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Morganti W, Custodero C, Veronese N, Topinkova E, Michalkova H, Polidori MC, Cruz-Jentoft AJ, von Arnim CAF, Azzini M, Gruner H, Castagna A, Cenderello G, Custureri R, Seminerio E, Zieschang T, Padovani A, Sanchez-Garcia E, Pilotto A. The Multidimensional Prognostic Index predicts incident delirium among hospitalized older patients with COVID-19: a multicenter prospective European study. Eur Geriatr Med 2024; 15:961-969. [PMID: 38878221 PMCID: PMC11377617 DOI: 10.1007/s41999-024-00987-y] [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: 01/18/2024] [Accepted: 05/01/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE Incident delirium is a frequent complication among hospitalized older people with COVID-19, associated with increased length of hospital stay, higher morbidity and mortality rates. Although delirium is preventable with early detection, systematic assessment methods and predictive models are not universally defined, thus delirium is often underrated. In this study, we tested the role of the Multidimensional Prognostic Index (MPI), a prognostic tool based on Comprehensive Geriatric Assessment, to predict the risk of incident delirium. METHODS Hospitalized older patients (≥ 65 years) with COVID-19 infection were enrolled (n = 502) from ten centers across Europe. At hospital admission, the MPI was administered to all the patients and two already validated delirium prediction models were computed (AWOL delirium risk-stratification score and Martinez model). Delirium occurrence during hospitalization was ascertained using the 4A's Test (4AT). Accuracy of the MPI and the other delirium predictive models was assessed through logistic regression models and the area under the curve (AUC). RESULTS We analyzed 293 patients without delirium at hospital admission. Of them 33 (11.3%) developed delirium during hospitalization. Higher MPI score at admission (higher multidimensional frailty) was associated with higher risk of incident delirium also adjusting for the other delirium predictive models and COVID-19 severity (OR = 12.72, 95% CI = 2.11-76.86 for MPI-2 vs MPI-1, and OR = 33.44, 95% CI = 4.55-146.61 for MPI-3 vs MPI-1). The MPI showed good accuracy in predicting incident delirium (AUC = 0.71) also superior to AWOL tool, (AUC = 0.63) and Martinez model (AUC = 0.61) (p < 0.0001 for both comparisons). CONCLUSIONS The MPI is a sensitive tool for early identification of older patients with incident delirium.
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Affiliation(s)
- Wanda Morganti
- Department of Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy.
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
| | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Helena Michalkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - M Cristina Polidori
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine, Ageing Clinical Research, University Hospital Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging- Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | | | | | - Margherita Azzini
- Geriatrics Unit, "Mater Salutis" Hospital, Legnago ULSS 9 Scaligera, Verona, Italy
| | - Heidi Gruner
- Serviço de Medicina Interna, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central/Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | - Romina Custureri
- Department of Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Emanuele Seminerio
- Department of Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Tania Zieschang
- University-Clinic for Geriatric Medicine, Klinikum Oldenburg AöR, Oldenburg University, Oldenburg, Germany
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Alberto Pilotto
- Department of Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy
- Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
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Huang C, Wu B, Chen H, Tao H, Wei Z, Su L, Wang L. Delirium in psychiatric settings: risk factors and assessment tools in patients with psychiatric illness: a scoping review. BMC Nurs 2024; 23:464. [PMID: 38977984 PMCID: PMC11229275 DOI: 10.1186/s12912-024-02121-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/24/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Delirium is a common disorder affecting patients' psychiatric illness, characterized by a high rate of underdiagnosis, misdiagnosis, and high risks. However, previous studies frequently excluded patients with psychiatric illness, leading to limited knowledge about risk factors and optimal assessment tools for delirium in psychiatric settings. OBJECTIVES The scoping review was carried out to (1) identify the risk factors associated with delirium in patients with psychiatric illness; (2) synthesize the performance of assessment tools for detecting delirium in patients with psychiatric illness in psychiatric settings. DESIGN Scoping review. DATA SOURCES PubMed, Web of Science, and Embase were searched to identify primary studies on delirium in psychiatric settings from inception to Dec 2023 inclusive. Two independent reviewers screened eligible studies against inclusion criteria. A narrative synthesis of the included studies was conducted. RESULTS A final set of 36 articles meeting the inclusion criteria, two main themes were extracted: risk factors associated with delirium in patients with psychiatric illness and assessment tools for detecting delirium in psychiatric settings. The risk factors associated with delirium primarily included advanced age, physical comorbid, types of psychiatric illness, antipsychotics, anticholinergic drug, Electroconvulsive therapy, and the combination of lithium and Electroconvulsive therapy. Delirium Rating Scale-Revised-98, Memorial Delirium Assessment Scale, and Delirium Diagnostic Tool-Provisional might be valuable for delirium assessment in patients with psychiatric illness in psychiatric settings. CONCLUSIONS Delirium diagnosis in psychiatric settings is complex due to the overlapping clinical manifestations between psychiatric illness and delirium, as well as their potential co-occurrence. It is imperative to understand the risk factors and assessment methods related to delirium in this population to address diagnostic delays, establish effective prevention and screening strategies. Future research should focus on designing, implementing, and evaluating interventions that target modifiable risk factors, to prevent and manage delirium in patients with psychiatric illness.
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Affiliation(s)
- Cheng Huang
- School of Medicine, Huzhou University, 759 Second Ring Road East, Huzhou, Zhejiang, 313000, China
- Health Management Center, Deyang People's Hospital, Deyang, Sichua, 618000, China
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Haiqin Chen
- Nursing Department, Huzhou Third People's Hospital, Huzhou, Zhejiang, 313000, China
| | - Hong Tao
- AdventHealth Whole-Person Research, Orlando, FL, USA
| | - Zhuqin Wei
- School of Medicine, Huzhou University, 759 Second Ring Road East, Huzhou, Zhejiang, 313000, China
| | - Liming Su
- School of Medicine, Huzhou University, 759 Second Ring Road East, Huzhou, Zhejiang, 313000, China
| | - Lina Wang
- School of Medicine, Huzhou University, 759 Second Ring Road East, Huzhou, Zhejiang, 313000, China.
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Papaioannou M, Papastavrou E, Kouta C, Tsangari H, Merkouris A. Investigating nurses' knowledge and attitudes about delirium in older persons: a cross-sectional study. BMC Nurs 2023; 22:10. [PMID: 36631856 PMCID: PMC9832247 DOI: 10.1186/s12912-022-01158-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Delirium is the most common emergency for older hospitalized patients that demands urgent treatment, otherwise it can lead to more severe health conditions. Nurses play a crucial part in diagnosing delirium and their competencies facilitate the appropriate treatment and management of the condition. AIM This study aims to enhance the understanding of delirium care by exploring both knowledge and attitudes of nurses toward patients in acute care hospital wards and the possible association between these two variables. METHOD The Nurses Knowledge of Delirium Questionnaire (NKD) and the Attitude Tool of Delirium (ATOD) that were created for the said inquiry, were disseminated to 835 nurses in the four largest Public Hospitals of the Republic. These tools focused particularly on departments with increased frequency of delirium (response rate = 67%). RESULTS Overall nurses have limited knowledge of acute confusion/delirium. The average of correct answers was 42.2%. Only 38% of the participants reported a correct definition of delirium, 41.6 correctly reported the tools to identify delirium and 42.5 answered correctly on the factors leading to delirium development. The results of the attitudes' questionnaire confirmed that attitudes towards patients with delirium may not be supportive enough. A correlation between the level of nurses' knowledge and their attitude was also found. The main factors influencing the level of knowledge and attitudes were gender, education, and workplace. CONCLUSION The findings of this study are useful for the international audience since they can be used to develop and modify educational programmes in order to rectify the knowledge deficits and uninformed attitudes towards patients with delirium. The development of a valid and reliable instrument for the evaluation of attitudes will help to further assess nurses' attitudes. Furthermore, the results are even more important and useful on a national level since there is no prior data on the subject area, making this study the first of its kind.
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Affiliation(s)
- Maria Papaioannou
- grid.15810.3d0000 0000 9995 3899Cyprus University of Technology, Limassol, Cyprus
| | - Evridiki Papastavrou
- grid.15810.3d0000 0000 9995 3899Cyprus University of Technology, Limassol, Cyprus
| | - Christiana Kouta
- grid.15810.3d0000 0000 9995 3899Cyprus University of Technology, Limassol, Cyprus
| | - Haritini Tsangari
- grid.413056.50000 0004 0383 4764University of Nicosia, Nicosia, Cyprus
| | - Anastasios Merkouris
- grid.15810.3d0000 0000 9995 3899Cyprus University of Technology, Limassol, Cyprus
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Lawson RA, Richardson SJ, Kershaw D, Davis D, Stephan BCM, Robinson L, Brayne C, Barnes L, Burn DJ, Yarnall AJ, Taylor JP, Parker S, Allan LM. Evaluation of Bedside Tests of Attention and Arousal Assessing Delirium in Parkinson's Disease, Dementia, and Older Adults. JOURNAL OF PARKINSON'S DISEASE 2022; 12:655-665. [PMID: 34842195 DOI: 10.3233/jpd-212849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Delirium is a serious acute neuropsychiatric condition associated with altered attention and arousal. OBJECTIVE To evaluate simple bedside tests for attention and arousal to detect delirium in those with and without Parkinson's disease (PD) and dementia. METHODS Participants from two prospective delirium studies were pooled comprising 30 with PD without cognitive impairment, 24 with Lewy body cognitive impairment (PD dementia or dementia with Lewy bodies), 16 with another dementia and 179 PD and dementia-free older adults. Participants completed standardised delirium assessments including tests of attention: digit span, Memorial Delirium Assessment Scale (MDAS) attention and months of the year backwards; and arousal: Glasgow Coma Scale (GSC), Observational Scale of Level of Arousal (OSLA), Modified Richmond Agitation Scale and MDAS consciousness. Delirium was diagnosed using the DSM-5 criteria. RESULTS On their first admission, 21.7%participants had prevalent delirium. Arousal measures accurately detected delirium in all participants (p < 0.01 for all), but only selected attention measures detected delirium in PD and dementia. In PD and dementia-free older adults, impaired digit span and OSLA were the optimal tests to detect delirium (area under the curve [AUC] = 0.838, p < 0.001) while in PD and dementia the optimal tests were MDAS attention and GCS (AUC=0.90 and 0.84, respectively, p < 0.001 for both). CONCLUSION Simple bedside tests of attention and arousal at a single visit could accurately detect delirium in PD, dementia and PD and dementia-free older adults; however, the optimal tests differed between groups. Combined attention and arousal scores increased accuracy, which could have clinical utility to aid the identification of delirium neurodegenerative disorders.
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Affiliation(s)
- Rachael A Lawson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah J Richardson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, UK
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Daisy Kershaw
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Blossom C M Stephan
- Institute of Mental Health, School of Medicine, Nottingham University, Nottingham, UK
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Carol Brayne
- Cambridge Public Health, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Linda Barnes
- Cambridge Public Health, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - David J Burn
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alison J Yarnall
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, UK
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, UK
| | - Stuart Parker
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Louise M Allan
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
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De Vincentis A, Behr AU, Bellelli G, Bravi M, Castaldo A, Galluzzo L, Iolascon G, Maggi S, Martini E, Momoli A, Onder G, Paoletta M, Pietrogrande L, Roselli M, Ruggeri M, Ruggiero C, Santacaterina F, Tritapepe L, Zurlo A, Antonelli Incalzi R. Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus. Aging Clin Exp Res 2021; 33:2405-2443. [PMID: 34287785 DOI: 10.1007/s40520-021-01898-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Health outcomes of older subjects with hip fracture (HF) may be negatively influenced by multiple comorbidities and frailty. An integrated multidisciplinary approach (i.e. the orthogeriatric model) is, therefore, highly recommended, but its implementation in clinical practice suffers from the lack of shared management protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues. AIM To develop evidence-based recommendations for the orthogeriatric co-management of older subjects with HF. METHODS A 20-member Expert Task Force of geriatricians, orthopaedics, anaesthesiologists, physiatrists, physiotherapists and general practitioners was established to develop evidence-based recommendations for the pre-, peri-, intra- and postoperative care of older in-patients (≥ 65 years) with HF. A modified Delphi approach was used to achieve consensus, and the U.S. Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence. RESULTS A total of 120 recommendations were proposed, covering 32 clinical topics and concerning preoperative evaluation (11 topics), perioperative (8 topics) and intraoperative (3 topics) management, and postoperative care (10 topics). CONCLUSION These recommendations should ease and promote the multidisciplinary management of older subjects with HF by integrating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.
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Garcez FB, Avelino-Silva TJ, Castro REVD, Inouye SK. Delirium in older adults. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.53886/gga.e0210032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
This narrative review provides a broad examination of the most current concepts on the etiopathogenesis, diagnosis, prevention, and treatment of delirium, an acute neuropsychiatric syndrome characterized by fluctuating changes in cognition and consciousness. With the interaction of underlying vulnerability and severity of acute insults, delirium can occur at any age but is particularly frequent in hospitalized older adults. Delirium is also associated with numerous adverse outcomes, including functional impairment, cognitive decline, increased healthcare costs, and death. Its diagnosis is based on clinical and cognitive assessments, preferably following systematized detection instruments, such as the Confusion Assessment Method (CAM). Delirium and its consequences are most effectively fought using multicomponent preventive interventions, like those proposed by the Hospital Elder Life Program (HELP). When prevention fails, delirium management is primarily based on the identification and reversal of precipitating factors and the non-pharmacological control of delirium symptoms. Pharmacological interventions in delirium should be restricted to cases of dangerous agitation or severe psychotic symptoms.
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FitzGerald JM, Price A. Delirium in the acute hospital setting: the role of psychiatry. BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2020.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
SUMMARYIn this overview we discuss the role of psychiatry in managing delirium in acute hospital admissions. We briefly discuss the role psychiatry can offer in four main domains: (a) assessment; (b) management; (c) recovery; and (d) paradigm, education and research. In the assessment section we discuss accurately detecting delirium in the context of comorbid mixed neuropsychiatric syndromes, including depression and dementia, and the clinical importance of delirium subtyping. The management section briefly outlines pharmacological and non-pharmacological approaches to delirium and their evidence-based rationale. The recovery section focuses on the effect delirium can have on cognitive decline, mental health and long-term health, including functional outcome and need for institutional care after hospital discharge. Finally, we outline the role of psychiatry in delirium research and education. We hope that this article will encourage clinicians to reflect on their current practice and consider holistic and evidence-based care for this vulnerable population in the acute hospital setting.
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Luijendijk HJ, Quispel-Aggenbach DWP, Stroomer-van Wijk AJM, Meijerink-Blom AH, van Walbeek A, Zuidema SU. A short delirium caregiver questionnaire for triage of elderly outpatients with cognitive impairment: a development and test accuracy study. Int Psychogeriatr 2021; 33:31-37. [PMID: 31658916 PMCID: PMC8482371 DOI: 10.1017/s1041610219001595] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 09/20/2019] [Accepted: 09/22/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Delirium is often missed in older outpatients. Caregivers can give valuable information that might improve identification rates. The aim of this study was to develop a short and sensitive delirium caregiver questionnaire (DCQ) for triage of elderly outpatients with cognitive impairment by telephone. DESIGN, SETTING, AND PARTICIPANTS The pilot questionnaire was administered to 112 caregivers of patients who were referred for dementia screening to our clinic for geriatric psychiatry, and the final DCQ to 234 other caregivers. MEASUREMENTS In phase I (2013-2014), we tested a pilot questionnaire with 17 items. Health professionals who established delirium diagnoses were blinded to the results. We then used the results and other information available at referral to construct the final DCQ with seven items. During phase II (2015-2016), we investigated the test accuracy of the final DCQ in a subsequent cohort. In both phases, the patients received a structured diagnostic workup. Time between referral and first visit was a secondary outcome. RESULTS The final DCQ consisted of the following items: emergency visit required, sleeping disorder, fluctuating course, hallucinations, suspicious thoughts, previous delirium, and recent discharge from hospital. DCQ results indicated that urgent intake was required in 85 of 234 patients. Sensitivity was 73.5% (95% CI: 58.9-85.1%) and specificity 73.5% (95% CI: 66.5-79.7%). The mean number of days to first visit dropped from 31.6 to 11.2 in delirious patients (p = 0.001). CONCLUSIONS Triage with the easy-to-use DCQ among patients referred for cognitive screening leads to earlier assessment and higher detection rates of delirium.
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Affiliation(s)
- Hendrika J. Luijendijk
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Geriatric Psychiatry, Parnassia Psychiatric Institute, Rotterdam, The Netherlands
| | - Daisy W. P. Quispel-Aggenbach
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Geriatric Psychiatry, Parnassia Psychiatric Institute, Rotterdam, The Netherlands
| | | | | | - Annemiek van Walbeek
- Department of Internal Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sytse U. Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Quispel‐Aggenbach DWP, Schep‐de Ruiter EPR, van Bergen W, Bolling JR, Zuidema SU, Luijendijk HJ. Prevalence and risk factors of delirium in psychogeriatric outpatients. Int J Geriatr Psychiatry 2021; 36:190-196. [PMID: 32844507 PMCID: PMC7754178 DOI: 10.1002/gps.5413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/19/2020] [Accepted: 08/08/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Delirium is a serious neuropsychiatric syndrome, which requires timely treatment. However, it is easily missed, especially in older patients with premorbid cognitive disorders. OBJECTIVES The aim of this study is to investigate the prevalence and risk factors of delirium in older outpatients with and without dementia. METHOD We assessed 444 patients referred to the memory clinic of a psychiatric hospital between March 2013 and March 2014. Demographic information, medical history, impairments in daily living activities and referral information were registered. Patients underwent a psychiatric examination using the Delirium Rating Scale-Revised-98 and cognitive tests, a physical examination and laboratory tests. We recorded medication use and changes before and after the onset of symptoms. RESULTS Among the 444 outpatients, 85 had probable delirium (prevalence of 19%), and 10 had subsyndromal delirium (2%). The most common triggers were infection (42%), drug-intoxication or withdrawal (22%), and metabolic/endocrine disturbance (12%). Age (OR 1.07, 95% CI 1.02-1.11) and prior delirium (OR 3.34, 95% CI 1.28-8.69) were independent non-modifiable factors associated with an increased risk of delirium. The only independent modifiable risk factor was infection (OR 17.31, 95% CI 8.44-35.49). CONCLUSIONS A delirium was detected in one of five patients referred for dementia screening. Most patients could be treated at home. Age and prior delirium were predictive of an increased risk of delirium.
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Affiliation(s)
- Daisy W. P. Quispel‐Aggenbach
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care MedicineGroningenThe Netherlands,Parnassia Groep/ Bavo Europoort, Department of Elderly PsychiatryRotterdamThe Netherlands
| | | | - Wilma van Bergen
- Parnassia Groep/ Bavo Europoort, Department of Elderly PsychiatryRotterdamThe Netherlands
| | - J. Rob Bolling
- Parnassia Groep/ Bavo Europoort, Department of Elderly PsychiatryRotterdamThe Netherlands
| | - Sytse U. Zuidema
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care MedicineGroningenThe Netherlands
| | - Hendrika J. Luijendijk
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care MedicineGroningenThe Netherlands,Parnassia Groep/ Bavo Europoort, Department of Elderly PsychiatryRotterdamThe Netherlands
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Affiliation(s)
- Sarah T Pendlebury
- Departments of Medicine and Geratology, Oxford University Hospitals NHS Foundation Trust and NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital and Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK., Professor Sarah Pendlebury is supported by the NIHR Oxford Biomedical Research Centre
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Martella LA, Carmisciano L, Giannotti C, Signori A, Pontremoli R, Giusti M, Gualco E, Beccati V, Marengoni A, Nencioni A, Monacelli F. Cross-Cultural Adaptation and Validation of the Italian Version of the Observational Scale of Level of Arousal. J Am Med Dir Assoc 2020; 22:1615-1620.e4. [PMID: 33271123 DOI: 10.1016/j.jamda.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Along with deficit of attention, level of arousal is a primary criterion for the diagnosis of delirium. The Observational Scale of Level of Arousal (OSLA) is a quick, simple, and observational instrument used to evaluate the variation of arousal for rapid screening of delirium in clinical practice. The current study aims to perform a cross-cultural adaption of and to validate the Italian version of the OSLA scale to detect delirium in older aged, hospitalized patients. DESIGN Longitudinal study. SETTING AND PARTICIPANTS In hospital and transitional care setting. Old age patients. METHODS A cross-cultural adaptation of the OSLA from English into Italian was conducted, including back-translation. The validation of the OSLA was assessed in 116 older patients (age >65 years) admitted to geriatric, internal medicine, and transitional care wards. The 4 "A"s Test serves as the gold standard for the measurement of delirium. RESULTS Incident delirium was assessed longitudinally at different time points during hospitalization. The Italian version of OSLA demonstrated adequate internal consistency, specificity, sensitivity, agreement, test-retest reliability, and sensitivity to change, indicating adequate its clinometric properties in the detection of delirium in a real world hospitalized cohort of older adults. CONCLUSIONS AND IMPLICATIONS The current study is among the few studies to assess arousal as a core feature of delirium by virtue of a longitudinal assessment of delirium, moving a step forward in the implementation of a brief and easy to use delirium-screening tool for the measurement of important clinical outcomes in a frail, old aged hospitalized population.
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Affiliation(s)
- Lucia Anna Martella
- Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Luca Carmisciano
- DISSAL, Section of Biostatistics, Department of Health Sciences, University of Genova, Genoa, Italy
| | - Chiara Giannotti
- Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessio Signori
- DISSAL, Section of Biostatistics, Department of Health Sciences, University of Genova, Genoa, Italy
| | - Roberto Pontremoli
- Internal Medicine Unit, Ospedale Policlinico San Martino, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Massimo Giusti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Endocrinology Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Elisa Gualco
- Internal Medicine Unit, Ospedale Policlinico San Martino, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valentina Beccati
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Endocrinology Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alessio Nencioni
- Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fiammetta Monacelli
- Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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Abstract
Delirium is an acute confusional state that is common and costly and is associated with significant functional decline and distress. It is the manifestation of acute encephalopathy and is variably called acute brain failure, acute brain dysfunction, or altered mental status. All patients are at risk for delirium, although those with more vulnerabilities (such as advanced age, exposures to other stressors like infection, and certain medications) are at higher risk. The pathophysiologic cause of delirium is not well understood. It is important to recognize patients at risk for and those with delirium and to immediately identify and treat factors contributing to it. There is no single intervention or medication to treat delirium, making it challenging to manage. Therefore, risk mitigation and prompt treatment rely on a sophisticated strategy to address the contributing factors. Delirium may be prevented or attenuated when multimodal strategies are used, thereby improving patient outcomes.
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Affiliation(s)
- Melissa L P Mattison
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (M.L.M.)
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Hall R, Stíobhairt A, Allerhand M, MacLullich AMJ, Tieges Z. The Observational Scale of Level of Arousal: A brief tool for assessing and monitoring level of arousal in patients with delirium outside the ICU. Int J Geriatr Psychiatry 2020; 35:1021-1027. [PMID: 32394506 DOI: 10.1002/gps.5324] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 04/17/2020] [Accepted: 04/25/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Altered level of arousal, encompassing drowsiness and hypervigilance, affects at least 10% of acutely unwell patients. Existing scales provide limited coverage of milder changes in level of arousal. We devised the Observational Scale of Level of Arousal (OSLA) to enable more detailed arousal assessment. Here, we provide a preliminary case-control study of performance of the OSLA in assessing abnormal level of arousal associated with delirium outside the ICU. METHODS Hip fracture patients (N = 108, median age = 82 years) were assessed for delirium pre- and post-operatively using the Confusion Assessment Method and the Delirium Rating Scale-Revised-98. The OSLA has four graded items assessing eye opening, eye contact, posture, and movement (score range 0 [normal arousal]-15). We assessed the psychometric and diagnostic characteristics of the OSLA. Adjusted linear mixed effects models were used to explore responsiveness of the OSLA to within-patient change in delirium status. RESULTS A total of 44 patients (40.7%) were diagnosed with delirium. OSLA scores were higher in delirium (pooled median = 3, InterQuartile Range [IQR] = 2-5) compared to no delirium (pooled median = 1, IQR = 1-2; P-values <.05 to <.001). The Area under the Receiver Operating Characteristic curve was 0.82 (95% Confidence Interval (CI) = 0.77-0.86). OSLA scores were responsive to change in delirium status (ß = -3.09. SE = 1.41, P < .03). CONCLUSIONS This study provides preliminary evidence supporting use of the OSLA as an instrument for identifying abnormal level of arousal associated with delirium and monitoring this longitudinally. Further validation in larger cohorts with blinded raters is required. J Am Geriatr Soc 68:-, 2020.
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Affiliation(s)
- Roanna Hall
- Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Medicine of the Elderly Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Antaine Stíobhairt
- Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, UK
| | - Mike Allerhand
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Alasdair M J MacLullich
- Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Medicine of the Elderly Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Zoë Tieges
- Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
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14
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Pérez-Ros P, Martínez-Arnau FM. Delirium Assessment in Older People in Emergency Departments. A Literature Review. Diseases 2019; 7:E14. [PMID: 30704024 PMCID: PMC6473718 DOI: 10.3390/diseases7010014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/27/2019] [Accepted: 01/28/2019] [Indexed: 12/21/2022] Open
Abstract
Delirium is a neuropsychiatric syndrome often manifesting in acute disease conditions, and with a greater prevalence in the older generation. Delirium in the Emergency Department (ED) is a highly prevalent problem that typically goes unnoticed by healthcare providers. The onset of a delirium episode in the ED is associated with an increase in morbidity and mortality. Because delirium is a preventable syndrome, these statistics are unacceptable. Emergency Department staff therefore should strive to perform systematic screening in order to detect delirium. Different tools have been developed for the assessment of delirium by healthcare professionals other than psychiatrists or geriatricians. Emergency Departments require delirium assessment scales of high sensitivity and specificity, suited to the characteristics of the Department, since the time available is scarce. In addition, the presence of dementia in the assessment of delirium may induce sensitivity bias. Despite the existence of numerous delirium rating scales, scales taking less than three minutes to complete are recommended. The choice of the tool depends on the characteristics of the ED. The only scale affording high sensitivity and specificity in older people with and without dementia is the Four "A"s Test (4AT); it requires no training on the part of the rater, and can be performed in under two minutes.
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Affiliation(s)
- Pilar Pérez-Ros
- School of Nursing, Universidad Católica de Valencia San Vicente Mártir, Calle Espartero, 7, 46007 València, Spain.
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Tamune H. Meningitis presenting as acute psychosis in the ED: Speciality collaboration and rethinking the generalizability to real-world practice. Am J Emerg Med 2018; 36:2076-2077. [DOI: 10.1016/j.ajem.2018.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 08/18/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022] Open
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16
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Pendlebury ST. Delirium screening in older patients. Age Ageing 2018; 47:635-637. [PMID: 30010699 DOI: 10.1093/ageing/afy103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Indexed: 01/23/2023] Open
Affiliation(s)
- Sarah T Pendlebury
- Departments of General (Internal) Medicine and Geratology, John Radcliffe hospital, Oxford, UK
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and the University of Oxford, Oxford, UK
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