Delirium prevalence in a Colombian hospital, association with geriatric syndromes and complications during hospitalization

Global incidence and prevalence of delirium and its risk factors in medically hospitalized older patients: A systematic review and meta-analysis

BACKGROUND

Delirium is a common complication among older medical patients that can lead to undesirable outcomes.

OBJECTIVES

This study systematically investigated the incidence, prevalence, and risk factors of delirium to improve its recognition, prevention, and management in medically hospitalized older patients.

METHODS

The study protocol was registered at PROSPERO on April 29, 2024 (registration number: CRD42024536624). We searched the PubMed, Embase, and ProQuest databases for relevant articles published between database inception and September 25, 2024. We included observational studies reporting the prevalence, incidence, and risk factors of delirium among medically hospitalized older patients. Two independent reviewers extracted the data. A random-effects model was used for data analysis.

RESULTS

A total of 35 studies encompassing 12,097 participants met the inclusion criteria, yielding a 23.6 % pooled prevalence of delirium (95 % confidence interval = 19 % to 29 %) and a 13.5 % pooled incidence of delirium (n = 32, 95 % confidence interval = 11 % to 17 %) among medically hospitalized older patients. Study quality and country were significant moderators for explaining the heterogeneity observed in the prevalence and incidence of delirium, respectively (both P < 0.001). The risk factors of delirium included frailty (odds ratio = 2.05), physical restraints (5.01), prior falls (1.99), severe illness (1.32) (evaluated using the Acute Physiology and Chronic Health Evaluation II), and cognitive impairment (2.61). Older age increased delirium risk, whereas years of education mitigated it (B = 1.69 and 0.92, respectively).

CONCLUSION

Our findings considerably enhance the understanding of the prevalence of delirium and its influencing factors in medically hospitalized older patients. The insights this study provides can enable health-care providers to apply quick and effective assessment tools and can thereby support the implementation of interventions to prevent delirium.

REGISTRATION

The study protocol has been prospectively registered on PROSPERO (registration no. CRD42024536624).

Nutrition care for older adults with delirium: A scoping review

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.

Delirium detection tools show varying completion rates and positive score rates when used at scale in routine practice in general hospital settings: A systematic review

BACKGROUND

Multiple short delirium detection tools have been validated in research studies and implemented in routine care, but there has been little study of these tools in real-world conditions. This systematic review synthesized literature reporting completion rates and/or delirium positive score rates of detection tools in large clinical populations in general hospital settings.

METHODS

PROSPERO (CRD42022385166). Medline, Embase, PsycINFO, CINAHL, and gray literature were searched from 1980 to December 31, 2022. Included studies or audit reports used a validated delirium detection tool performed directly with the patient as part of routine care in large clinical populations (n ≥ 1000) within a general acute hospital setting. Narrative synthesis was performed.

RESULTS

Twenty-two research studies and four audit reports were included. Tools used alone or in combination were the Confusion Assessment Method (CAM), 4 'A's Test (4AT), Delirium Observation Screening Scale (DOSS), Brief CAM (bCAM), Nursing Delirium Screening Scale (NuDESC), and Intensive Care Delirium Screening Checklist (ICDSC). Populations and settings varied and tools were used at different stages and frequencies in the patient journey, including on admission only; inpatient, daily or more frequently; on admission and as inpatient; inpatient post-operatively. Tool completion rates ranged from 19% to 100%. Admission positive score rates ranged from: CAM 8%-51%; 4AT 13%-20%. Inpatient positive score rates ranged from: CAM 2%-20%, DOSS 6%-42%, and NuDESC 5-13%. Postoperative positive score rates were 21% and 28% (4AT). All but two studies had moderate-high risk of bias.

CONCLUSIONS

This systematic review of delirium detection tool implementation in large acute patient populations found clinically important variability in tool completion rates, and in delirium positive score rates relative to expected delirium prevalence. This study highlights a need for greater reporting and analysis of relevant healthcare systems data. This is vital to advance understanding of effective delirium detection in routine care.

Manifestaciones psiquiátricas en pacientes atendidos en un hospital universitario durante el confinamiento obligatorio por la pandemia de COVID 19

Introducción: no es la primera vez que la humanidad enfrenta las consecuencias catastróficas de una pandemia, hace un siglo fue la de la gripe española. La causada por COVID-19 en un mundo globalizado y conectado logró su rápida propagación, un alto impacto en el número de fallecidos y en la economía, y secuelas importantes sobre la salud mental. Objetivo: caracterizar las principales manifestaciones psiquiátricas en adultos evaluados por el servicio de psiquiatría de un hospital universitario de Bogotá, durante el confinamiento obligatorio por la pandemia de COVID-19 (20-03 a 01-06/2020). Materiales y métodos: estudio observacional retrospectivo de corte transversal que analizó las manifestaciones psiquiátricas más frecuentes en 122 pacientes. Resultados y discusión: hubo una notable reducción (47,7%) de las interconsultas, comparadas con el periodo prepandemia. El promedio de edad fue 51,7 ± 22 años, la mayoría fueron hombres (60,7%), 42,6% estaban desempleados y 92,6% eran contribuyentes del régimen de aseguramiento. Los hallazgos más frecuentes fueron ansiedad (35,2%), trastornos depresivos (32%) y delirium 23,7%; el intento suicida (12,3%) fue mayor que en un estudio previo en el servicio de urgencias. Ninguno de los pacientes presentó infección por COVID-19. Conclusiones: el confinamiento por la pandemia de COVID-19 disminuyó la demanda del servicio de psiquiatría, los trastornos de ansiedad, depresión y el intento suicida fueron los más frecuentes, siguiendo las tendencias esperadas. Es necesario desarrollar servicios de telepsiquiatría para afrontar emergencias futuras.

A Machine Learning Approach for Investigating Delirium as a Multifactorial Syndrome

Delirium is a psycho-organic syndrome common in hospitalized patients, especially the elderly, and is associated with poor clinical outcomes. This study aims to identify the predictors that are mostly associated with the risk of delirium episodes using a machine learning technique (MLT). A random forest (RF) algorithm was used to evaluate the association between the subject’s characteristics and the 4AT (the 4 A’s test) score screening tool for delirium. RF algorithm was implemented using information based on demographic characteristics, comorbidities, drugs and procedures. Of the 78 patients enrolled in the study, 49 (63%) were at risk for delirium, 32 (41%) had at least one episode of delirium during the hospitalization (38% in orthopedics and 31% both in internal medicine and in the geriatric ward). The model explained 75.8% of the variability of the 4AT score with a root mean squared error of 3.29. Higher age, the presence of dementia, physical restraint, diabetes and a lower degree are the variables associated with an increase of the 4AT score. Random forest is a valid method for investigating the patients’ characteristics associated with delirium onset also in small case-series. The use of this model may allow for early detection of delirium onset to plan the proper adjustment in healthcare assistance.