoactive medications was documented daily. Strengths of association with delirium were expressed as hazard ratios (HRs) in univariate and multivariate analyses by using Cox regression models. All medication variables were coded as time-dependent covariates. Whenever possible, exposure was computed by using cumulative daily doses in equivalents; dichotomous cutoffs were determined. Results During follow-up (mean, 8.6 days), 43 patients became delirious (16.5%). Delirium was associated with a history of delirium and the presence of hepatic metastases at admission. Analysis of the effect of medications was performed adjusting for these factors. Patients exposed to daily doses of benzodiazepines above 2 mg (HR, 2.04; 95% CI, 1.05 to 3.97), above 15 mg of corticosteroids (HR, 2.67; 95% CI, 1.18 to 6.03), or above 90 mg of opioids (HR, 2.12; 95% CI, 1.09 to 4.13) had increases in the risks for delirium. We did not observe associations between anticholinergics and risk for delirium. Conclusion Exposure to opioids, corticosteroids, and benzodiazepines is independently associated with an increased risk of delirium in hospitalized cancer patients.
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Ryan, Sophia L., and Eyal Y. Kimchi. "Evaluation and Management of Delirium." Seminars in Neurology 41, no. 05 (October 2021): 572–87. http://dx.doi.org/10.1055/s-0041-1733791.
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AbstractDelirium, sometimes referred to as encephalopathy, is an acute confusional state that is both common in hospitalized patients and associated with poor outcomes. For patients, families, and caregivers, delirium can be a traumatic experience. While delirium is one of the most common diagnoses encountered by the consulting neurologist, the majority of the time it will have been previously unrecognized as such by the care team. Neurologic syndromes such as dementia or aphasia can either be misdiagnosed as delirium or may coexist with it, necessitating careful neurologic assessment. Once the diagnosis of delirium has been established, a careful evaluation for predisposing and precipitating factors can help uncover modifiable contributors, which should be addressed as part of a multicomponent, primarily nonpharmacologic intervention. Importantly, delirium management, which begins with comprehensive prevention, should emphasize the humanity of the delirious patient and the challenges of caring for this vulnerable population. When considered, delirium represents an important opportunity for the neurologist to substantially enhance patient care.
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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.