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Chen S, Tang L, Chen J, Cai L, Liu C, Song J, Chen Y, Liu Y, Zheng S. Prevalence and risk factors of subsyndromal delirium among postoperative patients: A systematic review and meta-analysis. J Adv Nurs 2024; 80:924-934. [PMID: 37788076 DOI: 10.1111/jan.15871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/21/2023] [Accepted: 09/09/2023] [Indexed: 10/04/2023]
Abstract
AIM The aim of this study is to determine the prevalence and risk factors for subsyndromal delirium in the postoperative patient. DESIGN A systematic review and meta-analysis. METHODS The Review Manager 5.3 statistics platform and the Newcastle-Ottawa Scale were used for quality evaluation. DATA SOURCES The following databases were searched: PubMed, Web of Science, EMBASE, The Cochrane Library, Scopus and EBSCO from January 2000 to December 2021. Additional sources were found by looking at relevant articles' citations. RESULTS A total of 1744 titles were originally identified, and five studies including 962 patients were included in the systematic review, with a pooled prevalence of postoperative subsyndromal delirium (PSSD) of 30% (95% CI: 0.28-0.32). Significant risk variables for PSSD were older age, low levels of education (≤9 years), cognitive impairment, higher comorbidity score, and the duration of operation. CONCLUSION PSSD is prevalent and is associated with a variety of risk factors as well as low academic performance. IMPACT Identification and clinical management of patients with PSSD should be improved. Future research on PSSD risk factors should look at a wider range of intraoperative and postoperative risk factors that can be changed. PATIENT AND PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Shunli Chen
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Lingyu Tang
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Jing Chen
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Luyao Cai
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Janying Song
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Yingyi Chen
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Yan Liu
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Silin Zheng
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Gao Y, Zhang C, Liao C, Gan X. Nurses' assessment of subsyndromal delirium and barriers to assessment: A cross-sectional survey in the intensive care unit. J Nurs Manag 2022; 30:4491-4502. [PMID: 36326205 PMCID: PMC10099329 DOI: 10.1111/jonm.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/08/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
AIMS The aims of the study are to investigate the current status of nurses' assessment of subsyndromal delirium (SSD) in the intensive care unit (ICU) and explore possible barriers to assessment. BACKGROUND SSD is a dynamic, recognizable disorder commonly seen in the ICU that can lead to poor patient outcomes. Timely recognition and management can prevent its progression. METHODS A cross-sectional survey design was used to collect data from ICU registered nurses in southwest China. The online survey containing an analysis of the current status of SSD assessment and barriers was completed by 237 nurses. RESULTS A total of 51.5% of nurses chose to assess SSD using an assessment tool, the most commonly used being the Confusion Assessment Method for the Intensive Care Unit; the frequency of assessment was mostly once a day (66, 41.0%) and often at shift change (178, 87.3%). There were statistically significant differences in the barrier factor scores by assessment frequency, assessment method, status of training in SSD, ability of SSD-related knowledge to meet clinical needs and willingness to receive SSD training. CONCLUSION Our study confirms that the current state of assessment of SSD in the ICU is unsatisfactory, with nurses' lack of assessment knowledge and skills, poor organization and management, and the complexity of patients' conditions being barriers. IMPLICATIONS FOR NURSING MANAGEMENT Nursing managers should systematically conduct training programmes on effective SSD assessment knowledge and skills, incorporate SSD assessment into the daily workflow, have standardized assessment tools, develop standardized processes and assign dedicated staff to monitor, audit and provide feedback on SSD assessments.
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Affiliation(s)
- Yan Gao
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chuanlai Zhang
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chunlian Liao
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiuni Gan
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Constaín GA, Ocampo Saldarriaga MV, Velásquez Tirado JD, Rodríguez-Gázquez MDLÁ, Betancur Morales LM, Rico Escobar JJ, Castilla Agudelo GA, Maya Osorno AF. Persistent Delirium in Elderly patients Three Months After Hospital Discharge from a University Clinic. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2018; 47:37-45. [PMID: 29428120 DOI: 10.1016/j.rcp.2016.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/29/2016] [Accepted: 10/31/2016] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The purpose of the study was to determine the prevalence and characteristics of patients with persistent delirium (PD) at three months after hospital discharge. METHODOLOGY Longitudinal descriptive study to assess the prevalence and characteristics of in-patients aged 65 years and older in the Clinica Universitaria Bolivariana who met DSM-5 criteria for delirium at admission, at discharge, and at a 3-month follow up assessment. Socio-demographic features were determined, and CGI-S and DRS-R98 scales used. RESULTS A total of 30 patients were evaluated between April and October 2013, but 6 did not fulfil the inclusion criteria. The study included 24 patients, with 9 (37.5%) dying during hospitalisation. Of the 15 surviving patients, five (20.8% of the total sample) had their delirium resolved at discharge, and ten (41.6% of the sample) continued with symptoms. These established the PD group, of whom five of them (20.8%) had full PD, and the other five (20.8%) sub-syndromal PD (SSPD). At the final assessment, only two patients (8.3%) continued with full PD, and another two (8.3%) with SSPD. Among the PD group, 30% had a full delirium at admission (prevalence), and 70% developed full delirium during hospitalization (incidence). CONCLUSIONS A significant number of patients did not recover from delirium at leaving hospital, and remained symptomatic three months after discharge. The study findings suggest a course of gradual improvement of delirium, with a persistence of symptoms over time in 40% of the patients, which would have implications for the clinical practice.
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Affiliation(s)
- Gustavo A Constaín
- Grupo de Investigación de Psiquiatría de Enlace, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia.
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Sepulveda E, Leonard M, Franco JG, Adamis D, McCarthy G, Dunne C, Trzepacz PT, Gaviria AM, de Pablo J, Vilella E, Meagher DJ. Subsyndromal delirium compared with delirium, dementia, and subjects without delirium or dementia in elderly general hospital admissions and nursing home residents. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 7:1-10. [PMID: 28116342 PMCID: PMC5233793 DOI: 10.1016/j.dadm.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction Subsyndromal delirium (SSD) complicates diagnosis of delirium and dementia, although there is little research comparing their symptom profiles. Methods Cross-sectional study of 400 elderly patients' admission to a general hospital or nursing home diagnosed with delirium, SSD, dementia, or no-delirium/no-dementia (NDND). Symptom profiles were assessed using the Delirium Rating Scale-Revised-98 (DRS-R98). Results Twenty percent patients had delirium, 19.3% had SSD, 29.8% had dementia-only, and 31% had NDND. Eighty-one percent of subsyndromal and 76% of delirium groups had comorbid dementia. DRS-R98 scores showed ascending severity from NDND < dementia-only < SSD < delirium. DRS-R98 scores for items evaluating the three core symptom domains (cognitive, higher-order thinking, and circadian) distinguished SSD from delirium and both from nondelirium groups. DRS-R98 profiles were essentially the same in delirium and SSD subgroups with or without dementia, although total scale scores were generally higher when in comorbid subgroups. Discussion SSD shared characteristic core domain symptoms with delirium, which distinguished each from nondelirium groups, although severity was intermediate in the subsyndromal group. Delirium core symptoms overshadowed the dementia phenotype when comorbid. Milder disturbances of delirium core domain symptoms are highly suggestive of SSD.
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Affiliation(s)
- Esteban Sepulveda
- Hospital Psiquiatric Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Reus, Tarragona, Spain
| | - Maeve Leonard
- University of Limerick Graduate Entry Medical School, Limerick, Ireland; Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland
| | - Jose G Franco
- Hospital Psiquiatric Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Reus, Tarragona, Spain; Grupo de Investigación en Psiquiatría de Enlace, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Dimitrios Adamis
- Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland; Research and Academic Institute of Athens, Athens, Greece; Sligo-Leitrim Mental Health Services, Sligo, Ireland
| | | | - Colum Dunne
- University of Limerick Graduate Entry Medical School, Limerick, Ireland
| | - Paula T Trzepacz
- Indiana University School of Medicine, Indianapolis, IN, USA; Tufts University School of Medicine, Boston, MA, USA
| | - Ana M Gaviria
- Hospital Psiquiatric Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Reus, Tarragona, Spain; Universidad de San Buenaventura, Faculty of Psychology, Medellín, Colombia
| | - Joan de Pablo
- Hospital Psiquiatric Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Reus, Tarragona, Spain
| | - Elisabet Vilella
- Hospital Psiquiatric Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Reus, Tarragona, Spain
| | - David J Meagher
- University of Limerick Graduate Entry Medical School, Limerick, Ireland; Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland; Department of Psychiatry, University Hospital Limerick, Limerick, Ireland
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Cabezón-Gutiérrez L, Gómez-Pavón J, Pérez-Cajaraville J, Viloria-Jiménez MA, Álamo-González C, Gil-Gregorio P. [Update on oncological pain in the elderly]. Rev Esp Geriatr Gerontol 2015; 50:289-97. [PMID: 25777946 DOI: 10.1016/j.regg.2015.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 02/04/2015] [Indexed: 01/05/2023]
Abstract
Pain is a prevalent symptom in cancer geriatric patients, appearing in up to 90% of patients with terminal cancer. This requires a multidimensional approach, as there is a high percentage of inappropriate assessments and treatments. Unrecognized or poorly treated pain in the geriatric population, especially in cancer patients, leads to the development of disabling symptoms such as depression, anxiety, isolation, sleep disturbances, and appetite, and very especially, loss of functional capacity and quality of life. In this review an analysis is made on the most relevant studies on the diagnosis and management of cancer pain in the geriatric population.
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Affiliation(s)
- Luis Cabezón-Gutiérrez
- Servicio de Oncología Médica, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España.
| | | | | | | | | | - Pedro Gil-Gregorio
- Servicio de Geriatría, Unidad de Cuidados Paliativos, Hospital Clínico Universitario San Carlos, Madrid, España; Coordinador del Comité de Expertos del Dolor de la Sociedad Española de Geriatría y Gerontología, España
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Outcomes in complex patients with delirium and subsyndromal delirium one year after hospital discharge. Int Psychogeriatr 2013; 25:2087-8. [PMID: 23803289 DOI: 10.1017/s1041610213000975] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There has been an increasing interest in delirium as a clinical syndrome in elderly patients in the last years (de Rooij et al., 2005). Until now the diagnosis has been dichotomous, but recent studies appear to show that a further categorization of this syndrome may lead to a higher diagnostic and prognostic value. The subsyndromal delirium (SSD) displays some of the symptoms without developing the full syndrome and it is intermediate in severity between non-delirious controls and full syndromal delirium, although it has no officially recognized diagnostic criteria (Levkoff et al., 1996). There is growing evidence about the prognostic significance of SSD among elderly individuals, but to date there are very few published studies on SSD in elderly patients. The goal of our study was to corroborate one-year outcomes after discharge. With this aim we performed a prospective multicenter study in March 2011 that recruited patients aged 75 years and older admitted to the acute geriatric wards of three tertiary hospitals in Spain – Complejo Hospitalario de Navarra, Hospital Universitario de Getafe, and Hospital Marqués de Valdecilla – at the same time during a 48-hour period, and were then followed up for one year. Four geriatricians were responsible for the patients’ screening and enrollment. A thorough geriatric assessment included clinical and demographic information (age, sex, education level, living arrangements before admission, presence of visual and hearing impairment) and comorbidity with the Cumulative Illness Rating Scale-Geriatric (CIRS-G). The CIRS-G rates 13 body systems on a five-point severity scale and is reliable because it allows all comorbid diseases from clinical examinations and medical files to be taken into account in a comprehensive manner.
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Gutiérrez Rodríguez J, Rodríguez Piñera M, Ortiz Cachero E, González Alonso A, Pérez Guillén P, Jiménez Muela FL, Alonso Collada A, Solano Jaurrieta JJ. [Delirium in nursing homes. Prevalence and risk factors]. Rev Esp Geriatr Gerontol 2013; 48:177-179. [PMID: 23537795 DOI: 10.1016/j.regg.2012.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/25/2012] [Accepted: 10/29/2012] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To study the prevalence of delirium in the residential environment and to analyse the associated clinical, functional and mental factors. MATERIAL AND METHODS A cross-sectional epidemic study was conducted on a population of elderly persons institutionalised in 2011 in 6 nursing homes in Asturias. Socio-demographic, clinical, functional (Barthel Index [BI]) and mental (Mini-Mental State Examination [MMSE]) variables were collected. Delirium was defined by the Confusion Assessment Method. RESULTS A total of 505 elderly were included in the study (age 83.30 ± 7.33 years, with 67.70% women), and scores on the MMSE of 17.19 ± 10.35 and a BI score of 55.11 ± 35.82. The prevalence of delirium was 11.70%. On examining the risk of delirium among the studied variables, there was statistical significance when considering: BI, MMSE, dementia, pressure ulcers, or urinary catheter, and the prescribing of clomethiazole, ACTH-I or trazodone. In the analysis of the variables in the logistic regression with BI, diagnosis of dementia, the prescribing of clomethiazole or trazodone, in the equation, there was a statistical significance associated with delirium. CONCLUSIONS The prevalence of delirium in a residential environment in our study population was 11.7%. The results show that BI, diagnosis of dementia, and prescribing of clomethiazole or trazodone were associated with risk of delirium in institutionalised patients.
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Velilla NM, Bouzon CA, Contin KC, Beroiz BI, Herrero AC, Renedo JA. Different functional outcomes in patients with delirium and subsyndromal delirium one month after hospital discharge. Dement Geriatr Cogn Disord 2013. [PMID: 23208559 DOI: 10.1159/000345609] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Subsyndromal delirium has an increasing relevance in the medical literature. There are only three studies in hospitalized elderly patients. Our goal is to demonstrate the importance of this syndrome in a population with more complexity and cognitive impairment than in previous studies. METHODS Prospective multicentre study in three tertiary hospitals. The health outcomes recorded in the follow-up at 1 month were the persistence of delirium, hospital readmission, discharge destination, death, Barthel index and the Delirium Rating Scale Revised 98. To assess the impact of delirium in the Barthel index at 30 days, we adjusted univariate and multivariate linear regression models. RESULTS 85 patients were enrolled; 75.3% of the patients had at least 1 positive item in the Confusion Assessment Method; 45 patients (53%) were diagnosed with delirium and 19 (22.3%) with subsyndromal delirium (SSD). The 30-day risk of death was associated with lower levels of albumin (p = 0.021) and the Cumulative Illness Rating Scale in Geriatrics (CIRS-G; p = 0.003). Adjusting for CIRS-G and the initial Barthel index, the diagnosis of delirium appears to be related to a lower Barthel index at 30 days (p = 0.019), showing a significant linear gradient (p < 0.005). CONCLUSION SSD could help get more accurate diagnoses as well as improve patient management.
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Affiliation(s)
- N Martínez Velilla
- Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Spain.
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Martinez Velilla N, Franco JG. [Subsyndromal delirium in elderly patients: a systematic review]. Rev Esp Geriatr Gerontol 2013; 48:122-129. [PMID: 23473583 DOI: 10.1016/j.regg.2012.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 11/15/2012] [Indexed: 06/01/2023]
Abstract
In this systemic review, the articles published between 1990 and November 2012 on subsyndromal delirium (SSD), and specifically those with reference to geriatric patients, were analysed. In SSD, symptoms from the three nuclear domains of delirium (cognitive, circadian and higher order thinking) are simultaneously present, with mild to moderate severity. Although the search for these clinical characteristics is a useful guide, there are no universally accepted diagnostic criteria for SSD. Regardless of the criteria used for diagnosis, SSD is persistently associated with poor functional and cognitive outcome, longer hospital stay, institutionalisation, and increased mortality. Studies are needed on the physiopathology, treatment and prevention in the field of SSD, which is a particularly important clinical condition in geriatric patients.
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