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Goettel N, Wueest AS. Diagnosing delirium in perioperative and intensive care medicine. Curr Opin Anaesthesiol 2023; 36:491-499. [PMID: 37427443 DOI: 10.1097/aco.0000000000001288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
PURPOSE OF REVIEW This article reviews the current literature on instruments used for screening and diagnosing delirium in perioperative and intensive care medicine. It summarizes recent findings to guide clinicians and researchers in choosing the most appropriate tools. RECENT FINDINGS The incidence of delirium in hospitalized patients ranges from 5% to over 50%, depending on the population of patients studied. Failure to diagnose delirium in a timely manner is associated with serious adverse outcomes, including death and institutionalization. Valid assessment tests are needed for delirium detection, as early identification and treatment of delirium may help to prevent complications. Currently, there are more than 30 available instruments, which have been developed to assist with the screening and diagnosis of delirium. However, these tools vary greatly in sensitivity, specificity, and administration time, and their overabundance challenges the selection of specific tool as well as direct comparisons and interpretation of results across studies. SUMMARY Overlooking or misdiagnosing delirium may result in poor patient outcomes. Familiarizing healthcare workers with the variety of delirium assessments and selecting the most appropriate tool to their needs is an important step toward improving awareness and recognition of delirium.
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Affiliation(s)
- Nicolai Goettel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Clinical Research, University of Basel
| | - Alexandra S Wueest
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel
- Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
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2
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Kramer I, Schubert M. The use of patient sitters at a Swiss hospital: A retrospective observational study. PLoS One 2023; 18:e0287317. [PMID: 37315098 DOI: 10.1371/journal.pone.0287317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 06/04/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE Patient sitters are frequently used in acute care hospitals to provide one-to-one care for agitated or disorientated patients to assure the safety and well-being of patients. However, there is still a lack of evidence on the use of patient sitters, especially in Switzerland. Therefore, the aim of this study was to describe and explore the use of patient sitters in a Swiss acute care hospital. METHODS In this retrospective, observational study we included all inpatients who were hospitalized between January and December 2018 in a Swiss acute care hospital and required a paid or volunteer patient sitter. Descriptive statistics were used to describe the extent of patient sitter use, patient characteristics, and organizational factors. For the subgroup analysis between internal medicine and surgical patients Mann-Whitney U tests and chi-square tests were used. RESULTS Of the total of 27'855 included inpatients, 631 (2.3%) needed a patient sitter. Of these, 37.5% had a volunteer patient sitter. The median patient sitter duration per patient per stay was 18.0 hours (IQR = 8.4-41.0h). The median age was 78 years (IQR = 65.0-86.0); 76.2% of patients were over the age of 64. Delirium was diagnosed in 41% of patients, and 15% had dementia. Most of the patients showed signs of disorientation (87.3%), inappropriate behavior (84.6%), and risk of falling (86.6%). Patient sitter uses varied during the year and between surgical and internal medicine units. CONCLUSIONS These results add to the limited body of evidence concerning patient sitter use in hospitals, supporting previous findings related to patient sitter use for delirious or geriatric patients. New findings include the subgroup analysis of internal medicine and surgical patients, as well as analysis of patient sitter use distribution throughout the year. These findings may contribute to the development of guidelines and policies regarding patient sitter use.
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Affiliation(s)
- Iris Kramer
- Institute of Nursing, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Maria Schubert
- Institute of Nursing, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
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3
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Babine RL, Hyrkäs KE, Scott C, Wierman HR. Individuals Who Developed Delirium While Enrolled in the Hospital Elder Life Program: An Exploratory Study. J Gerontol Nurs 2023; 49:19-29. [PMID: 37126011 DOI: 10.3928/00989134-20230414-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Delirium prevention in hospitalized older adults is important due to delirium's high prevalence and negative impact on outcomes. Today, there are evidence-based programs with well-documented effectiveness aimed at preventing delirium, such as the Hospital Elder Life Program (HELP); however, approximately 4% to 5% of patients develop delirium regardless of implemented prevention interventions. It remains unknown why some patients develop delirium. The current retrospective exploratory chart review analyzed 98 records for clinical risk factors and outcomes of patients who developed delirium while enrolled in the HELP. On admission, immobility (86.7%) was the most common risk factor. Patients developed delirium approximately 70 hours after admission. Average length of stay was 8 days. Approximately one half (44.9%) of patients died within 1 year. Immobility (97.7% vs. 77.8%, p = 0.005) and renal disease (52.3% vs. 24.1%, p = 0.008) were more often found in patients who died. This study identifies risk factors that seem to require heightened attention during hospitalization to prevent the negative outcomes associated with delirium in older adults. [Journal of Gerontological Nursing, 49(5), 19-29.].
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Martínez-García M, Sánchez-López E, Fernández-Trinidad M. Managing delirium in acute inpatient units: A cross-sectional study of nursing teams' knowledge and perceived limitations. Nurs Open 2023; 10:2213-2221. [PMID: 36379912 PMCID: PMC10006588 DOI: 10.1002/nop2.1471] [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: 11/08/2021] [Revised: 10/05/2022] [Accepted: 10/29/2022] [Indexed: 11/17/2022] Open
Abstract
AIM The aim of the study was to describe nursing teams' theoretical knowledge of delirium and their perceptions of the way in which it is handled in acute inpatient units. DESIGN This is a descriptive cross-sectional study using a questionnaire comprising ten questions on knowledge and seven on perception. METHODS The sample consisted of 216 professionals working at a hospital complex in Madrid, Spain. Descriptive and non-parametric bivariate analyses were performed for a p < .05. RESULTS Fifty-three point two per cent of staff possessed sufficient theoretical knowledge, and this figure rose significantly among professionals with more years of experience. Areas for improvement in theoretical knowledge included the use of therapeutic immobilization, screening scale, subtypes of delirium and precipitating factors. Sixty-eight point five per cent of staff perceived their knowledge as fair, 50% agreed that delirium was underdiagnosed and 48.1% agreed that preventive measures were only occasionally taken. Perceived barriers included lack of training, work overload, ineffective coordination and lack of standardized protocols.
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Affiliation(s)
- Marta Martínez-García
- Hospital Universitario Infanta Leonor, Madrid, Spain.,Facultad de Enfermería Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Miriam Fernández-Trinidad
- Hospital Universitario Infanta Leonor, Madrid, Spain.,Facultad de Enfermería Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
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Oliveira J. e Silva L, Stanich JA, Jeffery MM, Lindroth HL, Miller DM, Campbell RL, Rabinstein AA, Pignolo RJ, Bellolio F. Association between emergency department modifiable risk factors and subsequent delirium among hospitalized older adults. Am J Emerg Med 2022; 53:201-207. [DOI: 10.1016/j.ajem.2021.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022] Open
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Arias F, Alegria M, Kind AJ, Jones RN, Travison TG, Marcantonio ER, Schmitt EM, Fong TG, Inouye SK. A framework of social determinants of health for delirium tailored to older adults. J Am Geriatr Soc 2022; 70:235-242. [PMID: 34693992 PMCID: PMC8742772 DOI: 10.1111/jgs.17465] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/15/2021] [Accepted: 08/21/2021] [Indexed: 01/03/2023]
Abstract
Delirium is a debilitating medical condition that disproportionately affects hospitalized older adults and is associated with adverse health outcomes, increased mortality, and high medical costs. Efforts to understand delirium risk in hospitalized older adults have focused on examining medical comorbidities, pre-existing cognitive deficits, and other clinical and demographic factors present in the period proximate to the hospitalization. The contribution of social determinants of health (SDOH), including social circumstances, environmental characteristics, and early-life exposures, referred as the social exposome, to delirium risk is poorly understood. Increased knowledge about the influence of SDOH will offer a more comprehensive understanding of factors that may increase vulnerability to delirium and poor outcomes. Clinically, these efforts can guide the development and implementation of holistic preventive strategies to improve clinical outcomes. We propose a SDOH framework for delirium adapted for older adults. We provide the definition, description, and rationale for the domains and variables in our proposed model.
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Affiliation(s)
- Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Margarita Alegria
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine and Psychiatry, Harvard Medical School, Boston, MA
| | - Amy J. Kind
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Madison VA Geriatrics Research Education and Clinical Center (GRECC), Middleton VA Hospital, Madison, WI
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School, Providence, RI
| | - Thomas G. Travison
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA
- Harvard Medical School, Boston, MA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew Senior Life, Boston, MA
| | - Edward R. Marcantonio
- Harvard Medical School, Boston, MA
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Eva M. Schmitt
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA
| | - Tamara G. Fong
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Sharon K. Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine and Psychiatry, Harvard Medical School, Boston, MA
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Ewens B, Seaman K, Whitehead L, Towell-Barnard A, Young M. A delirium prevalence audit and a pre and post evaluation of an interprofessional education intervention to increase staff knowledge about delirium in older adults. BMC Nurs 2021; 20:202. [PMID: 34666763 PMCID: PMC8525041 DOI: 10.1186/s12912-021-00692-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/23/2021] [Indexed: 11/11/2022] Open
Abstract
Background Delirium is more prevalent in older people and estimated to occur in up to 50% of the hospital population. Delirium comprises a spectrum of behaviours, including cognitive and attention deficits, and fluctuating levels of consciousness, often associated with an underlying physiological disturbance. Delirium has been increasingly associated with adverse outcomes. Although often preventable or can at least be mitigated, delirium may not be a standard part of assessment and thus may not be recognized in the early stages when it is most likely to be treated successfully. The aim of this study was to evaluate the level of knowledge of delirium amongst clinicians caring for patients at high risk of developing delirium and to determine whether education can improve clinical assessment of delirium. Methods Two hundred and forty-six case notes were audited before and 149 were reviewed after the education intervention and implementation of a delirium screening tool. Clinicians at the hospital were invited to complete a questionnaire on knowledge of delirium. The questionnaire was based on a validated tool which contained 39 questions about delirium. The questionnaire also contained 28 questions on delirium knowledge. Additional questions were included to gather demographic information specific to the hospital. Descriptive statistics, chi square and independent t-tests were conducted to test for differences in knowledge between the pre and post periods. The Squire Checklist Reporting Guidelines for Quality Improvement Studies informed the preparation of the manuscript. Results The audit demonstrated that the use of a cognitive assessment tool overall increased from 8.5% in pre education to 43% in the post education period. One hundred and fifty-nine staff completed the questionnaire in total, 118 the pre and 41 post. The knowledge subscale score was high pre and post education and no statistically significant difference was observed. The greatest increase in knowledge was related to knowledge of the risk factors subscale. The increase in knowledge (6.8%) was statistically significant. Conclusion An interprofessional approach to delirium education was effective in not only increasing awareness of the factors associated with this syndrome but also increased the use of a delirium assessment tool. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00692-2.
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Affiliation(s)
- Beverley Ewens
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
| | - Karla Seaman
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Amanda Towell-Barnard
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Michelle Young
- Joondalup Health Campus, Cnr Grand Boulevard and Shenton Avenue, Joondalup, WA, 6027, Australia
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Ocagli H, Bottigliengo D, Lorenzoni G, Azzolina D, Acar AS, Sorgato S, Stivanello L, Degan M, Gregori D. A Machine Learning Approach for Investigating Delirium as a Multifactorial Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137105. [PMID: 34281037 PMCID: PMC8297073 DOI: 10.3390/ijerph18137105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Honoria Ocagli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (D.B.); (G.L.); (D.A.)
| | - Daniele Bottigliengo
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (D.B.); (G.L.); (D.A.)
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (D.B.); (G.L.); (D.A.)
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (D.B.); (G.L.); (D.A.)
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64B, 44121 Ferrara, Italy
| | - Aslihan S. Acar
- Department of Actuarial Sciences, Hacettepe University, Ankara 06800, Turkey;
| | - Silvia Sorgato
- Health Professional Management Service (DPS) of the University Hospital of Padova, 35128 Padova, Italy; (S.S.); (L.S.); (M.D.)
| | - Lucia Stivanello
- Health Professional Management Service (DPS) of the University Hospital of Padova, 35128 Padova, Italy; (S.S.); (L.S.); (M.D.)
| | - Mario Degan
- Health Professional Management Service (DPS) of the University Hospital of Padova, 35128 Padova, Italy; (S.S.); (L.S.); (M.D.)
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (D.B.); (G.L.); (D.A.)
- Correspondence: ; Tel.: +39-049-827-5384
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Han CY, Redley B, Lin CC, Chen LC, Ng CJ, Wang LH. Standard risk assessment forms help reduce preventable harm in older adult inpatients: A retrospective chart review study. J Adv Nurs 2021; 77:4439-4450. [PMID: 34133782 DOI: 10.1111/jan.14931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/16/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Abstract
AIMS To examine nurse documentation of assessments using standard risk assessment forms in older inpatients, and to determine the value of such assessment. DESIGN Cross-sectional retrospective chart review. METHODS This retrospective review of risk evaluation documentation in patients' medical records focused on skin, continence, medical complications, nutrition, cognition, mobility, medications and pain. RESULTS A total of 1000 medical records from Taiwan hospitals were reviewed from January 2016 to December 2017, and 379 from Australian hospitals were reviewed from March 2011 to February 2012. Taiwanese patients with documented assessment of skin (aOR =2.94, 95%CI =1.88-4.54), nutrition (aOR =3.22, 95%CI =1.08-9.59), cognition (aOR =2.61, 95%CI =1.32-5.16) and pain (aOR =5.01, 95%CI=1.63-15.38) had significantly higher odds of developing new problems; while Australian patients with documented assessments of continence (aOR =11.55, 95%CI =1.48-90.45) and nutrition (aOR =12.90, 95%CI =1.67-99.06) had significantly higher odds of developing new problems. DISCUSSION Nursing assessments and interventions documented in standard risk assessment forms help clinical nurses detect new preventable problems and prevent harm in older hospital inpatients across geographic locations and hospital types. Standard nursing forms can be used in clinical practice to guide proactive care by nurses to prevent harm during hospitalisation. IMPACT Older inpatients are at risk of preventable harm and new health problems. The present study found that incorporating eight factors sensitive to nursing care into standard risk assessment forms can help reduce preventable harm in older inpatients. In addition, these forms guide assessment and intervention effectively in different countries.
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Affiliation(s)
- Chin-Yen Han
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Clinical Competency Center, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Bernice Redley
- Centre for Quality and Patient Safety Research-Monash Health Partnership, School of Nursing and Midwifery, Deakin University, Waurn Ponds, VIC, Australia
| | - Chun-Chih Lin
- Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Puzi City, Chiayi County, Taiwan
| | - Li-Chin Chen
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Nursing, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital, New Taipei City, Taiwan
| | - Chip Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Li-Hsiang Wang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
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Profiling Delirium Progression in Elderly Patients via Continuous-Time Markov Multi-State Transition Models. J Pers Med 2021; 11:jpm11060445. [PMID: 34064001 PMCID: PMC8223967 DOI: 10.3390/jpm11060445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/12/2022] Open
Abstract
Poor recognition of delirium among hospitalized elderlies is a typical challenge for health care professionals. Considering methodological insufficiency for assessing time-varying diseases, a continuous-time Markov multi-state transition model (CTMMTM) was used to investigate delirium evolution in elderly patients. This is a longitudinal observational study performed in September 2016 in an Italian hospital. Change of delirium states was modeled according to the 4AT score. A Cox model (CM) and a CTMMTM were used for identifying factors affecting delirium onset both with a two-state and three-state model. In this study, 78 patients were enrolled and evaluated for 5 days. Both the CM and the CTMMTM show that urine catheter (UC), aging, drugs, and invasive devices (ID) are risk factors for delirium onset. The CTMMTM model shows that transition from no-delirium/cognitive impairment to delirium was associated with aging (HR = 1.14; 95%CI, 1.05, 1.23) and neuroleptics (HR = 4.3; 1.57, 11.77), dopaminergic drugs (HR = 3.89; 1.2, 12.6), UC (HR = 2.92; 1.09, 7.79) and ID (HR = 1.67; 103, 2.71). These results are confirmed by the multivariable model. Aging, ID, antibiotics, drugs affecting the central nervous system, and absence of moving ability are identified as the significant predictors of delirium. Additionally, it seems that modeling with CTMMTM may show associations that are not directly detectable with the traditional CM.
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11
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[Descriptive study of delirium in the emergency department]. Aten Primaria 2021; 53:102042. [PMID: 33839636 PMCID: PMC8055560 DOI: 10.1016/j.aprim.2021.102042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/16/2020] [Accepted: 11/28/2020] [Indexed: 11/25/2022] Open
Abstract
Objetivo Conocer mejor las variables clínicas, funcionales y analíticas que se asocian al síndrome confusional agudo (SCA) en urgencias y la evolución de las mismas con el fin de obtener una mejora en el abordaje terapéutico del paciente anciano previniendo así la morbimortalidad en este tipo de pacientes. Diseño Se trata de un estudio descriptivo prospectivo de SCA en urgencias. Emplazamiento Hospital General Universitario de Ciudad Real. Participantes Se incluyó, en el intervalo de las 24 h siguientes al ingreso en el Servicio de Geriatría, a todos los pacientes procedentes del Servicio de Urgencias con diagnóstico de SCA. Mediciones principales Se realizó un análisis de las variables del conjunto de datos (variables sociodemográficas y clínicas), calculando tablas de frecuencias para variables de tipo cualitativo y estadísticos descriptivos para las variables cuantitativas. Posteriormente, se han empleado técnicas de inferencia estadística. Resultados El antecedente médico más frecuente fueron la enfermedad neurológica y la HTA, seguida de las enfermedades reumatológicas. Los motivos de consulta principales fueron el deterioro del estado general, la disnea, la disminución del nivel de consciencia y la fiebre. Se debe destacar la incidencia de la polifarmacia, especialmente de fármacos como los diuréticos, benzodiacepinas o hipnóticos. En relación con la etiología principal, destaca el papel de las infecciones de tipo urinario y respiratorio. Conclusiones Se destaca el papel fundamental de las enfermedades neurológicas (especialmente la demencia), la HTA, la polifarmacia (uso inadecuado de benzodiacepinas e hipnóticos) y las infecciones urinarias y respiratorias como factores tratables o prevenibles del delirium en el paciente de Atención Primaria en nuestro medio.
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Huang K, Lu J, Zhu Y, Cheng T, Du D, Qian X, Pan H, Wang X, Yang H, Lou S. Incidence and risk factors of delirium after percutaneous coronary intervention in individuals hospitalised for acute myocardial infarction: protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e044564. [PMID: 33380487 PMCID: PMC7780515 DOI: 10.1136/bmjopen-2020-044564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Delirium in the postoperative period is a wide-reaching problem that affects important clinical outcomes. The incidence and risk factors of delirium in individuals with acute myocardial infarction (AMI) after primary percutaneous coronary intervention (PCI) has not been completely determined and no relevant systematic review and meta-analysis of incidence or risk factors exists. Hence, we aim to conduct a systematic review and meta-analysis to ascertain the incidence and risk factors of delirium among AMI patients undergoing PCI. METHODS AND ANALYSES We will undertake a comprehensive literature search among PubMed, EMBASE, Cochrane Library, PsycINFO, CINAHL and Google Scholar from their inception to the search date. Prospective cohort and cross-sectional studies that described the incidence or at least one risk factor of delirium will be eligible for inclusion. The primary outcome will be the incidence of postoperative delirium. The quality of included studies will be assessed using a risk of bias tool for prevalence studies and the Cochrane guidelines. Heterogeneity of the estimates across studies will be assessed. Incidence and risk factors associated with delirium will be extracted. Incidence data will be pooled. Each risk factor reported in the included studies will be recorded together with its statistical significance; narrative and meta-analytical approaches will be employed. The systematic review and meta-analysis will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. ETHICS AND DISSEMINATION This proposed systematic review and meta-analysis is based on published data, and thus there is no requirement for ethics approval. The study will provide an up to date and accurate incidence and risk factors of delirium after PCI among patients with AMI, which is necessary for future research in this area. The findings of this study will be disseminated through publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020184388.
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Affiliation(s)
- Kaizhuang Huang
- Intensive Care Unit, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai 519000, China
| | - Jiaying Lu
- Department of Gastroenterology, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai 519000, China
| | - Yaoli Zhu
- Intensive Care Unit, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai 519000, China
| | - Tao Cheng
- Intensive Care Unit, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai 519000, China
| | - Dahao Du
- Intensive Care Unit, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai 519000, China
| | - Xueqin Qian
- Intensive Care Unit, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai 519000, China
| | - Haiyan Pan
- Intensive Care Unit, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai 519000, China
| | - Xiaohua Wang
- Intensive Care Unit, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai 519000, China
| | - Hong Yang
- Intensive Care Unit, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai 519000, China
| | - Shaofei Lou
- Intensive Care Unit, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai 519000, China
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Pritchard E, Soh SE, Morello R, Berkovic D, Blair A, Anderson K, Bateman C, Moran C, Tsindos T, O’Donnell R, Ayton D. Volunteer Programs Supporting People With Dementia/Delirium in Hospital: Systematic Review and Meta-Analysis. THE GERONTOLOGIST 2020; 61:e421-e434. [DOI: 10.1093/geront/gnaa058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Objectives
Volunteer-delivered programs to assist people with dementia and/or delirium in-hospital can provide person-centered one-on-one support in addition to usual care. These programs could mitigate hospital resource demands; however, their effectiveness is unknown. This review evaluated literature of volunteer programs in acute hospital settings for people living with dementia and/or delirium.
Research Design and Methods
Four databases were searched. Studies that reported patient or program outcomes were included (i.e., delirium incidence, length of stay, number of falls, satisfaction). Risk of bias was completed. Meta-analysis was performed where 2 or more studies measured the same outcome. Narrative synthesis was performed on the qualitative results.
Results
Eleven studies were included in the review, with varied design, participant groups and outcomes measured. Risk of bias averaged 71%. Volunteer-delivered programs addressed delirium risk factors, for example, hydration/nutrition, mobility, use of sensory aids. Eight patients and 6 program outcomes were captured, but only 3 patient outcomes could be pooled. Meta-analyses demonstrated a reduction in delirium incidence (rate ratio = 0.65; 95% confidence interval [CI] 0.47, 0.90) but no reduction in length of stay (mean difference −1.09; 95% CI −0.58, 2.77) or number of falls (rate ratio = 0.67; 95% CI 0.19, 2.35). Narrative synthesis identified benefits to patients (e.g., less loneliness), volunteers (sense of meaning), and staff (timesaving, safety).
Discussion and Implications
Volunteer-delivered programs for inpatients with dementia and/or delirium may provide benefits for patients, volunteers, and staff. However, studies conducted with more robust designs are required to determine overall effectiveness on program outcomes. Further high-quality research appropriate for this vulnerable population is required to identify volunteer program effectiveness.
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Affiliation(s)
- Elizabeth Pritchard
- Department of Epidemiology and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Australia
| | - Sze-Ee Soh
- Department of Epidemiology and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Australia
- Department of Physiotherapy, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Australia
| | - Renata Morello
- Department of Epidemiology and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Australia
| | - Danielle Berkovic
- Department of Epidemiology and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Australia
| | - Annaliese Blair
- Aged Care Evaluation Unit, Southern NSW Local Health District, Queanbeyan, Australia
| | - Katrina Anderson
- Aged Care Evaluation Unit, Southern NSW Local Health District, Queanbeyan, Australia
| | - Catherine Bateman
- Aged Care Evaluation Unit, Southern NSW Local Health District, Queanbeyan, Australia
| | - Chris Moran
- Peninsula Clinical School, Monash University, Peninsula, Melbourne, Australia
| | - Tess Tsindos
- Medical Education Research and Quality, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Australia
| | - Renee O’Donnell
- Monash Centre for Health Research and Implementation, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Australia
| | - Darshini Ayton
- Department of Epidemiology and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Australia
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14
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Zrour C, Haddad R, Zoghbi M, Kharsa Z, Hijazi M, Naja W. Prospective, multi-centric benchmark study assessing delirium: prevalence, incidence and its correlates in hospitalized elderly Lebanese patients. Aging Clin Exp Res 2020; 32:689-697. [PMID: 31203529 DOI: 10.1007/s40520-019-01242-2] [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: 03/29/2019] [Accepted: 06/05/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND With the increase in the proportion of elderly Lebanese patients, little is known about delirium's prevalence, incidence and correlated factors. AIMS To identify the prevalence, incidence and factors associated with overall and incident delirium in hospitalized elderly Lebanese patients. METHODS A convenient sample was recruited from three university hospitals affiliated to the Lebanese university faculty of medical sciences. We included patients aged more than 65 years. Baseline factors were examined upon presentation and the confusion assessment method (CAM) was used to detect prevalent delirium upon admission or within the first 48 h. Enrolled patients were then assessed every other day to detect incident delirium cases. RESULTS Among the 230 patients included, delirium prevalence was 17% and incidence 8.7%. We found that a history of falls (odds ratio (OR) = 5.12; p = 0.001), immobilization (OR = 7.33; p = 0.035), polypharmacy (OR = 5.07; p = 0.026) along with tachycardia (OR = 6.94; p = 0.03) and severe anemia (OR = 12.5; p = 0.005) upon admission were significant factors associated with overall delirium (incident and prevalent delirium cases). Whereas, living alone was significantly associated with lower odds for overall delirium (OR = 0.03; p = 0.02). Moreover, current smoking (OR = 14; p = 0.02), low oxygen saturation (OR = 9.6; p = 0.008) and severe anemia (OR = 8.4; p = 0.013) upon admission remained significantly associated with higher odds for incident delirium along with urine catheter placement (OR = 7.8; p = 0.015). CONCLUSION Secondary to the burden of delirium and its impact on mortality among elderly population, trying to understand and adjust modifiable factors would promote more appropriate prevention strategies.
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Affiliation(s)
- Carmen Zrour
- Psychiatry Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon. .,, Boulevard de Smet de Naeyer 414, Jette 1090, Brussels, Belgium.
| | - Ramzi Haddad
- Psychiatry Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Marouan Zoghbi
- Family Medicine Department, Faculty of Medical Sciences, Saint Joseph University, Beirut, Lebanon
| | - Zahraa Kharsa
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Mariam Hijazi
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Wadih Naja
- Psychiatry Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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15
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McNeil J, Denis AM, Michel U, Concert CM. Effectiveness of non-pharmacological strategies for managing delirium in hospitalized postoperative adults: an umbrella review protocol. ACTA ACUST UNITED AC 2019. [PMID: 29521857 DOI: 10.11124/jbisrir-2017-003455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
REVIEW QUESTION/OBJECTIVE The question of this review: What is the effectiveness of non-pharmacological strategies for the management of delirium in hospitalized adult postoperative patients?The objective of this umbrella review is to determine the effectiveness of non-pharmacological strategies for the management of delirium in adult postoperative patients, 18 years and over, in an acute care hospitalized setting.More specifically, the review aims to identify which non-pharmacological strategy/strategies, provided as a single strategy or combined as two or more strategies, is the most effective for management of delirium in hospitalized postoperative adult patients?
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Affiliation(s)
- Joan McNeil
- College of Health Professions, Pace University, New York, USA
| | | | - Urick Michel
- College of Health Professions, Pace University, New York, USA
| | - Catherine M Concert
- College of Health Professions, Pace University, New York, USA.,The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence
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16
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Jin T, Jin Y, Lee SM. Medication Use and Risk of Delirium in Mechanically Ventilated Patients. Clin Nurs Res 2019; 30:474-481. [PMID: 31466469 DOI: 10.1177/1054773819868652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
One of the principal complications in patients in the intensive care unit, particularly in those receiving mechanical ventilation, is medication-induced delirium. The present study aimed to intensively analyze pharmaceutical factors affecting the development of delirium in mechanically ventilated patients using the electronic health records. The present study was designed as a retrospective case-control study. The delirium group included 500 mechanically ventilated patients. The non-delirium group included 2,000 patients who were hospitalized during the same period as the delirium group and received mechanical ventilation. A total of seven types of medications (narcotic analgesics, non-narcotic analgesics, psychopharmaceuticals, sleep aid medications, anticholinergics, steroids, and diuretics), conventionally used to manage mechanical ventilation, were found to be major risk factors associated with the occurrence of delirium. Since these medications are an integral part of managing mechanically ventilated patients, prudent protocol-based medication approaches are essential to decrease the risk of delirium.
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Affiliation(s)
- Taixian Jin
- The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Sun-Mi Lee
- The Catholic University of Korea, Seoul, Republic of Korea
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17
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Redley B, Richardson B, Peel C, Ockerby C, Rawson H, Tomlinson E, Hutchinson A. Co-development of "BRAIN-TRK": Qualitative examination of acceptability, usability and feasibility of an App to support nurses' care for patients with behavioural and psychological symptoms of neurocognitive disorders in hospital. J Clin Nurs 2019; 28:2868-2879. [PMID: 30938865 DOI: 10.1111/jocn.14874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/13/2019] [Accepted: 03/23/2019] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES (a) Describe the co-development of a point-of-care App to promote uptake of best practice recommendations and consolidate nurses' knowledge for managing symptoms of neurocognitive disorders. (b) Report acceptability, usability and feasibility of the App to nurses for patient care in hospital. BACKGROUND Strategies used in hospitals to reduce symptoms, risk of harm, or complications of behavioural and psychological symptoms associated with neurocognitive disorders are frequently inconsistent with best practice recommendations. DESIGN Three-stage, mixed-methods, process and outcome evaluation. METHODS The App was co-developed with experts, nurse end-users and a consumer. Evaluation data were collected from a convenience sample of nurses observed during delivery of 80.5 hr of care to 38 patients; the App (n = 32 patients); and individual and focus group interviews with nurses (n = 25). Reporting adhered to an adapted STROBE checklist. RESULTS The App included three components: cognition and risk assessment; tailored evidence-based strategies; and monitoring and evaluation of effectiveness. Observation data captured nurses using the App with 44.7% (n = 17) of eligible inpatients. Cognitive screening was completed at least once for each patient, with 146 risk assessments recorded. Interview data indicated the App's acceptability was enhanced by familiarity and perceived benefits, but hindered by perceived increases in workload, inconsistent use, pressure to use the App and resistance to change. Feasibility and usability were enhanced by easy navigation, and clear and useful content, but hindered by unclear expectations, unfamiliarity and device-related factors. CONCLUSIONS The App provided an evidence-based tool that was, overall, considered feasible and acceptable to support best practice. Findings provide guidance to enhance usability for future implementation. RELEVANCE TO CLINICAL PRACTICE Co-development using best evidence and key stakeholders enabled creation of a novel, feasible and acceptable technology. Real-time access to assessment tools and tailored knowledge supported nurses' clinical decision-making; workload and unfamiliarity were barriers to use.
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Affiliation(s)
- Bernice Redley
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research - Monash Health Partnership, Monash Health, Clayton, Victoria, Australia
| | - Ben Richardson
- Cairnmillar Institute, Hawthorn East, Victoria, Australia
| | - Charlotte Peel
- Centre for Quality and Patient Safety Research - Monash Health Partnership, Monash Health, Clayton, Victoria, Australia
| | - Cherene Ockerby
- Centre for Quality and Patient Safety Research - Monash Health Partnership, Monash Health, Clayton, Victoria, Australia
| | - Helen Rawson
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research - Monash Health Partnership, Monash Health, Clayton, Victoria, Australia
| | - Emily Tomlinson
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Alison Hutchinson
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research - Monash Health Partnership, Monash Health, Clayton, Victoria, Australia
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18
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Bo M, Porrino P, Di Santo SG, Mazzone A, Cherubini A, Mossello E, Bianchetti A, Musicco M, Ferrari A, Ferrara N, Filippini C, Trabucchi M, Morandi A, Bellelli G. The association of indwelling urinary catheter with delirium in hospitalized patients and nursing home residents: an explorative analysis from the "Delirium Day 2015". Aging Clin Exp Res 2019; 31:411-420. [PMID: 29858986 DOI: 10.1007/s40520-018-0974-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/22/2018] [Indexed: 11/30/2022]
Abstract
BACKROUND Use of indwelling urinary catheter (IUC) in older adults has negative consequences, including delirium. AIM This analysis, from the "Delirium Day 2015", a nationwide multicenter prevalence study, aim to evaluate the association of IUC with delirium in hospitalized and Nursing Homes (NHs) patients. METHODS Patients underwent a comprehensive geriatric assessment, including the presence of IUC; inclusion criteria were age > 65 years, being Italian speaker and providing informed consent; exclusion criteria were coma, aphasia, end-of-life status. Delirium was assessed using the 4AT test (score ≥ 4: possible delirium; scores 1-3: possible cognitive impairment). RESULTS Among 1867 hospitalized patients (mean age 82.0 ± 7.5 years, 58% female), 539 (28.9%) had IUC, 429 (22.9%) delirium and 675 (36.1%) cognitive impairment. IUC was significantly associated with cognitive impairment (OR 1.60, 95% CI 1.19-2.16) and delirium (2.45, 95% CI 1.73-3.47), this latter being significant also in the subset of patients without dementia (OR 2.28, 95% CI 1.52-3.43). Inattention and impaired alertness were also independently associated with IUC. Among 1454 NHs residents (mean age 84.4 ± 7.4 years, 70.% female), 63 (4.3%) had IUC, 535 (36.8%) a 4AT score ≥ 4, and 653 (44.9%) a 4AT score 1-3. The multivariate logistic regression analysis did not show a significant association between 4AT test or its specific items with IUC, neither in the subset of patients without dementia. DISCUSSION We confirmed a significant association between IUC and delirium in hospitalized patients but not in NHs residents. CONCLUSION Environmental and clinical factors of acute setting might contribute to IUC-associated delirium occurrence.
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Affiliation(s)
- Mario Bo
- Section of Geriatrics, Città della Salute e della Scienza, Molinette, Corso Bramante, 88, 10126, Torino, Italy
| | - Paola Porrino
- Section of Geriatrics, Città della Salute e della Scienza, Molinette, Corso Bramante, 88, 10126, Torino, Italy.
| | - Simona G Di Santo
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Fondation S Lucia, Via Ardeatina, 306-354, 00179, Roma, Italy
| | - Andrea Mazzone
- Redaelli Geriatric Institute, Via Bartolomeo d'Alviano, 78, 20146, Milano, Italy
| | - Antonio Cherubini
- Geriatrics and Geriatric Emergency Care, IRCCS-INRCA, Via della Montagnola, 81, 60127, Ancona, Italy
| | - Enrico Mossello
- Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence and AziendaOspedaliero-UniversitariaCareggi, Largo Brambilla, 3a, 50134, Firenze, Italy
| | - Angelo Bianchetti
- Medicine and Rehabilitation Department, IstitutoClinico S. Anna, Via del Franzone, 31, 25127, Brescia, Italy
| | - Massimo Musicco
- Institute of Biomedical Technologies, National Research Council, Via Fratelli Cervi 93, Segrate, 20090, Milano, Italy
- Italian Society of Neurology for Dementia (SINDEM), via del Rastrello, 7, 53100, Siena, Italy
| | - Alberto Ferrari
- Italian Society of Hospital and Community Geriatrics (SIGOT), Roma, Italy
| | - Nicola Ferrara
- Department of Translational Medical Sciences, Federico II University of Naples, Corso Umberto I 40, 80138, Napoli, Italy
| | - Claudia Filippini
- Department of Surgical Sciences, University of Turin, Corso Bramante, 88, 10126, Torino, Italy
| | - Marco Trabucchi
- Geriatric Research Group, via Fratelli Lombardi, 2, 25121, Brescia, Italy
- Italian Psychogeriatric Association (AIP), Via Fratelli Lombardi, 2, 25121, Brescia, Italy
| | - Alessandro Morandi
- Department of Rehabilitation and Aged Care "Fondazione Camplani" Hospital, Via Aselli, 14, 26100, Cremona, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milano, Italy
- Geriatric Unit, San Gerardo University Hospital, Via G. B. Pergolesi, 33, 20900, Monza, Italy
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Redley B, Baker T. Have you SCAND MMe Please? A framework to prevent harm during acute hospitalisation of older persons: A retrospective audit. J Clin Nurs 2018; 28:560-574. [PMID: 30129081 DOI: 10.1111/jocn.14650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To test the mnemonic Have you SCAND MMe Please? as a framework to audit nursing care to prevent harms common to older inpatients. BACKGROUND It is not known if acute hospital care comprehensively addresses eight interrelated factors that contribute to preventable harms common in older hospitalised patients. DESIGN Retrospective audit of medical records. METHODS A random selection of 400 medical records of inpatients over 65 years of age with an unplanned admission of longer than 72 hr in acute medical wards at four hospitals in Victoria, Australia, during 2011-12, was examined for frequency of documented evidence of assessments, interventions or new problems related to eight factors contributing to common preventable harms during hospitalisation. RESULTS Assessments of skin integrity (94%-97%), mobility (95%-98%) and pain (93%-97%) were most often documented. Gaps in assessment of continence (4%-31%), nutrition (9%-49%), cognition (delirium, depression and dementia) (10%-24%) were most common. No patient record had evidence of all eight factors being assessed. Almost 80% of records had interventions documented for one or more factors that contribute to preventable harms. In almost 20% of patient records, a new preventable harm was documented during hospitalisation. CONCLUSIONS The mnemonic Have you SCAND MMe Please? brings together eight factors known to contribute to preventable harms common in older hospitalised patients. This framework was useful to identify gaps in assessment and interventions for factors that contribute to preventable harms during acute hospital care. Future research should test if the mnemonic can assist nurses with comprehensive harm prevention during acute hospitalisation. RELEVANCE TO CLINICAL PRACTICE The mnemonic Have you SCAND MMe Please? represents eight factors that contribute to preventable harms common in older hospitalised patients. This framework provides a model for harm prevention to assist nurses to implement comprehensive harm prevention to improve quality of care and safety for older hospitalised patients.
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Affiliation(s)
- Bernice Redley
- School of Nursing and Midwifery, Nursing Research Centre, Monash Health-Deakin Partnership, Deakin University, Burwood, Victoria, Australia
| | - Tim Baker
- Centre for Rural Emergency Medicine, Deakin University, Warrnambool, Victoria, Australia
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20
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Schubert M, Schürch R, Boettger S, Garcia Nuñez D, Schwarz U, Bettex D, Jenewein J, Bogdanovic J, Staehli ML, Spirig R, Rudiger A. A hospital-wide evaluation of delirium prevalence and outcomes in acute care patients - a cohort study. BMC Health Serv Res 2018; 18:550. [PMID: 30005646 PMCID: PMC6045819 DOI: 10.1186/s12913-018-3345-x] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 07/01/2018] [Indexed: 12/15/2022] Open
Abstract
Background Delirium is a well-known complication in cardiac surgery and intensive care unit (ICU) patients. However, in many other settings its prevalence and clinical consequences are understudied. The aims of this study were: (1) To assess delirium prevalence in a large, diverse cohort of acute care patients classified as either at risk or not at risk for delirium; (2) To compare these two groups according to defined indicators; and (3) To compare delirious with non-delirious patients regarding hospital mortality, ICU and hospital length of stay, nursing hours and cost per case. Methods This cohort study was performed in a Swiss university hospital following implementation of a delirium management guideline. After excluding patients aged < 18 years or with a length of stay (LOS) < 1 day, 29′278 patients hospitalized in the study hospital in 2014 were included. Delirium period prevalence was calculated based on a Delirium Observation Scale (DOS) score ≥ 3 and / or Intensive Care Delirium Screening Checklist (ICDSC) scores ≥4. Results Of 10′906 patients admitted, DOS / ICDSC scores indicated delirium in 28.4%. Delirium was most prevalent (36.2–40.5%) in cardiac surgery, neurosurgery, trauma, radiotherapy and neurology patients. It was also common in geriatrics, internal medicine, visceral surgery, reconstructive plastic surgery and cranio-maxillo-facial surgery patients (prevalence 21.6–28.6%). In the unadjusted and adjusted models, delirious patients had a significantly higher risk of inpatient mortality, stayed significantly longer in the ICU and hospital, needed significantly more nursing hours and generated significantly higher costs per case. For the seven most common ICD-10 diagnoses, each diagnostic group’s delirious patients had worse outcomes compared to those with no delirium. Conclusions The results indicate a high number of patients at risk for delirium, with high delirium prevalence across all patient groups. Delirious patients showed significantly worse clinical outcomes and generated higher costs. Subgroup analyses highlighted striking variations in delirium period-prevalence across patient groups. Due to the high prevalence of delirium in patients treated in care centers for radiotherapy, visceral surgery, reconstructive plastic surgery, cranio-maxillofacial surgery and oral surgery, it is recommended to expand the current focus of delirium management to these patient groups. Electronic supplementary material The online version of this article (10.1186/s12913-018-3345-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Schubert
- Nursing Science, Faculty of Medicine, Department of Public Health, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland. .,Directorate of Nursing/MTT, Insel Gruppe, University Hospital Inselspital, Bern, Freiburgstr. 44a, 3010, Bern, Switzerland. .,School of Health Professions, Institute of Nursing, Zurich University of Applied Science, Technikumstr. 81, P.O. Box, 8401, Winterthur, Switzerland.
| | - Roger Schürch
- Clinical Trial Unit, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.,Virginia Tech, Department of Entomology (MC0319), 170 Drillfield Drive, Blacksburg, VA, 24061, USA
| | - Soenke Boettger
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland
| | - David Garcia Nuñez
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland.,Center for Gender Variance, University Hospital Basel, Spitalstrasse 21, 4056, Basel, Switzerland
| | - Urs Schwarz
- Division of Neurology, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland
| | - Dominique Bettex
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Josef Jenewein
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland
| | - Jasmina Bogdanovic
- Nursing Science, Faculty of Medicine, Department of Public Health, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland
| | - Marina Lynne Staehli
- Nursing Department, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Rebecca Spirig
- Directorate of Nursing/MTT, Insel Gruppe, University Hospital Inselspital, Bern, Freiburgstr. 44a, 3010, Bern, Switzerland.,Nursing and Allied Health Care Professions Office, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland
| | - Alain Rudiger
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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22
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Jones J, Sim TF, Hughes J. Pain Assessment of Elderly Patients with Cognitive Impairment in the Emergency Department: Implications for Pain Management-A Narrative Review of Current Practices. PHARMACY 2017; 5:E30. [PMID: 28970442 PMCID: PMC5597155 DOI: 10.3390/pharmacy5020030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/05/2017] [Accepted: 05/26/2017] [Indexed: 01/08/2023] Open
Abstract
Elderly people are susceptible to both falls and cognitive impairment making them a particularly vulnerable group of patients when it comes to pain assessment and management in the emergency department (ED). Pain assessment is often difficult in patients who present to the ED with a cognitive impairment as they are frequently unable to self-report their level of pain, which can have a negative impact on pain management. This paper aims to review how cognitive impairment influences pain assessment in elderly adults who present to the ED with an injury due to a fall. A literature search of EMBASE, ProQuest, PubMed, Science Direct, SciFinder and the Curtin University Library database was conducted using keyword searches to generate lists of articles which were then screened for relevance by title and then abstract to give a final list of articles for full-text review. Further articles were identified by snowballing from the reference lists of the full-text articles. The literature reports that ED staff commonly use visual or verbal analogue scales to assess pain, but resort to their own intuition or physiological parameters rather than using standardised observational pain assessment tools when self-report of pain is not attainable due to cognitive impairment. While studies have found that the use of pain assessment tools improves the recognition and management of pain, pain scores are often not recorded for elderly patients with a cognitive impairment in the ED, leading to poorer pain management in this patient group in terms of time to analgesic administration and the use of strong opioids. All healthcare professionals involved in the care of such patients, including pharmacists, need to be aware of this and strive to ensure analgesic use is guided by appropriate and accurate pain assessment in the ED.
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Affiliation(s)
- Joshua Jones
- School of Pharmacy, Curtin University, Western Australia 6102, Australia.
| | - Tin Fei Sim
- School of Pharmacy, Curtin University, Western Australia 6102, Australia.
| | - Jeff Hughes
- School of Pharmacy, Curtin University, Western Australia 6102, Australia.
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