1
|
Deeth S, Stevens S, Bell J, Mudge A. Nutrition care for older adults with delirium: A scoping review. J Clin Nurs 2024; 33:3886-3904. [PMID: 38379358 DOI: 10.1111/jocn.17069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/30/2023] [Accepted: 02/02/2024] [Indexed: 02/22/2024]
Abstract
AIMS This scoping review aimed to identify and map the available information on the nutrition care process in older adults with delirium to analyse and summarise key concepts, and gaps, including the barriers and enablers to providing nutrition care for this group. DESIGN Scoping review. METHODS This review was conducted in accordance with the JBI methodology for scoping reviews. Published and grey sources in English were considered. DATA SOURCES Databases searched were CINAHL, Medline, Embase, JBI Evidence-based Practice, Scopus, ProQuest and Google. The initial search was conducted from October 2021 to March 2022 and repeated in October 2023. RESULTS The database search identified 1561 articles, 186 underwent full-text review and 17 articles were included. The grey literature search identified eight articles. Malnutrition and delirium were identified as mutually reinforcing, and nutrition strategies were included as part of multicomponent interventions for delirium management. There was no mention of barriers or enablers to nutrition care and minimal descriptive or empirical data available to guide nutrition care processes in this group. CONCLUSION This scoping review revealed a need for further research into nutrition care processes in older patients with delirium, in particular the barriers and enablers, to inform appropriate management strategies in this vulnerable group. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Providing nutrition care for older patients with delirium is important and further practical guidance could help patients, healthcare staff and families. IMPACT This scoping review yielded instructive data suggesting that delirium is an important risk factor for malnutrition and vice versa, which leads to poor patient and health service outcomes. REPORTING METHOD This scoping review adhered to relevant EQUATOR guidelines and used the Preferred Reporting Items For Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). PATIENT OF PUBLIC CONTRIBUTION No patient or public contribution.
Collapse
Affiliation(s)
- Sophie Deeth
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Allied Health, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Sarah Stevens
- Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jack Bell
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Allied Health, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Alison Mudge
- Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Greater Brisbane Medical School, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
2
|
Delirium in Nursing Home Residents: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10081544. [PMID: 36011202 PMCID: PMC9407867 DOI: 10.3390/healthcare10081544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Delirium is an important component of the geriatric syndromes and has been recognized to negatively influence the prognosis of older people in hospital and in a post-acute setting. About 2–5% of older people world-wide live in nursing homes and are characterized by functional impairment, cognitive decline, dementia, comorbidities, and polypharmacotherapy, all factors which influence the development of delirium. However, in this setting, delirium remains often understudied. Therefore, in this narrative review, we aimed to describe the latest evidence regarding delirium screening tools, epidemiology characteristics, outcomes, risk factors, and preventions strategies in nursing homes.
Collapse
|
3
|
Ordóñez-Velasco LM, Hernández-Leiva E. Factors associated with delirium after cardiac surgery: A prospective cohort study. Ann Card Anaesth 2021; 24:183-189. [PMID: 33884974 PMCID: PMC8253013 DOI: 10.4103/aca.aca_43_20] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Delirium is a frequent complication after cardiac surgery and is associated with a higher incidence of morbidity and mortality and a prolonged hospital stay. However, knowledge of the variables involved in its occurrence is still limited; therefore, in this study, we evaluated the perioperative risk factors independently associated with this complication. Methods: This study was conducted in a referral tertiary care university hospital with a cardiovascular focus. A total of 311 consecutive adult patients undergoing any type of cardiac surgery were evaluated. The subjects were examined at regular intervals in the postoperative period using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) tool. Results: The incidence of postoperative delirium (PD) was 10%. Among the 18 pre-, intra- and postoperative variables evaluated, the logistic regression analysis showed that low education level, history of diabetes or stroke, type of surgery, prolonged extracorporeal circulation, or red blood cell transfusion in the intra- or postoperative period were independently associated with delirium after cardiac surgery. An increased body mass index was identified as a protective factor. Conclusions: The aforementioned risk factors are significantly and independently associated with the presentation of PD. Because some of these factors can be treated or avoided, the results of this study are highly relevant to reduce the risk of this complication and improve the care of patients undergoing cardiac surgery.
Collapse
Affiliation(s)
- Lina Maria Ordóñez-Velasco
- Intensivist at Cardiovascular Intensive Care Unit. Instituto de Cardiología - Fundación Cardioinfantil, Colombia
| | - Edgar Hernández-Leiva
- Department of Cardiology, Head of the Cardiac Surgical Intensive Care Unit, Instituto de Cardiología - Fundación Cardioinfantil, Colombia
| |
Collapse
|
4
|
Preoperative Nutritional Status and Risk for Subsyndromal Delirium in Older Adults Following Joint Replacement Surgery. Orthop Nurs 2020; 39:384-392. [PMID: 33234908 DOI: 10.1097/nor.0000000000000710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Subsyndromal delirium following surgery in older adults is related to increased lengths of hospital stay and increased admissions to long-term care. Impaired nutrition increases risk for delirium, but its relationship to subsyndromal delirium remains unclear. PURPOSE This correlational study examined the relationship between nutritional status and subsyndromal delirium in older adults. METHODS Assessments for subsyndromal delirium in 53 adults 65 years or older were completed for three consecutive days following joint replacement surgery. Relationships between nutritional status and subsyndromal delirium were analyzed. Level of significance for all tests was set at p ≤ .05. RESULTS Participants' scores from the Mini Nutritional Assessment screen were significantly related (p = .05) to subsyndromal delirium severity after accounting for variability posed by age and cognition status. CONCLUSION When preoperative risk assessment of older adults indicates nutritional risk, preoperative optimization may improve effectiveness of delirium prevention efforts.
Collapse
|
5
|
Boockvar KS, Judon KM, Eimicke JP, Teresi JA, Inouye SK. Hospital Elder Life Program in Long-Term Care (HELP-LTC): A Cluster Randomized Controlled Trial. J Am Geriatr Soc 2020; 68:2329-2335. [PMID: 32710658 PMCID: PMC7718417 DOI: 10.1111/jgs.16695] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES The Hospital Elder Life Program (HELP) has been shown to prevent delirium in hospitalized older adults. The objective of this study was to test the efficacy of HELP adapted to long-term care (HELP-LTC). DESIGN Cluster randomized controlled trial. SETTING A 514-bed academic urban nursing home. PARTICIPANTS A total of 219 long-term nursing home residents who developed an acute illness or change in condition were randomly assigned to HELP-LTC (n = 105) or usual care (n = 114) by unit. INTERVENTION HELP-LTC is a multicomponent intervention targeting delirium risk factors of cognitive impairment, immobility, dehydration, and malnutrition. Two certified nursing assistants (CNAs) delivered HELP-LTC components twice daily 7 days per week. In addition, recommendations were given to primary providers to reduce medications associated with delirium. MEASUREMENTS Delirium (primary outcome) and delirium severity were ascertained each weekday by a research assistant blinded to group assignment, using the Confusion Assessment Method (CAM) and CAM severity score (CAM-S), respectively. Cognitive function was determined using the Cognitive Performance Scale (CPS). Hospitalization was ascertained by chart review. RESULTS Participants were 81.7 years of age on average and 65.3% female. At baseline, usual care group participants had better cognitive function than intervention group participants (CPS = 1.33 vs 2.25; P = .004). Delirium symptoms declined over the course of the episode (mean CAM-S = 3.63 at start vs 3.27 at end). Overall, 33.8% of the total sample experienced incident delirium. After adjusting for baseline cognitive function, no significant differences were found in delirium or delirium severity between intervention and usual care groups. Hospitalization was not significantly different between groups. CONCLUSION An intervention targeting delirium risk in long-term nursing home residents did not prevent delirium or reduce delirium symptoms. Baseline differences in cognitive function between groups, greater than expected improvements in both groups, quality-enhancing practices such as consistent assignments delivered to both groups, and adaptations of the intervention may have biased results toward null. J Am Geriatr Soc 68:2329-2335, 2020.
Collapse
Affiliation(s)
- Kenneth S Boockvar
- The New Jewish Home, New York, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J. Peters VA Medical Center, Bronx, New York, USA
| | | | - Joseph P Eimicke
- Research Division, Hebrew Home at Riverdale, Bronx, New York, USA
| | - Jeanne A Teresi
- Research Division, Hebrew Home at Riverdale, Bronx, New York, USA
- Columbia University Stroud Center at New York State Psychiatric Institute, New York, New York, USA
- Division of Geriatrics and Palliative Care, Weill Cornell Medical College, New York, New York, USA
| | - Sharon K Inouye
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Negro A, Leggieri C, Villa G, Lembo R, Signò F, Lanzalaco MR, Miconi L, Tira T, Ponzetta G, Dossi M, Marzo E, Rolandi S, D'Aloia P, Manara DF, Iannaccone S. Delirium prevalence point: an observational monocentric study in a tertiary university hospital. Ir J Med Sci 2020; 190:793-798. [PMID: 32812115 DOI: 10.1007/s11845-020-02348-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/13/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Delirium is a serious and common condition that needs an upgrade of the scientific and clinical attention. AIM To assess the delirium prevalence in an Italian university hospital. METHODS The monocentric 1-day observational study cohort has been conducted on March 15, 2018; the population was composed of adult hospitalized patients. All the eligible patients have been evaluated for the presence of delirium with the 4AT. RESULTS We enrolled 596 patients. Twenty-nine Acute and 3 Rehabilitation Units were involved in the study. The median age of the sample was 60 (IQR 48-74) and 52% (n = 313) were male. Patients from medical units were 42% (n = 252), from surgery units 41% (n = 249), and from rehabilitation units 15% (n = 95). Results of 4AT showed that 5.4% (n = 32) had delirium (4AT = 4), 12% (n = 73) had cognitive impairment (4AT = 1-3), and 82% (n = 491) had no delirium or cognitive impairment (4AT = 0). We found association between delirium and age, BMI, mortality at 30 days, and hospital mortality. Delirium was related with Barthel Index, dementia, and anticholinesterase inhibitors. About devices in use, we observed a correlation of delirium with central venous catheter, feeding tube, and urinary catheter. Physical restraints were also correlated to delirium. CONCLUSIONS We confirmed the presence of delirium across the hospital units, more in medical than in surgical ones. We found associations of delirium with conditions that limit movement, such as dementia, physical restraints, or devices. The development of delirium initiates a cascade of events culminating in the loss of independence and increased morbidity.
Collapse
Affiliation(s)
- Alessandra Negro
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Carlo Leggieri
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Giulia Villa
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy.
| | - Rosalba Lembo
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Federica Signò
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | | | - Lucia Miconi
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Tiziana Tira
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Giuseppe Ponzetta
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Mauro Dossi
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | | | - Stefano Rolandi
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| | | | | | - Sandro Iannaccone
- IRCCS San Raffaele Institute, Via Olgettina, 60, 20132, Milan, Italy
| |
Collapse
|
7
|
Velayati A, Vahdat Shariatpanahi M, Shahbazi E, Vahdat Shariatpanahi Z. Association between preoperative nutritional status and postoperative delirium in individuals with coronary artery bypass graft surgery: A prospective cohort study. Nutrition 2019; 66:227-232. [DOI: 10.1016/j.nut.2019.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 06/08/2019] [Accepted: 06/08/2019] [Indexed: 11/26/2022]
|
8
|
Tonkikh O, Shadmi E, Zisberg A. Food intake assessment in acutely ill older internal medicine patients. Geriatr Gerontol Int 2019; 19:890-895. [DOI: 10.1111/ggi.13744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/28/2019] [Accepted: 06/19/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Orly Tonkikh
- The Cheryl Spencer Department of NursingUniversity of Haifa Haifa Israel
| | - Efrat Shadmi
- The Cheryl Spencer Department of NursingUniversity of Haifa Haifa Israel
| | - Anna Zisberg
- The Cheryl Spencer Department of NursingUniversity of Haifa Haifa Israel
| |
Collapse
|
9
|
Van Ancum JM, Scheerman K, Pierik VD, Numans ST, Verlaan S, Smeenk HE, Slee-Valentijn M, Kruizinga RC, Meskers CGM, Maier AB. Muscle Strength and Muscle Mass in Older Patients during Hospitalization: The EMPOWER Study. Gerontology 2017; 63:507-514. [PMID: 28817825 DOI: 10.1159/000478777] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 06/19/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Low muscle strength and muscle mass are associated with an increased length of hospital stay and higher mortality rate in inpatients. To what extent hospitalization affects muscle strength and muscle mass is unclear. OBJECTIVE We aimed to assess muscle strength and muscle mass at admission and during hospitalization in older patients and its relation with being at risk of geriatric conditions. METHODS The EMPOWER study included patients aged 70 years and older, admitted to 4 wards of the VU University Medical Center in the Netherlands between April and December 2015. At admission, patients were screened for being at risk of 4 geriatric conditions: delirium, falls, malnutrition, and functional disability. At admission and at discharge, muscle strength and muscle mass were assessed. RESULTS A total of 373 patients (mean age, standard deviation [SD]: 79.6, 6.38 years) were included at admission, and 224 patients (mean age, SD: 80.1, 6.32 years) at discharge. At admission, lower muscle strength in both female and male patients and low muscle mass in male patients were associated with being at risk of a higher cumulative number of geriatric conditions. Muscle strength increased during hospitalization, but no change in muscle mass was observed. Changes in muscle measures were not associated with being at risk of geriatric conditions. DISCUSSION Older patients with lower muscle strength and muscle mass at admission were at risk of a higher cumulative number of geriatric conditions. However, being at risk of geriatric conditions did not forecast further decrease in muscle strength and muscle mass during hospitalization.
Collapse
Affiliation(s)
- Jeanine M Van Ancum
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Crenitte MRF, Avelino-Silva TJ, Apolinario D, Curiati JAE, Campora F, Jacob-Filho W. Predictors of Enteral Tube Feeding in Hospitalized Older Adults. JPEN J Parenter Enteral Nutr 2016; 41:1423-1425. [PMID: 27932700 DOI: 10.1177/0148607116683142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite general recognition that enteral tube feeding (ETF) is frequently employed in long-term care facilities and patients with dementia, remarkably little research has determined which factors are associated with its use in acutely ill older adults. In this study, we aimed to investigate determinants of ETF introduction in hospitalized older adults. METHODS We examined a retrospective cohort of acutely ill patients, aged 60 years and older, admitted to a university hospital's geriatric ward from 2014-2015, in São Paulo, Brazil. The main outcome was the introduction of ETF during hospitalization. Predictors of interest included age, sex, referring unit, comorbidity burden, functional status, malnutrition, depression, dementia severity, and delirium. Multivariate analysis was performed using backward stepwise logistic regression. RESULTS A total of 214 cases were included. Mean age was 81 years, and 63% were women. Malnutrition was detected in 47% of the cases, dementia in 46%, and delirium in 36%. ETF was initiated in 44 (21%) admissions. Independent predictors of ETF were delirium (odds ratio [OR], 4.83; 95% CI, 2.12-11.01; P < .001) and total functional dependency (OR, 8.95; 95% CI, 2.87-27.88; P < .001). Malnutrition was not independently associated with ETF. CONCLUSION One in five acutely ill older adults used ETF while hospitalized. Delirium and functional dependency were independent predictors of its introduction. Risks and benefits of enteral nutrition in this particular context need to be further explored.
Collapse
Affiliation(s)
- Milton Roberto Furst Crenitte
- 1 Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, SP-Brazil
| | | | - Daniel Apolinario
- 1 Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, SP-Brazil
| | - Jose Antonio Esper Curiati
- 1 Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, SP-Brazil
| | - Flavia Campora
- 1 Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, SP-Brazil
| | - Wilson Jacob-Filho
- 1 Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, SP-Brazil
| |
Collapse
|
11
|
|
12
|
Boockvar KS, Teresi JA, Inouye SK. Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long-Term Care Delivered by Certified Nursing Assistants. J Am Geriatr Soc 2016; 64:1108-13. [PMID: 27160212 DOI: 10.1111/jgs.14091] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nursing home (NH) residents have a high prevalence of delirium risk factors, experience two to four acute medical conditions (e.g., infections) each year, and have an incidence of delirium during these conditions similar to that of hospitalized older adults. Many NH residents with delirium do not return to their prior level of cognitive function. They are more likely to die, be hospitalized, and less likely to be discharged home than those without delirium. Research on the prevention or treatment of delirium in NHs is limited. This article describes the development and pilot testing of a multicomponent delirium prevention intervention in the NH setting adapted from the Hospital Elder Life Program (HELP-LTC). Activities to reduce the risk of delirium that were appropriate for functionally impaired NH residents were developed and delivered during treatment for and recovery from acute illness, a novel resident-targeting approach. Expertly trained certified nursing assistants (CNAs - a total of 1.4 full-time equivalent (FTE) positions-) visited residents throughout the facility and delivered the activities. The current study reports on incident delirium, delirium remission, cognitive and physical function change, hospitalization, and death associated with acute medical conditions as ascertained by a program coordinator. The integration and acceptance of the CNAs' activities by residents and staff are also reported on. Hospitalization and death were ascertained in a nonintervention comparison group. Findings support a test of the intervention in a controlled trial. The potential effect is great; there are approximately 1.4 million NH residents in the United States and an estimated 1 million with dementia or cognitive impairment, an important delirium risk factor. An intervention would be broadly adoptable if a reduction in healthcare costs through prevention of hospitalization offset the cost of the program's CNAs.
Collapse
Affiliation(s)
- Kenneth S Boockvar
- The New Jewish Home, New York, New York.,Icahn School of Medicine at Mount Sinai, New York, New York.,James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Jeanne A Teresi
- Research Division, Hebrew Home at Riverdale, Bronx, New York.,Stroud Center at New York State Psychiatric Institute, Columbia University, New York, New York.,Weill Cornell Division of Geriatrics and Palliative Care, New York, New York
| | - Sharon K Inouye
- Aging Brain Center, Hebrew SeniorLife, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
13
|
Flaherty JH, Morley JE. Delirium in the Nursing Home. J Am Med Dir Assoc 2013; 14:632-4. [DOI: 10.1016/j.jamda.2013.06.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
|
14
|
de Lange E, Verhaak PFM, van der Meer K. Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: a review. Int J Geriatr Psychiatry 2013; 28:127-34. [PMID: 22513757 DOI: 10.1002/gps.3814] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 03/14/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study is to provide an overview of prevalence, symptoms, risk factors and prognosis of delirium in primary care and institutionalized long-term care. DESIGN The method used in this study is a systematic PubMed search and literature review. RESULTS The prevalence of delirium in the population among the elderly aged 65+ years is 1-2%. Prevalence rises with age: 10% among a "general" population aged 85+ years. Prevalence rises up to 22% in populations with higher percentages of demented elder. In long-term care, prevalence ranges between 1.4% and 70%, depending on diagnostic criteria and on the prevalence of dementia. There is a significant increase of the risk of delirium with age and cognitive decline in all groups. Concerning prognosis, most studies agree that older people who previously experienced delirium have a higher risk of dementia and a higher mortality rate. Population and long-term care studies show the same tendency. CONCLUSIONS Delirium in a non-selected population aged 65+ years is uncommon. However, prevalence rises very quickly in selected older groups. Primary care doctors should be aware of a relatively high risk of delirium among the elderly in long-term care, those older than 85 years and those with dementia.
Collapse
Affiliation(s)
- E de Lange
- Academische huisartsenpraktijk Groningen, University Medical Center Groningen, Hanzeplein 1, Postbus 880, 9700, AW, Groningen, The Netherlands.
| | | | | |
Collapse
|
15
|
Quinlan N, Marcantonio ER, Inouye SK, Gill TM, Kamholz B, Rudolph JL. Vulnerability: the crossroads of frailty and delirium. J Am Geriatr Soc 2012; 59 Suppl 2:S262-8. [PMID: 22091571 DOI: 10.1111/j.1532-5415.2011.03674.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Frailty and delirium, although seemingly distinct syndromes, both result in significant negative health outcomes in older adults. Frailty and delirium may be different clinical expressions of a shared vulnerability to stress in older adults, and future research will determine whether this vulnerability is age related, pathological, genetic, environmental, or most likely, a combination of all of these factors. This article explores the clinical overlap of frailty and delirium, describes possible pathophysiological mechanisms linking the two, and proposes research opportunities to further knowledge of the interrelationships between these important geriatric syndromes. Frailty, a diminished ability to compensate for stressors, is generally viewed as a chronic condition, whereas delirium is an acute change in attention and cognition, but there is a developing literature on transitions in frailty status around acute events, as well as on delirium as a chronic, persistent condition. If frailty predisposes an individual to delirium, and delirium delays recovery from a stressor, then both syndromes may contribute to a downward spiral of declining function, increasing risk, and negative outcomes. In addition, frailty and delirium may have shared pathophysiology, such as inflammation, atherosclerosis, and chronic nutritional deficiencies, which will require further investigation. The fields of frailty and delirium are rapidly evolving, and future research may help to better define the interrelationship of these common and morbid geriatric syndromes. Because of the heterogeneous pathophysiology and presentation associated with frailty and delirium, typical of all geriatric syndromes, multicomponent prevention and treatment strategies are most likely to be effective and should be developed and tested.
Collapse
Affiliation(s)
- Nicky Quinlan
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA
| | | | | | | | | | | |
Collapse
|
16
|
Abstract
Polypharmacy is generally defined as the use of 5 or more prescription medications on a regular basis. The average number of prescribed and over-the-counter medications used by community-dwelling older adults per day in the United States is 6 medications, and the number used by institutionalized older persons is 9 medications. Almost all medications affect nutriture, either directly or indirectly, and nutriture affects drug disposition and effect. This review will highlight the issues surrounding polypharmacy, food-drug interactions, and the consequences of these interactions for the older adult.
Collapse
Affiliation(s)
- Roschelle Heuberger
- Department of Human Environmental Studies, Central Michigan University, Mt Pleasant, Michigan 48859, USA.
| |
Collapse
|
17
|
Abstract
This study used data from the Delirium Among the Elderly in Rural Long-Term Care Facilities Study and data from the National Death Index (NDI) to examine mortality among 320 individuals. Individuals were grouped into noncases, subsyndromal cases, hypoactive delirium, hyperactive delirium, and mixed delirium on the basis of scoring using the Confusion Assessment Method (CAM), NEECHAM Scale, Mini-Mental State Examination (MMSE), Clinical Assessment of Confusion-A (CAC-A), and Vigilance A instruments. Risk ratios of mortality using "days of survival" did not reach statistical significance (α = .05) for any subgroup. Underlying cause of death (UCD) using International Classification of Disease, 10th version (ICD-10), showed typical UCD among older adults. There appeared to be clinical differences in UCD between delirium subgroups. Findings supported the conclusion that careful monitoring of patients with delirium and subsyndromal delirium is needed to avoid complications and injuries that could increase mortality.
Collapse
Affiliation(s)
- Susan K DeCrane
- Purdue University School of Nursing, 502 North University Street, West Lafayette, IN 47907-2069, USA.
| | | | | |
Collapse
|
18
|
Abstract
Attention has been drawn to the potential risks of several medications in the long-term care setting. Most of these medications deemed as inappropriate affect the central nervous system and are indicated only for select populations with specific conditions. Many of these drugs are prescribed without clear indications and continued indefinitely without critical decision-making about the potentially salutary effects of discontinuing medications. This article describes the increasing awareness of potentially inappropriate prescribing in the long-term care setting and reviews the rationale for why various types of medications are deemed inappropriate, with a focus on agents that affect central nervous system functioning.
Collapse
|
19
|
Lu SH, Leasure AR, Dai YT. A systematic review of body temperature variations in older people. J Clin Nurs 2010; 19:4-16. [DOI: 10.1111/j.1365-2702.2009.02945.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
20
|
Abstract
Delirium is an often acute and highly fluctuating syndrome that can be transient or in some cases associated with prolonged disturbances. The best way to capture its natural course is to conduct studies with longitudinal design, but data analysis in longitudinal studies is difficult, as often the measured variables of each subject are correlated over the course of time. As such, there has been limited application of such methods for analysing longitudinal data in the study of delirium. This overview considers simple traditional approaches along with more complex methods that involve modelling of data. The relative merits of survival analysis, structural equation modelling, and path analysis are reviewed. Furthermore, two flexible modelling techniques are considered; the mixed effects model and generalized estimating equations with emphasis on their use with binary outcomes, as often the outcome in delirium studies is delirium/no delirium. Their contrasting approach to parameter interpretation and methods for accounting for correlation and dealing with missing data are detailed. Information on available software is provided. Delirium research will be substantially enhanced by incorporating such methods.
Collapse
|