Síndrome confusional agudo en pacientes ancianos ingresados por patología médica

Effect of Morphine Used to Relieve Dyspnea Due to Heart Failure on Delirium

Background: Delirium management is crucial in palliative care. Morphine effectively relieves dyspnea due to heart failure. However, the effect of morphine, which is used to relieve dyspnea due to heart failure, on the incidence of delirium has not been examined to date. Objective: To evaluate the effect of morphine, which is used to relieve dyspnea due to heart failure, on delirium. Design: Retrospective observational study. Setting/Subjects: Subjects were identified from Osaka University Hospital records, located in Japan, from January 1, 2010, to September 30, 2021. The case group consisted of admissions for heart failure or cardiomyopathy registered in electronic medical records. Morphine was administered to relieve dyspnea due to heart failure, and no surgeries or procedures were performed. The control group consisted of admissions for heart failure or cardiomyopathy in the Diagnosis Procedure Combination (DPC) database, which did not include administration of morphine, oxycodone, or fentanyl during the hospitalization period and patients did not undergo surgery or any other procedure. Measurements: The incidence of delirium was assessed. Results: The odds ratios for morphine in the multivariate logistic regression analysis with propensity score and univariate logistic regression analysis after propensity score matching were 1.406 (95% confidence interval (CI) [0.249-7.957]) and 1.034 (95% CI [0.902-1.185]), respectively. Conclusions: Morphine, which is used to relieve dyspnea due to heart failure, had minimal effect on the incidence of delirium. This information is likely to be beneficial for the future use of morphine in the management of dyspnea in patients with heart failure.

Long-term prognostic value of functional status and delirium in emergency patients with decompensated heart failure

AIMS

Heart failure (HF) is prevalent in older adults and is associated with impaired physical and cognitive function. However, these factors are rarely included in studies about long-term prognosis of HF. The aim of the study was to determine whether functional status and delirium at admission (prevalent delirium) would predict 1-year mortality in patients with decompensated HF (DHF).

METHODS

We performed a prospective observational study in adult patients with DHF attended at two Spanish Emergency Departments (ED) in the context of the Epidemiology Acute HF Emergency project. Functional status was assessed by Barthel Index (BI) and prevalent delirium by the Brief Confusion Assessment Method within the first 24 h of admission. We used Kaplan-Meier survival curves for delirium and multivariable Cox regression models to estimated hazard ratio (HR) and survival probability for death while adjusting for six potential confounders.

RESULT

We enrolled 239 patients (age 81.7 ± 9.4 years, women 61.1%). BI < 60 was 23.4 and 14.6% of patients had delirium. Age (HR 1.046 CI 95% 1.014-1.080, p < 0.004) and BI (HR 0.979 CI 95% 0.972-0.979, p < 0.001) were independently associated with 1-year mortality. In patients without severe functional dependence at admission, delirium (HR 3.579 CI 95% 1.730-7.403, p < 0.001) and age (HR 1.051 CI 95% 1.014-1.090, p = 0.007) independently predicted long-term mortality.

CONCLUSION

Age and functional dependence are strong predictors of long-term mortality in patients with DHF. In patients without severe functional dependence, delirium-a potentially modifiable risk factor-identified a subgroup of patients with higher mortality. Evaluating functional status and delirium in ED could improve decision-making and future care of patients with DHF.

[Anticholinergic burden and delirium in elderly patients during acute hospital admission]

BACKGROUND

The use of anticholinergic drugs in the elderly has been associated to an increased frequency of delirium. There are different scales for estimating the anticholinergic burden, such as the Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and Anticholinergic Cognitive Burden (ACB). The aim of the study is to establish the relationship between anticholinergic burden measured by ADS, ARS, and ACB scales and incident or prevalent delirium.

METHODS

An ambispective observational study was conducted for 76 days in the acute geriatric unit of a tertiary hospital. All patients over 80 years-old were included, except re-admissions or those subjected to palliative care. The data collected included sex, age, chronic medication and any recent changes, recent drugs prescribed prior to an episode of delirium, chronic kidney disease, diabetes mellitus, dementia, visual and auditory impairment, and their combination as sensory impairment, previous falls, stroke, brain tumour, and incident and prevalent delirium.

RESULTS

A total of 72 patients were included. Incident delirium was detected in 8.1% of the patients, and prevalent delirium in 40.9%. A statistically significant association was established between anticholinergic drugs and the incident delirium measured by the ARS scale (P=.017). None of the scales was able to establish a significant association with prevalent delirium.

CONCLUSION

The ARS scale was related to new episodes of delirium. All scales were insufficient when it came to establishing an association with prevalent delirium.

[Review of functional impairment associated with acute illness in the elderly]

Hospitalization is a risk for elderly population, with a high probability of having adverse events. The most important one is functional impairment, due to its high prevalence and the serious impact it has on the quality of life. The main risk factors for functional decline associated with hospitalization are, age, immobility, cognitive impairment, and functional status prior to admission. It is necessary to detect patients at risk in order to implement the necessary actions to prevent this deterioration, with physical exercise and multidisciplinary geriatric care being the most important.

[Delirium prevention and treatment in elderly hip fracture]

The fracture of the proximal femur or hip fracture in the elderly usually happens after a fall and carries a high morbidity and mortality. One of the most common complications during hospitalization for hip fracture is the onset of delirium or acute confusional state that in elderly patients has a negative impact on the hospital stay, and prognosis, worsening functional ability, cognitive status and mortality. Also the development of delirium during hospitalization increases health care costs. Strategies to prevent and treat delirium during hospitalization for hip fracture have been less studied. In this context, this paper aims to conduct a review of the literature on strategies that exist in the prevention and treatment of delirium in elderly patients with hip fracture.

[Delirium risk assessment in elderly hospitalized patients]

Delirium is a major geriatric syndrome that affects a significant percentage of elderly hospitalized patients. It involves major negative consequences for users and professionals and can be prevented. The aim of this paper is to identify and describe the tools for predicting delirium in hospitalized patients. Lastly, the work analyzes the sources of heterogeneity and the scarcity of such instruments, as well as the reasons why their use is not widespread in clinical practice.

[Delirium in patients aged more the 94 years with femur fracture]

OBJECTIVE

Delirium is a frequent problem during hospital admission in the elderly. The aim of the present study was to evaluate the occurrence of delirium in patients aged more than 94 years admitted to hospital for femur fracture. A further aim was to analyze the possible existence of differences in length of hospital stay or in-hospital mortality according to the presence or absence of delirium.

MATERIAL AND METHODS

A total of 25 patients (mean age 96.8 years) admitted for femur fracture were included. Functional status was determined through the Barthel index and comorbidity through Charlson's index. Diagnosis of delirium was based on the Confusional Assessment Method.

RESULTS

There were 13 women (52%) and 12 men. The mean Barthel score before admission was 64.6 +/- 22 and the mean Charlson Index was 1.4 +/- 1. The mean length of hospital stay was 15.2 +/- 1.4 days. Five patients (20%) died during admission. Twelve patients (48%) developed delirium. Mortality (25% vs 15.4%) and the mean number of days of hospital stay (17.5 vs 13 days) were higher in patients with delirium, although these differences were not statistically significant.

CONCLUSIONS

Practically half the patients aged more than 94 years with fracture of the femur had an episode of delirium during admission.

Delirium in hospitalised older persons: review

Delirium, a mental disorder that becomes established over a few hours or days, is characterised by fluctuating attention and cognitive states. This article reviews the disorder, which has all the features of an important geriatric syndrome: it appears mainly in persons older than 65 years of age, is closely linked with very prevalent diseases and complications arising in the elderly, and is the mode of presentation of many other diseases in this age group. We discuss diagnostic, clinical preventive and therapeutic aspects and analyse the most common risk and precipitating factors in our hospitalised patients from the viewpoint of clinical practice. Finally, we propose a scheme for the prevention and treatment of delirium.