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Instenes I, Eide LSP, Andersen H, Fålun N, Pettersen T, Ranhoff AH, Rudolph JL, Steihaug OM, Wentzel-Larsen T, Norekvål TM. Detection of delirium in older patients-A point prevalence study in surgical and non-surgical hospital wards. Scand J Caring Sci 2024; 38:579-588. [PMID: 38702945 DOI: 10.1111/scs.13270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/13/2024] [Accepted: 04/20/2024] [Indexed: 05/06/2024]
Abstract
AIMS AND OBJECTIVES To (i) determine the prevalence of delirium and identify delirium subtypes in surgical and non-surgical patients aged ≥65 years, (ii) determine whether certain precipitating factors affect the prevalence of delirium and (iii) review patients' medical records for description of delirium symptoms and the presence of International Classification of Diseases (ICD-10) coding for delirium in discharge summaries. METHODOLOGICAL DESIGN AND JUSTIFICATIONS Despite being a robust predictor of morbidity and mortality in older adults, delirium might be inadequately recognised and under-reported in patients' medical records and discharge summaries. A point prevalence study (24-h) of patients ≥65 years from surgical and non-surgical wards was therefore conducted in a tertiary university hospital. ETHICAL ISSUES AND APPROVAL The study was approved by the Data Protection Officer at the university hospital (2018/3454). RESEARCH METHODS, INSTRUMENTS AND/OR INTERVENTIONS Patients were assessed for delirium with 4AT and delirium subtypes with the Delirium Motor Subtype Scale. Information about room transfers, need and use of sensory aids and medical equipment was collected onsite. Patients' medical records were reviewed for description of delirium symptoms and of ICD-10 codes. RESULTS Overall, 123 patients were screened (52% female). Delirium was identified in 27% of them. Prevalence was associated with advanced age (≥85 years). The uncharacterised delirium subtype was most common (36%), followed by hypoactive (30%), hyperactive (24%) and mixed (9%). There were significant associations between positive screening tests and the need and use of sensory aids. Delirium symptoms were described in 58% of the patients who tested positive for delirium and the ICD-10 code for delirium was registered in 12% of these patients' discharge summaries. CONCLUSIONS The high prevalence of delirium and limited use of discharge codes highlight the need to improve the identification of delirium in hospital settings and at discharge. Increased awareness and detection of delirium in hospital settings are vital to improve patient care.
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Affiliation(s)
- Irene Instenes
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Leslie S P Eide
- Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Hege Andersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Nina Fålun
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Trond Pettersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Anette H Ranhoff
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - James L Rudolph
- Department of Health Services, Policy and Practice, Brown University, Providence, USA
| | - Ole Martin Steihaug
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tore Wentzel-Larsen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Eastern and Southern Norway, Oslo, Norway
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Aggar C, Craswell A, Bail K, Compton RM, Hughes M, Sorwar G, Baker J, Greenhill J, Shinners L, Nichols B, Langheim R, Wallis A, Bowen K, Bridgett H. A Toolkit for Delirium Identification and Promoting Partnerships Between Carers and Nurses: A Pilot Pre-Post Feasibility Study. J Gen Intern Med 2024; 39:2001-2008. [PMID: 38647970 PMCID: PMC11306898 DOI: 10.1007/s11606-024-08734-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/15/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Delirium is frightening for people experiencing it and their carers, and it is the most common hospital-acquired complication worldwide. Delirium is associated with higher rates of morbidity, mortality, residential care home admission, dementia, and carer stress and burden, yet strategies to embed the prevention and management of delirium as part of standard hospital care remain challenging. Carers are well placed to recognize subtle changes indicative of delirium, and partner with nurses in the prevention and management of delirium. OBJECTIVE To evaluate a Prevention & Early Delirium Identification Carer Toolkit (PREDICT), to support partnerships between carers and nurses to prevent and manage delirium. DESIGN A pre-post-test intervention and observation study. MAIN MEASURES Changes in carer knowledge of delirium; beliefs about their role in partnering with nurses and intended and actual use of PREDICT; carer burden and psychological distress. Secondary measures were rates of delirium. PARTICIPANTS Participants were carers of Indigenous patients aged 45 years and older and non-Indigenous patients aged 65 years and older. INTERVENTION Nurses implemented PREDICT, with a view to provide carers with information about delirium and strategies to address caregiving stress and burden. KEY RESULTS Participants included 25 carers (43% response rate) (n = 17, 68% female) aged 29-88 (M = 65, SD = 17.7 years). Carer delirium knowledge increased significantly from pre-to-post intervention (p = < .001; CI 2.07-4.73). Carers' intent and actual use of PREDICT was (n = 18, 72%; and n = 17, 68%). Carer burden and psychological distress did not significantly change. The incidence of delirium in the intervention ward although not significant, decreased, indicating opportunity for scaling up. CONCLUSION The prevention and management of delirium are imperative for safe and quality care for patients, carers, and staff. Further comprehensive and in-depth research is required to better understand underlying mechanisms of change and explore facets of nursing practice influenced by this innovative approach.
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Affiliation(s)
- Christina Aggar
- Faculty of Health, Southern Cross University, Bilinga, QLD, Australia.
- Northern NSW Local Health District, Lismore, NSW, Australia.
| | - Alison Craswell
- School of Health, University of the Sunshine Coast, Maroochydore BC, QLD, Australia
| | - Kasia Bail
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Roslyn M Compton
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - Mark Hughes
- Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
| | - Golam Sorwar
- Faculty of Business, Law and Arts, Southern Cross University, Bilinga, QLD, Australia
| | - James Baker
- Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
| | - Jennene Greenhill
- Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
| | - Lucy Shinners
- Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
| | - Belinda Nichols
- Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
- Northern NSW Local Health District, Lismore, NSW, Australia
| | | | - Allison Wallis
- Northern NSW Local Health District, Lismore, NSW, Australia
| | - Karen Bowen
- Northern NSW Local Health District, Lismore, NSW, Australia
| | - Hazel Bridgett
- Northern NSW Local Health District, Lismore, NSW, Australia
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Alhammadi E, Kuhlmann JM, Rana M, Frohnhofen H, Moellmann HL. Postoperative delirium in oral and maxillofacial surgery: a scoping review. Head Face Med 2024; 20:39. [PMID: 39044223 PMCID: PMC11265362 DOI: 10.1186/s13005-024-00439-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/12/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Postoperative delirium (POD) in the oral and maxillofacial settings has gained more attention in recent decades. Due to advances in medical technology, treatment possibilities have expanded treatment for elderly and frail patients. This scoping review explores the correlation between POD and oral and maxillofacial surgery, summarizing screening and management protocols and identifying risk factors in this surgical field. METHODS This review follows the Scoping Review extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR). A comprehensive literature search was performed using multiple databases, focusing on articles published from 2002 to 2023 that discuss delirium in oral and maxillofacial surgery settings. The review was registered beforehand in the Open Science Framework ( https://osf.io/r2ebc ). RESULTS From the initial 644 articles, 68 met the inclusion criteria. These studies highlighted the significant heterogeneity in POD diagnosis methods. The review identifies multiple risk factors across the preoperative, intraoperative, and postoperative phases that influence the occurrence of POD. Significant and independent risk factors in multiple regression analysis were highlighted, creating a clinical prediction list for the occurrence of POD. CONCLUSION It is crucial to preoperatively identify patients at risk for POD and actively modify these risks throughout the patient's hospital stay. Implementing nonpharmacological preventive measures for at-risk patients is recommended to decrease the incidence of POD. Future research should focus on creating standardized specialty-specific protocols incorporating validated assessment tools and addressing the full spectrum of risk factors associated with POD.
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Affiliation(s)
- Eman Alhammadi
- Cranio-and-Maxillo Facial Surgery, University Hospital Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany.
- Dubai Health, Dubai, United Arab Emirates.
| | - Julian Max Kuhlmann
- Heinrich-Heine-Universität Düsseldorf, Universitätsstrasse 1, Düsseldorf, 40225, Germany
| | - Majeed Rana
- Cranio-and-Maxillo Facial Surgery, University Hospital Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Helmut Frohnhofen
- Orthopedics and Trauma Surgery, University Hospital Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Henriette Louise Moellmann
- Cranio-and-Maxillo Facial Surgery, University Hospital Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany.
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Ornago AM, Pinardi E, Okoye C, Mazzola P, Ferrara MC, Finazzi A, Nydahl P, von Haken R, Lindroth H, Liu K, Morandi A, Bellelli G. Delirium prevalence and delirium literacy across Italian hospital wards: a secondary analysis of data from the World Delirium Awareness Day 2023. Eur Geriatr Med 2024:10.1007/s41999-024-01019-5. [PMID: 39023695 DOI: 10.1007/s41999-024-01019-5] [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: 04/20/2024] [Accepted: 06/26/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE Delirium, a common medical emergency among hospitalized patients, requires effective detection and management protocols. This study aims to evaluate the delirium point prevalence and its management across Italian hospitals, categorized by delirium literacy levels. Additionally, it seeks to identify prevailing barriers and future priorities in delirium practice and research. METHODS We analyzed data from World Delirium Awareness Day (WDAD) on March 15th, 2023, collected by participating clinicians in Italian hospitals. High delirium literacy (HL) was determined based on the use of validated delirium assessment tools and the presence of a written protocol for delirium management. Conversely, low delirium literacy (LL) was determined by meeting only one or neither of these criteria. RESULTS Fifty-eight hospital wards participated in the survey, with 25 (43.1%) classified as HL. The overall reported point prevalence of delirium was found to be approximately 10%. Notably, the reported prevalence was twice as high in the HL group compared to the LL group. Despite minimal differences compared to the other group, the HL group demonstrated greater adherence to appropriate delirium management strategies, encompassing both non-pharmacological and pharmacological strategies. Critical gaps in delirium care emerged, including suboptimal management practices, barriers to implementing evidence-based strategies, and insufficient awareness and training among professionals. CONCLUSION The study highlights the suboptimal identification and management of delirium among Italian hospitals, emphasizing the necessity of enhancing awareness and implementing evidence-based strategies. Addressing these shortcomings is crucial for optimizing delirium care, improving patient outcomes, and mitigating the burden of delirium in hospital settings.
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Affiliation(s)
- Alice Margherita Ornago
- School of Medicine and Surgery, University of Milano-Bicocca, Piazza Dell'Ateneo Nuovo 1, Milan, Italy.
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Elena Pinardi
- School of Medicine and Surgery, University of Milano-Bicocca, Piazza Dell'Ateneo Nuovo 1, Milan, Italy
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Chukwuma Okoye
- School of Medicine and Surgery, University of Milano-Bicocca, Piazza Dell'Ateneo Nuovo 1, Milan, Italy
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Acute Geriatric Unit, IRCCS San Gerardo Foundation, Monza, Italy
| | - Paolo Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, Piazza Dell'Ateneo Nuovo 1, Milan, Italy
- Acute Geriatric Unit, IRCCS San Gerardo Foundation, Monza, Italy
| | - Maria Cristina Ferrara
- School of Medicine and Surgery, University of Milano-Bicocca, Piazza Dell'Ateneo Nuovo 1, Milan, Italy
| | - Alberto Finazzi
- School of Medicine and Surgery, University of Milano-Bicocca, Piazza Dell'Ateneo Nuovo 1, Milan, Italy
| | - Peter Nydahl
- Nursing Research, University Hospital Schleswig-Holstein, Kiel, Germany
- Institute of Nursing Science and Development, Paracelsus Medical University, Salzburg, Austria
| | - Rebecca von Haken
- Department of Anesthesiology, University Hospital Mannheim, Mannheim, Germany
| | - Heidi Lindroth
- Division of Nursing Research, Department of Nursing, Mayo Clinic, Rochester, MN, USA
- Center for Aging Research, Regenstrief Institute, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Department Intensive Care, Radboud University Medica Center, Nijmegen, The Netherlands
| | - Alessandro Morandi
- Intermediate Care and Rehabilitation, Azienda Speciale Cremona Solidale, Cremona, Italy
- Parc Sanitari Pere Virgili, Val d'Hebron Institute of Research, Barcelona, Spain
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Piazza Dell'Ateneo Nuovo 1, Milan, Italy
- Acute Geriatric Unit, IRCCS San Gerardo Foundation, Monza, Italy
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Kamwa V, Knight T, Atkin C, Cooksley T, Subbe C, Holland M, Lasserson D, Sapey E. Acute frailty services: results of a national day of care survey. BMC Geriatr 2024; 24:608. [PMID: 39014306 PMCID: PMC11251303 DOI: 10.1186/s12877-024-05075-1] [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: 06/02/2023] [Accepted: 05/14/2024] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Older people living with frailty are at high risk of emergency hospital admission and often have complex care needs which may not be adequately met by conventional models of acute care. This has driven the introduction of adaptations to acute care pathways designed to improve outcomes in this patient group. The identification of differences in the organisational approach to frailty may highlight opportunities for quality improvement. METHODS The Society for Acute Medicine Benchmarking audit is a national service evaluation which uses a single day-of-care methodology to record patient and organisational level data. All acute hospitals in the United Kingdom are eligible to participate. Emergency admissions referred to acute medical services between 00:00 and 23:59 on Thursday 23rd June 2022 were recorded. Information on the structure and operational design of acute frailty services was collected. The use of a validated frailty assessment tool, clinical frailty scale within the first 24 h of admission, assessment by an acute frailty service and clinical outcomes were reported in patients aged 70 year and above. A mixed effect generalised linear model was used to determine factors associated same-day discharge without overnight stay in patients with frailty. RESULTS A total of 152 hospitals participated. There was significant heterogeneity in the operational design and staffing model of acute frailty services. The presence of an acute frailty unit was reported in 57 (42.2%) hospitals. The use of validated frailty assessment tools was reported in 117 (90.0%) hospitals, of which 107 (91.5%) used the clinical frailty scale. Patient-level data were recorded for 3604 patients aged 70 years and above. At the patient level, 1626 (45.1%) were assessed using a validated tool during the admission process. Assessment by acute frailty services was associated with an increased likelihood of same-day discharge (adjusted OR 1.55, 95%CI 1.03- 2.39). CONCLUSION There is significant variation in the provision of acute frailty services. Frailty-related policies and services are common at the organisational level but implemented inconsistently at the patient level. Older people with frailty or geriatric syndromes assessed by acute frailty services were more likely to be discharged without the need for overnight bed-based admission.
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Affiliation(s)
- Vicky Kamwa
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, NIHR Applied Research Collaborative West Midlands, NIHR Patient Safety Research Collaborative West Midlands, University of Birmingham, Birmingham, England
| | - Thomas Knight
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, NIHR Applied Research Collaborative West Midlands, NIHR Patient Safety Research Collaborative West Midlands, University of Birmingham, Birmingham, England.
| | - Catherine Atkin
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, NIHR Applied Research Collaborative West Midlands, NIHR Patient Safety Research Collaborative West Midlands, University of Birmingham, Birmingham, England
| | - Tim Cooksley
- The Christie NHS Foundation Trust, Manchester, England
| | - Chris Subbe
- School of Medical and Health Sciences, Bangor University, Bangor, Wales
| | - Mark Holland
- School of Clinical and Biomedical Sciences, University of Bolton, Bolton, England
| | - Daniel Lasserson
- Warwick Medical School, University of Warwick, Coventry, England
| | - Elizabeth Sapey
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, NIHR Applied Research Collaborative West Midlands, NIHR Patient Safety Research Collaborative West Midlands, University of Birmingham, Birmingham, England
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Richardson SJ, Cropp AD, Ellis SW, Gibbon J, Sayer AA, Witham MD. The interrelationship between multiple long-term conditions (MLTC) and delirium: a scoping review. Age Ageing 2024; 53:afae120. [PMID: 38965032 PMCID: PMC11223896 DOI: 10.1093/ageing/afae120] [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: 06/15/2023] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Delirium and multiple long-term conditions (MLTC) share numerous risk factors and have been shown individually to be associated with adverse outcomes following hospitalisation. However, the extent to which these common ageing syndromes have been studied together is unknown. This scoping review aims to summarise our knowledge to date on the interrelationship between MLTC and delirium. METHODS Searches including terms for delirium and MLTC in adult human participants were performed in PubMed, EMBASE, Medline, Psycinfo and CINAHL. Descriptive analysis was used to summarise findings, structured according to Synthesis Without Meta-analysis reporting guidelines. RESULTS After removing duplicates, 5256 abstracts were screened for eligibility, with 313 full-texts sought along with 17 additional full-texts from references in review articles. In total, 140 met inclusion criteria and were included in the final review. Much of the literature explored MLTC as a risk factor for delirium (n = 125). Fewer studies explored the impact of MLTC on delirium presentation (n = 5), duration (n = 3) or outcomes (n = 6) and no studies explored how MLTC impacts the treatment of delirium or whether having delirium increases risk of developing MLTC. The most frequently used measures of MLTC and delirium were the Charlson Comorbidity Index (n = 98/140) and Confusion Assessment Method (n = 81/140), respectively. CONCLUSION Existing literature largely evaluates MLTC as a risk factor for delirium. Major knowledge gaps identified include the impact of MLTC on delirium treatment and the effect of delirium on MLTC trajectories. Current research in this field is limited by significant heterogeneity in defining both MLTC and delirium.
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Affiliation(s)
- Sarah Joanna Richardson
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Faculty of Medical Sciences Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | | | | | - Jake Gibbon
- South Tyneside and Sunderland NHS Foundation Trust, South Shields, Tyne and Wear, UK
| | - Avan Aihie Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Faculty of Medical Sciences Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Miles David Witham
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Faculty of Medical Sciences Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
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Bianchi LA, Harris R, Fitzpatrick JM. Barriers to healthcare professionals recognizing and managing delirium in older adults during a hospital stay: A mixed-methods systematic review. J Adv Nurs 2024; 80:2672-2689. [PMID: 38108154 DOI: 10.1111/jan.16018] [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: 07/11/2023] [Revised: 11/17/2023] [Accepted: 11/26/2023] [Indexed: 12/19/2023]
Abstract
AIM To investigate barriers to healthcare professionals recognizing and managing delirium in hospitalized older people. DESIGN A mixed-methods systematic review. PROSPERO ID CRD42020187932. DATA SOURCES MEDLINE, EMBASE, PsycINFO and CINAHL were searched (2007 to February 2023). REVIEW METHODS Included studies focused on healthcare professionals' recognition and management of delirium for patients aged 65 years and over in a hospital ward or emergency department. Enhancing rigour, screening of results was conducted independently by two researchers. Qualitative and quantitative data were tabulated separately and grouped. Data were compared to identify similarities and differences. All studies were quality appraised. RESULTS 43 studies were included; 24 quantitative, 16 qualitative and three mixed-methods. Data synthesis highlighted synergy between qualitative and quantitative findings. Barriers were reflected in six themes: (1) healthcare professionals' knowledge and understanding; (2) communication; (3) workforce development; (4) interprofessional working; (5) confounders; and (6) organizational constraints. CONCLUSIONS Of significance, for older adults in hospital experiencing delirium, there is variability in whether and how well it is recognized and managed. To prevent adverse outcomes best practice guidance for screening, recognizing, diagnosing and managing delirium in older people needs to be agreed and disseminated widely. Supporting healthcare professionals to care for this patient population using an integrated approach is essential, how to involve and communicate with patients and their family and friends, how to recognize and manage delirium for patients with additional needs, e.g., those living with dementia and/or a learning disability. Hospitals need to have policy and guidance in place for the recognition and management of delirium in older adults presenting to a ward or to an emergency department. An IT infrastructure is needed that integrates assessments and care management plans in patient electronic records and makes them accessible within and across teams in hospital, primary and community care settings. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution to this systematic review. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Healthcare professionals can be better supported to be able to recognize and manage delirium during an acute hospital stay for older adults. This includes maximizing best care for those patients living with dementia, involving families and friends to help understand patients' baseline status and changes and supporting families and friends during this process. Of significance, attention to hospital IT infrastructures is warranted, integrating screening, assessment and care management plans in patients' electronic records and making these accessible to healthcare professionals caring for this patient population across care settings. IMPACT What problem did the study address? Delirium is a common condition experienced by older hospitalized patients, but it is consistently under-recognized which has implications for patient and organization outcomes. To help address this, understanding barriers to healthcare professionals recognizing and managing delirium for this patient population is paramount. What were the main findings? Barriers to healthcare professionals recognizing and managing delirium for this patient population were synthesized in six themes: (1) healthcare professionals' knowledge and understanding, (2) communication; (3) workforce development; (4) interprofessional working; (5) confounders; and (6) organizational constraints. Where and on whom will the research have an impact? The findings of this original systematic review can contribute to hospital policy and protocol for the recognition and management of delirium in older patients. The findings can meaningfully contribute to workforce professional development for practitioners caring for older people during an acute hospital stay and for practitioners in primary and community settings involved in the follow-up of patients post hospital discharge. For researchers, the findings indicate several research recommendations including investigating the impact of an education programme for nurses and other healthcare professionals on the recognition and management of the condition and understanding and investigating how best to support delirium-related distress experienced by patients and their families and practitioners. REPORTING METHOD This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Page et al., 2021).
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Affiliation(s)
- Leda A Bianchi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ruth Harris
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Joanne M Fitzpatrick
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Desai M, Findeisen S, Blitzer S, Tardif-Douglin M, Miller I, Leff B, Edmondson L, Hernandez C, Levine DM. Outcomes from an Early Adopters Home Hospital Accelerator for Acute Care at Home. J Gen Intern Med 2024:10.1007/s11606-024-08869-6. [PMID: 38937363 DOI: 10.1007/s11606-024-08869-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/11/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Following the Centers for Medicare and Medicaid Services' approval of the Acute Hospital Care at Home waiver, an increasing number of health care organizations launched Home Hospital (HH) programs in the USA. Ongoing barriers include access to HH expertise and a standard, comprehensive set of implementation tools. We created the HH Early Adopters Accelerator to bring together a network of health care organizations to develop tools ("knowledge products") necessary for HH implementation. OBJECTIVE To demonstrate the feasibility of the Accelerator approach for generating and implementing relevant, high-quality knowledge products. DESIGN Mixed methods evaluation of the Accelerator. Surveys and qualitative interviews of Accelerator participants were conducted. Surveys elicited feedback on the knowledge products, including time spent on development, perceived utility and quality, and implementation success. The qualitative interviews gathered more in-depth information on topics covered in the surveys. PARTICIPANTS Eighteen healthcare organizations and 105 individuals participated in the Accelerator. KEY RESULTS The Accelerator reached its goal and developed 20 knowledge products in 32 working weeks (more efficient than expected). Participants agreed that the knowledge products were useful (developers: 98.1%; stakeholders: 93.8%), of high quality (developers: 96.8%), and would improve patient care if implemented in their HH program (developers: 91.7%; stakeholders: 91.2%). Two thirds (66.7%) of the participating organizations who had implemented knowledge products at 3 months continued utilizing knowledge products in their HH program at 1 year. Agreement that knowledge products improve patient care persisted (92% strongly agreed or agreed) at 1 year. Several programs created new tools, policies, and workflows as a result of implementing the knowledge products. CONCLUSIONS The Accelerator created high-quality, comprehensive knowledge products that healthcare organizations found useful for safe HH implementation 1 year later. The Accelerator approach can feasibly help healthcare organizations safely bridge the gap between innovation and standard practice.
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Affiliation(s)
| | | | | | | | | | - Bruce Leff
- Center for Transformative Geriatric Research, Division of Geriatric Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - LaPonda Edmondson
- CaroNova, Cary, NC, USA
- North Carolina Healthcare Association, Cary, NC, USA
| | - Carme Hernandez
- Research and Innovation Management, Hospital Clinic, Barcelona, Spain
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital; Boston, Boston, MA, USA
| | - David M Levine
- Ariadne Labs, Boston, MA, USA.
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital; Boston, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Geßele C, Saller T, Smolka V, Dimitriadis K, Amann U, Strobach D. Development and validation of a new drug-focused predictive risk score for postoperative delirium in orthopaedic and trauma surgery patients. BMC Geriatr 2024; 24:422. [PMID: 38741037 DOI: 10.1186/s12877-024-05005-1] [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: 02/23/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Postoperative delirium (POD) is the most common complication following surgery in elderly patients. During pharmacist-led medication reconciliation (PhMR), a predictive risk score considering delirium risk-increasing drugs and other available risk factors could help to identify risk patients. METHODS Orthopaedic and trauma surgery patients aged ≥ 18 years with PhMR were included in a retrospective observational single-centre study 03/2022-10/2022. The study cohort was randomly split into a development and a validation cohort (6:4 ratio). POD was assessed through the 4 A's test (4AT), delirium diagnosis, and chart review. Potential risk factors available at PhMR were tested via univariable analysis. Significant variables were added to a multivariable logistic regression model. Based on the regression coefficients, a risk score for POD including delirium risk-increasing drugs (DRD score) was established. RESULTS POD occurred in 42/328 (12.8%) and 30/218 (13.8%) patients in the development and validation cohorts, respectively. Of the seven evaluated risk factors, four were ultimately tested in a multivariable logistic regression model. The final DRD score included age (66-75 years, 2 points; > 75 years, 3 points), renal impairment (eGFR < 60 ml/min/1.73m2, 1 point), anticholinergic burden (ACB-score ≥ 3, 1 point), and delirium risk-increasing drugs (n ≥ 2; 2 points). Patients with ≥ 4 points were classified as having a high risk for POD. The areas under the receiver operating characteristic curve of the risk score model were 0.89 and 0.81 for the development and the validation cohorts, respectively. CONCLUSION The DRD score is a predictive risk score assessable during PhMR and can identify patients at risk for POD. Specific preventive measures concerning drug therapy safety and non-pharmacological actions should be implemented for identified risk patients.
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Affiliation(s)
- Carolin Geßele
- Hospital Pharmacy, LMU University Hospital, LMU Munich, Munich, Germany.
- Doctoral Program Clinical Pharmacy, LMU University Hospital, LMU Munich, Munich, Germany.
| | - Thomas Saller
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Vera Smolka
- Department of Orthopaedics and Trauma Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | | | - Ute Amann
- Faculty of Medicine, LMU Munich, Munich, Germany
| | - Dorothea Strobach
- Hospital Pharmacy, LMU University Hospital, LMU Munich, Munich, Germany
- Doctoral Program Clinical Pharmacy, LMU University Hospital, LMU Munich, Munich, Germany
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10
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Oldham MA, Heinrich T, Luccarelli J. Requesting That Delirium Achieve Parity With Acute Encephalopathy in the MS-DRG System. J Acad Consult Liaison Psychiatry 2024; 65:302-312. [PMID: 38503671 PMCID: PMC11179982 DOI: 10.1016/j.jaclp.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 03/21/2024]
Abstract
Since 2007, the Medicare Severity Diagnosis Related Groups classification system has favored billing codes for acute encephalopathy over delirium codes in determining hospital reimbursement and several quality-of-care value metrics, despite broad overlap between these sets of diagnostic codes. Toxic and metabolic encephalopathy codes are designated as major complication or comorbidity, whereas causally specified delirium codes are designated as complication or comorbidity and thus associated with a lower reimbursement and lesser impact on value metrics. The authors led a submission to the U.S. Centers for Medicare and Medicaid Services requesting that causally specified delirium be designated major complication or comorbidity alongside toxic and metabolic encephalopathy. Delirium warrants reclassification because it satisfies U.S. Centers for Medicare and Medicaid Services' guiding principles for re-evaluating Medicare Severity Diagnosis Related Group severity levels. Delirium: (1) has a bidirectional relationship with the permanent condition of dementia (major neurocognitive disorder per DSM-5-TR), (2) indexes vulnerability across populations, (3) impacts healthcare systems across levels of care, (4) complicates postoperative recovery, (5) consigns patients to higher levels of care, (6) impedes patient engagement in care, (7) has several recent treatment guidelines, (8) often indicates neuronal/brain injury, and (9) represents a common expression of terminal illness. The proposal's impact was explored using the 2019 National Inpatient Sample, which suggested that increasing delirium's complexity designation would lead to an upcoding of less than 1% of eligible discharges. Parity for delirium is essential to enhancing awareness of delirium's clinical and economic costs. Appreciating delirium's impact would encourage delirium prevention and screening efforts, thereby mitigating its dire outcomes for patients, families, and healthcare systems.
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Affiliation(s)
- Mark A Oldham
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY.
| | - Thomas Heinrich
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI; Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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11
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Gillett G, Davis O, Gill A, van Hamel C. Exploring foundation doctors' self-reported confidence in the assessment and management of mental health conditions. BJPsych Bull 2024; 48:139-144. [PMID: 37408445 PMCID: PMC10985717 DOI: 10.1192/bjb.2023.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 07/07/2023] Open
Abstract
AIMS AND METHOD This study assesses newly qualified doctors' confidence in practising clinical skills related to the assessment and management of mental health conditions and how this correlates with other areas of medicine. We conducted a national survey of 1311 Foundation Year 1 doctors in the UK. Survey items assessed confidence recognising mentally unwell patients, conducting a mental state examination, assessing cognition and mental capacity, formulating a psychiatric diagnosis and prescribing psychotropic medications. RESULTS A substantial proportion of surveyed doctors lacked confidence in their clinical skills related to mental health and prescribing psychotropic medications. Network analysis revealed that items corresponding to mental health were highly correlated, suggesting a potential generalised lack of confidence in mental healthcare. CLINICAL IMPLICATIONS We identify areas of lack of confidence in some newly qualified doctors' ability to assess and manage mental health conditions. Future research might explore how greater exposure to psychiatry, integrated teaching and clinical simulation might better support medical students for future clinical work.
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Affiliation(s)
- George Gillett
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Owen Davis
- UK Foundation Programme Office, Birmingham, UK
| | - Amarit Gill
- UK Foundation Programme Office, Birmingham, UK
| | - Clare van Hamel
- Severn Postgraduate Medical Education Foundation School, Bristol, UK
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12
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Wieczorek-Stawińska W, Ryś M, Perera I, Rudzińska A, Gryglewska B, Gąsowski J, Piotrowicz K. Delirium is not dementia: Delirium Awareness Day-related event at the University Hospital in Krakow. Eur Geriatr Med 2024; 15:407-410. [PMID: 38316720 DOI: 10.1007/s41999-023-00924-5] [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: 08/05/2023] [Accepted: 12/19/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE To present the two-day Delirium Awareness Day-related event held at the University Hospital, Kraków, Poland. METHODS Activities included a lecture, a multimedia presentation, meetings with healthcare workers at their respective wards, and distribution of information posters about delirium. Local news outlets were also engaged. RESULTS We reached out to approximately 300 persons in the hospital itself and several thousand via TV and radio broadcasts. We prompted interdisciplinary discussions about delirium, especially concerning preventive measures. The most common questions were how to alleviate symptoms as soon as possible, with the expectation of straightforward solutions for the non-geriatrician staff. Patient distress and burden on caregivers were important topics brought-up in the discussions. CONCLUSION We demonstrated that our educational initiative was feasible and well-accepted among medical staff. Local media helped in building public understanding of delirium. Education about the syndrome should be one of the key societal tasks of geriatricians.
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Affiliation(s)
- Wiktoria Wieczorek-Stawińska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, and Geriatric Ward, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 31-501, Kraków, Poland
| | - Monika Ryś
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, and Geriatric Ward, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 31-501, Kraków, Poland
| | - Ian Perera
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, and Geriatric Ward, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 31-501, Kraków, Poland
| | - Anna Rudzińska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, and Geriatric Ward, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 31-501, Kraków, Poland
| | - Barbara Gryglewska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, and Geriatric Ward, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 31-501, Kraków, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, and Geriatric Ward, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 31-501, Kraków, Poland.
| | - Karolina Piotrowicz
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, and Geriatric Ward, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 31-501, Kraków, Poland
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13
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Gerakios F, Yarnall AJ, Bate G, Wright L, Davis D, Stephan BCM, Robinson L, Brayne C, Stebbins G, Taylor JP, Burn DJ, Allan LM, Richardson SJ, Lawson RA. Delirium is more common and associated with worse outcomes in Parkinson's disease compared to older adult controls: results of two prospective longitudinal cohort studies. Age Ageing 2024; 53:afae046. [PMID: 38497236 PMCID: PMC10945294 DOI: 10.1093/ageing/afae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Inpatient prevalence of Parkinson's disease (PD) delirium varies widely across the literature. Delirium in general older populations is associated with adverse outcomes, such as increased mortality, dementia, and institutionalisation. However, to date there are no comprehensive prospective studies in PD delirium. This study aimed to determine delirium prevalence in hospitalised PD participants and the association with adverse outcomes, compared to a control group of older adults without PD. METHODS Participants were hospitalised inpatients from the 'Defining Delirium and its Impact in Parkinson's Disease' and the 'Delirium and Cognitive Impact in Dementia' studies comprising 121 PD participants and 199 older adult controls. Delirium was diagnosed prospectively using the Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria. Outcomes were determined by medical note reviews and/or home visits 12 months post hospital discharge. RESULTS Delirium was identified in 66.9% of PD participants compared to 38.7% of controls (p < 0.001). In PD participants only, delirium was associated with a significantly higher risk of mortality (HR = 3.3 (95% confidence interval [CI] = 1.3-8.6), p = 0.014) and institutionalisation (OR = 10.7 (95% CI = 2.1-54.6), p = 0.004) 12 months post-discharge, compared to older adult controls. However, delirium was associated with an increased risk of developing dementia 12 months post-discharge in both PD participants (OR = 6.1 (95% CI = 1.3-29.5), p = 0.024) and in controls (OR = 13.4 (95% CI = 2.5-72.6), p = 0.003). CONCLUSION Delirium is common in hospitalised PD patients, affecting two thirds of patients, and is associated with increased mortality, institutionalisation, and dementia. Further research is essential to understand how to accurately identify, prevent and manage delirium in people with PD who are in hospital.
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Affiliation(s)
- Florence Gerakios
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alison J Yarnall
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, UK
| | - Gemma Bate
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Wright
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Blossom C M Stephan
- Institute of Mental Health, School of Medicine, Nottingham University, Nottingham, UK
- Dementia Centre of Excellence, EnAble Institute, Curtin University, Perth, Australia
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Carol Brayne
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Glenn Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, USA
| | - 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
| | - David J Burn
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise M Allan
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, 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
| | - Rachael A Lawson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, UK
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14
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Evensen S, Taraldsen K, Aam S, Morandi A. Delirium is associated with low levels of upright activity in geriatric inpatients-results from a prospective observational study. Aging Clin Exp Res 2024; 36:41. [PMID: 38353776 PMCID: PMC10867047 DOI: 10.1007/s40520-024-02699-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Delirium is common in geriatric inpatients and associated with poor outcomes. Hospitalization is associated with low levels of physical activity. Motor symptoms are common in delirium, but how delirium affects physical activity remains unknown. AIMS To investigate differences in physical activity between geriatric inpatients with and without delirium. METHODS We included acutely admitted patients ≥ 75 years in a prospective observational study at a medical geriatric ward at a Norwegian University Hospital. Delirium was diagnosed according to the DSM-5 criteria. Physical activity was measured by an accelerometer-based device worn on the right thigh. The main outcome was time in upright position (upright time) per 24 h (00.00 to 23.59) on the first day of hospitalization with verified delirium status. Group differences were analysed using t test. RESULTS We included 237 patients, mean age 86.1 years (Standard Deviation (SD) 5.1), and 73 patients (30.8%) had delirium. Mean upright time day 1 for the entire group was 92.2 min (SD 84.3), with 50.9 min (SD 50.7) in the delirium group and 110.6 min (SD 89.7) in the no-delirium group, mean difference 59.7 minutes, 95% Confidence Interval 41.6 to 77.8, p value < 0.001. DISCUSSION Low levels of physical activity in patients with delirium raise the question if immobilization may contribute to poor outcomes in delirium. Future studies should investigate if mobilization interventions could improve outcomes of delirium. CONCLUSIONS In this sample of geriatric inpatients, the group with delirium had lower levels of physical activity than the group without delirium.
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Affiliation(s)
- Sigurd Evensen
- Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway.
| | - Kristin Taraldsen
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University (OsloMet), Oslo, Norway
| | - Stina Aam
- Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Service, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Alessandro Morandi
- Intermediate Care and Rehabilitation, Azienda Speciale Di Cremona Solidale, Cremona Parc Sanitari Pere Virgili, Cremona, Italy
- Vall d'Hebrón Institute of Research, Barcelona, Spain
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15
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Taylor ME, Harvey LA, Crotty M, Harris IA, Sherrington C, Close JCT. Variation in care and outcomes for people after hip fracture with and without cognitive impairment; results from the Australian and New Zealand Hip Fracture Registry. J Nutr Health Aging 2024; 28:100030. [PMID: 38388111 DOI: 10.1016/j.jnha.2023.100030] [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: 10/15/2023] [Accepted: 11/20/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND People with dementia have poorer outcomes after hip fracture and this may be due in part to variation in care. We aimed to compare care and outcomes for people with and without cognitive impairment after hip fracture. METHODS Retrospective cohort study using Australian and New Zealand Hip Fracture Registry data for people ≥50 years of age who underwent hip fracture surgery (n = 49,063). Cognitive impairment or known dementia and cognitively healthy groups were defined using preadmission cognitive status. Descriptive statistics and multivariable mixed effects models were used to compare groups. RESULTS In general, cognitively impaired people had worse care and outcomes compared to cognitively healthy older people. A lower proportion of the cognitively impaired group had timely pain assessment (≤30 min of presentation: 61% vs 68%; p < 0.0001), were given the opportunity to mobilise (89% vs 93%; p < 0.0001) and achieved day-1 mobility (34% vs 58%; p < 0.0001) than the cognitively healthy group. A higher proportion of the cognitively impaired group had delayed pain management (>30 mins of presentation: 26% vs 20%; p < 0.0001), were malnourished (27% vs 15%; p < 0.0001), had delirium (44% vs 13%; p < 0.0001) and developed a new pressure injury (4% vs 3%; p < 0.0001) than the cognitively healthy group. Fewer of the cognitively impaired group received rehabilitation (35% vs 64%; p < 0.0001), particularly patients from RACFs (16% vs 39%; p < 0.0001) and were prescribed bone protection medication on discharge (24% vs 27%; p < 0.0001). Significantly more of the cognitively impaired group had a new transfer to residential care (46% vs 11% from private residence; p < 0.0001) and died at 30-days (7% vs 3% from private residence; 15% vs 10% from RACF; both p < 0.0001). In multivariable models adjusting for covariates with facility as the random effect, the cognitively impaired group had a greater odds of being malnourished, not achieving day-1 walking, having delirium in the week after surgery, dying within 30 days, and in those from private residences, having a new transfer to a residential care facility than the cognitively healthy group. CONCLUSIONS We have identified several aspects of care that could be improved for patients with cognitive impairment - management of pain, mobility, nutrition and bone health, as well as delirium assessment, prevention and management strategies and access to rehabilitation. Further research is needed to determine whether improvements in care will reduce hospital complications and improve outcomes for people with dementia after hip fracture.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia; UNSW Ageing Futures Research Institute, Sydney, New South Wales, Australia.
| | - Lara A Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Rehabilitation Unit, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool Hospital, Liverpool, NSW, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health, Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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Titlestad I, Haugarvoll K, Solvang SEH, Norekvål TM, Skogseth RE, Andreassen OA, Årsland D, Neerland BE, Nordrehaug JE, Tell GS, Giil LM. Delirium is frequently underdiagnosed among older hospitalised patients despite available information in hospital medical records. Age Ageing 2024; 53:afae006. [PMID: 38342753 PMCID: PMC10859244 DOI: 10.1093/ageing/afae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND In-hospital delirium is associated with adverse outcomes and is underdiagnosed, limiting research and clinical follow-up. OBJECTIVE To compare the incidence of in-hospital delirium determined by chart-based review of electronic medical records (D-CBR) with delirium discharge diagnoses (D-DD). Furthermore, to identify differences in symptoms, treatments and delirium triggers between D-CBR and D-DD. METHOD The community-based cohort included 2,115 participants in the Hordaland Health Study born between 1925 and 1927. Between 2018 and 2022, we retrospectively reviewed hospital electronic medical records from baseline (1997-99) until death prior to 2023. D-DD and D-CBR were validated using The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for delirium. RESULTS Of the 2,115 participants, 638 had in-hospital delirium. The incidence rate (IR) of D-CBR was 29.8 [95% confidence interval 28, 32] per 1,000 person-years, whereas the IR by D-DD was 3.4 [2.8, 4.2]. The IR ratio was 9.14 (P < 0.001). Patients who received pharmacological treatment for delirium (n = 121, odds ratio (OR) 3.4, [2.1, 5.4], P < 0.001), who were affected by acute memory impairment (n = 149, OR 2.8, [1.8, 4.5], P < 0.001), or change in perception (n = 137, OR 2.9, [1.8, 4.6] P < 0.001) had higher odds for D-DD. In contrast, post-operative cases (OR 0.2, [0.1, 0.4], P < 0.001) had lower odds for D-DD. CONCLUSION Underdiagnosis of in-hospital delirium was a major issue in our study, especially in less severe delirium cases. Our findings emphasise the need for integrating systematic delirium diagnostics and documentation into hospital admission and discharge routines.
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Affiliation(s)
- Irit Titlestad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Kristoffer Haugarvoll
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Stein-Erik H Solvang
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tone Merete Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ragnhild E Skogseth
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ole A Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dag Årsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Bjørn Erik Neerland
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lasse M Giil
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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17
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Wang J, Ji M, Han Y, Wu Y. Development and Usability Testing of a Mobile App-Based Clinical Decision Support System for Delirium: Randomized Crossover Trial. JMIR Aging 2024; 7:e51264. [PMID: 38298029 PMCID: PMC10850851 DOI: 10.2196/51264] [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: 07/26/2023] [Accepted: 01/02/2024] [Indexed: 02/02/2024] Open
Abstract
Background The 3-Minute Diagnostic Interview for Confusion Assessment Method-Defined Delirium (3D-CAM) is an instrument specially developed for the assessment of delirium in general wards, with high reported sensitivity and specificity. However, the use of the 3D-CAM by bedside nurses in routine practice showed relatively poor usability, with multiple human errors during assessment. Objective This study aimed to develop a mobile app-based delirium assessment tool based on the 3D-CAM and evaluate its usability among older patients by bedside nurses. Methods The Delirium Assessment Tool With Decision Support Based on the 3D-CAM (3D-DST) was developed to address existing issues of the 3D-CAM and optimize the assessment process. Following a randomized crossover design, questionnaires were used to evaluate the usability of the 3D-DST among older adults by bedside nurses. Meanwhile, the performances of both the 3D-DST and the 3D-CAM paper version, including the assessment completion rate, time required for completing the assessment, and the number of human errors made by nurses during assessment, were recorded, and their differences were compared. Results The 3D-DST included 3 assessment modules, 9 evaluation interfaces, and 16 results interfaces, with built-in reminders to guide nurses in completing the delirium assessment. In the usability testing, a total of 432 delirium assessments (216 pairs) on 148 older adults were performed by 72 bedside nurses with the 3D-CAM paper version and the 3D-DST. Compared to the 3D-CAM paper version, the mean usability score was significantly higher when using the 3D-DST (4.35 vs 3.40; P<.001). The median scores of the 6 domains of the satisfactory evaluation questionnaire for nurses using the 3D-CAM paper version and the 3D-DST were above 2.83 and 4.33 points, respectively (P<.001). The average time for completing the assessment reduced by 2.1 minutes (4.4 vs 2.3 min; P<.001) when the 3D-DST was used. Conclusions This study demonstrated that the 3D-DST significantly improved the efficiency of delirium assessment and was considered highly acceptable by bedside nurses.
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Affiliation(s)
- Jiamin Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
- School of Nursing, Capital Medical University, Beijing, China
| | - Meihua Ji
- School of Nursing, Capital Medical University, Beijing, China
| | - Yuan Han
- Peking University First Hospital, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
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18
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Harrison JD, Rathfon M, Binford S, Miranda J, Oreper S, Holt B, Rogers SE. Development and evaluation of a concise nurse-driven non-pharmacological delirium reduction workflow for hospitalized patients: An interrupted time series study. Geriatr Nurs 2024; 55:6-13. [PMID: 37956601 PMCID: PMC10955602 DOI: 10.1016/j.gerinurse.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023]
Abstract
We created a concise nurse-driven delirium reduction workflow with the aim of reducing delirium rates and length of stay for hospitalized adults. Our nurse-driven workflow included five evidence-based daytime "sunrise" interventions (patient room lights on, blinds up, mobilization/out-of-bed, water within patient's reach and patient awake) and five nighttime "turndown" interventions (patient room lights off, blinds down, television off, noise reduction and pre-set bedtime). Interventions were also chosen because fidelity could be quickly monitored twice daily without patient interruption from outside the room. To evaluate the workflow, we used an interrupted time series study design between 06/01/17 and 05/30/22 to determine if the workflow significantly reduced the unit's delirium rate and average length of stay. Our workflow is feasible to implement and monitor and initially significantly reduced delirium rates but not length of stay. However, the reduction in delirium rates were not sustained following the emergence of the COVID-19 pandemic.
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Affiliation(s)
- James D Harrison
- Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Megan Rathfon
- Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA
| | - Sasha Binford
- Center for Nursing Excellence and Innovation, University of California San Francisco Medical Center, San Francisco, CA, USA; School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | | | - Sandra Oreper
- Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Brian Holt
- Continuous Improvement Department, University of California Medical Center, San Francisco, CA, USA
| | - Stephanie E Rogers
- Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA
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Webber C, Milani C, Bjerre LM, Lawlor PG, Bush SH, Watt CL, Pugliese M, Knoefel F, Casey G, Momoli F, Thavorn K, Tanuseputro P. Potentially Inappropriate Prescribing in Long-Term Care and its Relationship With Probable Delirium. J Am Med Dir Assoc 2024; 25:130-137.e4. [PMID: 37743042 DOI: 10.1016/j.jamda.2023.08.019] [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: 07/04/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES This study examined potentially inappropriate prescribing (PIP) of medication and its association with probable delirium among long-term care (LTC) residents in Ontario, Canada. DESIGN Population-based cross-sectional study using provincial health administrative data, including LTC assessment data via the Resident Assessment Instrument-Minimum Dataset version 2.0 (RAI-MDS 2.0). SETTING AND PARTICIPANTS LTC residents in Ontario between January 1, 2016, and December 31, 2019. METHODS We used residents' first RAI-MDS 2.0 assessment in the study period as the index assessment. Probable delirium was identified via the delirium Clinical Assessment Protocol. Medication use in the 2 weeks preceding assessment was captured using medication claims data. PIP was measured using the STOPP/START criteria and 2015 Beers criteria, with residents classified as having 0, 1, 2, or 3+ instances of PIP. Relationships between PIP and probable delirium was assessed via bivariate and multivariable logistic regression models. RESULTS The study population included 171,190 LTC residents (mean age 84.5 years, 66.8% female, 62.9% with dementia). More than half (51.8%) of residents had 1+ instances of PIP and 21% had 3+ instances of PIP according to the STOPP/START criteria; PIP prevalence was slightly lower when assessed using Beers criteria (36.5% with 1+, 11.1% with 3+). Overall, 3.7% of residents had probable delirium. The prevalence of probable delirium increased as the number of instances of PIP increased, with residents with 3+ instances of STOPP/START PIP being 1.66 times more likely (95% CI 1.56-1.77) to have probable delirium compared to those with no instances of PIP. Similar findings were observed when PIP was measured using the Beers criteria. Central nervous system (CNS)-related PIP criteria showed a stronger association with probable delirium than non-CNS-related PIP criteria. CONCLUSIONS AND IMPLICATIONS This population-based study highlighted that PIP was highly prevalent in long-term care residents and was associated with an increased prevalence of probable delirium.
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Affiliation(s)
- Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; ICES, Ontario, Canada.
| | | | - Lise M Bjerre
- ICES, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Institut du savoir Montfort, Ottawa, Ontario, Canada
| | - Peter G Lawlor
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shirley H Bush
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christine L Watt
- Bruyère Research Institute, Ottawa, Ontario, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Pugliese
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES, Ontario, Canada
| | - Frank Knoefel
- Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Genevieve Casey
- Division of Geriatrics, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Franco Momoli
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; ICES, Ontario, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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20
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Vizzacchi BA, Dettino ALA, Besen BAMP, Caruso P, Nassar AP. Delirium During Critical Illness and Subsequent Change of Treatment in Patients With Cancer: A Mediation Analysis. Crit Care Med 2024; 52:102-111. [PMID: 37855674 DOI: 10.1097/ccm.0000000000006070] [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: 10/20/2023]
Abstract
OBJECTIVES To assess whether delirium during ICU stay is associated with subsequent change in treatment of cancer after discharge. DESIGN Retrospective cohort study. SETTING A 50-bed ICU in a dedicated cancer center. PATIENTS Patients greater than or equal to 18 years old with a previous proposal of cancer treatment (chemotherapy, target therapy, hormone therapy, immunotherapy, radiotherapy, oncologic surgery, and bone marrow transplantation). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We considered delirium present if Confusion Assessment Method for the ICU was positive. We assessed the association between delirium and modification of the treatment after discharge. We also performed a mediation analysis to assess both the direct and indirect (i.e., mediated by the development of functional dependence after discharge) of delirium on modification of cancer treatment and whether the modification of cancer treatment was associated with mortality at 1 year. We included 1,134 patients, of whom, 189 (16.7%) had delirium. Delirium was associated with the change in cancer treatment (adjusted odds ratio [OR], 3.80; 95% CI, 2.72-5.35). The association between delirium in ICU and change of treatment was both direct and mediated by the development of functional dependence after discharge. The proportion of the total effect of delirium on change of treatment mediated by the development of functional dependence after discharge was 33.0% (95% CI, 21.7-46.0%). Change in treatment was associated with increased mortality at 1 year (adjusted OR, 2.68; 95% CI, 2.01-3.60). CONCLUSIONS Patients who had delirium during ICU stay had a higher rate of modification of cancer treatment after discharge. The effect of delirium on change in cancer treatment was only partially mediated by the development of functional dependence after discharge. Change in cancer treatment was associated with increased 1-year mortality.
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Affiliation(s)
- Bárbara A Vizzacchi
- Rehabilitation and Palliative Care Supervision, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Aldo L A Dettino
- Department of Clinical Oncology. A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Bruno A M P Besen
- Department of Critical Care, Intensive Care Unit, A. C. Camargo Cancer Center, São Paulo, Brazil
- Medical ICU, Internal Medicine Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Pedro Caruso
- Department of Critical Care, Intensive Care Unit, A. C. Camargo Cancer Center, São Paulo, Brazil
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Antonio P Nassar
- Department of Critical Care, Intensive Care Unit, A. C. Camargo Cancer Center, São Paulo, Brazil
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Kodama L, Woldemariam S, Tang A, Li Y, Oskotsky T, Raphael E, Sirota M. Sex-stratified phenotyping of comorbidities associated with an inpatient delirium diagnosis using real world data. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.02.23297925. [PMID: 37961487 PMCID: PMC10635265 DOI: 10.1101/2023.11.02.23297925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Delirium is a heterogeneous and detrimental mental condition often seen in older, hospitalized patients and is currently hard to predict. In this study, we leverage large-scale, real- world data using the electronic health records (EHR) to identify two cohorts comprised of 7,492 UCSF patients and 19,417 UC health system patients (excluding UCSF patients) with an inpatient delirium diagnosis and the same number of propensity score-matched control patients without delirium. We found significant associations between comorbidities or laboratory test values and an inpatient delirium diagnosis which were validated independently. Most of these associations were those previously-identified as risk factors for delirium, including metabolic abnormalities, mental health diagnoses, and infections. Some of the associations were sex- specific, including those related to dementia subtypes and infections. We further explored the diagnostic associations with anemia and bipolar disorder by conducting longitudinal analyses from the time of first diagnosis of the risk factor to development of delirium demonstrating a significant relationship across time. Finally, we show that an inpatient delirium diagnosis leads to dramatic increases in mortality outcome across both cohorts. These results demonstrate the powerful application of leveraging EHR data to shed insights into prior diagnoses and laboratory test values that could help predict development of inpatient delirium and emphasize the importance of considering patient demographic characteristics including documented sex when making these assessments. One Sentence Summary Longitudinal analysis of electronic health record data reveals associations between inpatient delirium, comorbidities, and mortality.
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22
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Gandossi CM, Zambon A, Ferrara MC, Tassistro E, Castoldi G, Colombo F, Mussi C, Martini E, Sergi G, Coin A, Zatti G, Trevisan C, Volpato S, Ungar A, Bellelli G. Frailty and post-operative delirium influence on functional status in patients with hip fracture: the GIOG 2.0 study. Aging Clin Exp Res 2023; 35:2499-2506. [PMID: 37542601 PMCID: PMC10628048 DOI: 10.1007/s40520-023-02522-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND This study analyzes the effect of frailty and Post-Operative Delirium (POD) on the functional status at hospital discharge and at 4-month follow-up in patients with hip fracture (HF). METHODS Multicenter prospective observational study of older patients with HF admitted to 12 Italian Orthogeriatric centers (July 2019-August 2022). POD was assessed using the 4AT. A 26-item Frailty Index (FI) was created using data collected on admission. The outcome measures were Cumulated Ambulation Score (CAS) ≤ 2 at discharge and a telephone-administered CAS ≤ 2 after 4 months. Poisson regression models were used to assess the effect of frailty and POD on outcomes. RESULTS 984 patients (median age 84 years, IQR = 79-89) were recruited: 480 (48.7%) were frail at admission, 311 (31.6%) developed POD, and 158 (15.6%) had both frailty and POD. In a robust Poisson regression, frailty alone (Relative Risk, RR = 1.56, 95% Confidence Intervals, CI 1.19-2.04, p = 0.001) and its combination with POD (RR = 2.57, 95% CI 2.02-3.26, p < 0.001) were associated with poor functional status at discharge. At 4-month follow-up, the combination of frailty with POD (RR 3.65, 95% CI 1.85-7.2, p < 0.001) increased the risk of poor outcome more than frailty alone (RR 2.38, 95% CI 1.21-4.66, p < 0.001). CONCLUSIONS POD development exacerbates the negative effect that frailty exerts on functional outcomes in HF patients.
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Affiliation(s)
| | - Antonella Zambon
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy
- Biostatistics Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Elena Tassistro
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Centre), School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Giuseppe Castoldi
- Orthopedic Unit, Carate Brianza Hospital, ASST Brianza, Vimercate, MB, Italy
| | - Francesca Colombo
- Orthopedic Unit, Carate Brianza Hospital, ASST Brianza, Vimercate, MB, Italy
| | - Chiara Mussi
- Orthogeriatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Emilio Martini
- Orthogeriatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Sergi
- Department of Medicine, Geriatrics Unit, University of Padua, Padua, Italy
| | - Alessandra Coin
- Department of Medicine, Geriatrics Unit, University of Padua, Padua, Italy
| | - Giovanni Zatti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Orthopedic Unit, IRCCS S. Gerardo Hospital, Monza, Italy
| | - Caterina Trevisan
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Orthogeriatric Unit, Arcispedale S. Anna, University Hospital of Ferrara, Ferrara, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Orthogeriatric Unit, Arcispedale S. Anna, University Hospital of Ferrara, Ferrara, Italy
| | - Andrea Ungar
- Geriatrics and Intensive Care Unit, University of Florence and AOU Careggi, Florence, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.
- Orthogeriatric Unit, IRCCS San Gerardo Hospital, Monza, Italy.
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23
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Dolan C, Mohd Zubir M, Melvin V, McCarthy G, Meagher D, Adamis D. Delirium occurrence in older Irish adults admitted to an acute medical hospital: a prospective cohort study. Ir J Psychol Med 2023; 40:369-377. [PMID: 33455597 DOI: 10.1017/ipm.2020.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Delirium, which is associated with adverse health outcomes, is poorly detected in hospital settings. This study aimed to determine delirium occurrence among older medical inpatients and to capture associated risk factors. METHODS This prospective cohort study was performed at an Irish University Hospital. Medical inpatients 70 years and over were included. Baseline assessments within 72 hours of admission included delirium status and severity as determined by the Revised Delirium Rating Scale (DRS-R-98), cognition, physical illness severity and physical functioning. Pre-existing cognitive impairment was determined with Short Informant Questionnaire on Cognitive Decline (IQCODE). Serial assessment of delirium status, cognition and the physical illness severity were undertaken every 3 (±1) days during participants' hospital admission. RESULTS Of 198 study participants, 92 (46.5%) were women and mean age was 80.6 years (s.d. 6.81; range 70-97). Using DRS-R-98, 17.7% (n = 35) had delirium on admission and 11.6% (n = 23) had new-onset delirium during admission. In regression analysis, older age, impaired cognition and lower functional ability at admission were associated with a significant likelihood of delirium. CONCLUSIONS In this study, almost one-third of older medical inpatients in an acute hospital had delirium during admission. Findings that increasing age, impaired cognition and lower functional ability at admission were associated with increased delirium risk suggest target groups for enhanced delirium detection and prevention strategies. This may improve clinical outcomes.
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Affiliation(s)
- C Dolan
- Sligo Leitrim Mental Health Services, Ballytivnan, Sligo, Ireland
| | - M Mohd Zubir
- Sligo Leitrim Mental Health Services, Ballytivnan, Sligo, Ireland
| | - V Melvin
- Sligo Leitrim Mental Health Services, Ballytivnan, Sligo, Ireland
| | - G McCarthy
- Sligo Leitrim Mental Health Services, Ballytivnan, Sligo, Ireland
- Sligo Medical Academy, NUI Galway, The Mall, Rathquarter, Sligo, Ireland
| | - D Meagher
- Cognitive Impairment Research Group (CIRG), Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - D Adamis
- Sligo Leitrim Mental Health Services, Ballytivnan, Sligo, Ireland
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Al Huraizi AR, Al-Maqbali JS, Al Farsi RS, Al Zeedy K, Al-Saadi T, Al-Hamadani N, Al Alawi AM. Delirium and Its Association with Short- and Long-Term Health Outcomes in Medically Admitted Patients: A Prospective Study. J Clin Med 2023; 12:5346. [PMID: 37629388 PMCID: PMC10455146 DOI: 10.3390/jcm12165346] [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: 06/26/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Delirium is highly prevalent among elderly hospitalized patients in various healthcare settings. This study aimed to assess the impact of delirium on short- and long-term health outcomes. METHODS A prospective cohort included medically ill patients (≥65 years) admitted to a tertiary healthcare facility. Delirium was screened using the 3-Minute Diagnostic confusion assessment method (3D-CAM). RESULTS During hospitalization, 53.8% (n = 153/284) had delirium. Patients with delirium had a longer length of hospital stay (LOS) (7 vs. 5 days; p < 0.01) compared to patients without delirium. Delirium caused a higher frequency of high-dependency unit (HDU) or intensive care unit (ICU) admission (p < 0.01) and an increased incidence of hospital-acquired complications, including infections (p = 0.03), pressure injuries (p = 0.01), and upper gastrointestinal bleeding (p < 0.01). Inpatient all-cause mortality was higher in patients with delirium than those without delirium (16.3% vs. 1.5%; p < 0.01). Patients with delirium had higher rates of 90-day all-cause mortality (25.4% vs. 8.4%; p < 0.01) and 1-year all-cause mortality (35.9% vs. 16%; p < 0.01) compared to patients without delirium. Patients with delirium exhibited shorter survival periods at 90 days and 1 year compared to patients without delirium with a hazard ratio (HR) = 3.41, 95% CI: 1.75-6.66, p < 0.01 and HR = 2.64, 95% CI: 1.59-4.37, p < 0.01, respectively. CONCLUSIONS Delirium is associated with serious short-term and long-term clinical consequences. Early recognition, prevention, and targeted interventions addressing reversible risk factors are crucial. Further research is warranted to explore effective strategies for delirium management in general medical wards.
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Affiliation(s)
- Aisha Ramadhan Al Huraizi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman; (A.R.A.H.); (K.A.Z.); (A.M.A.A.)
| | - Juhaina Salim Al-Maqbali
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat 123, Oman
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Science, Sultan Qaboos University, Muscat 123, Oman
| | - Rajaa Saleh Al Farsi
- Internal Medicine Residency Training Program, Oman Medical Specialty Board, Muscat 130, Oman;
| | - Khalfan Al Zeedy
- Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman; (A.R.A.H.); (K.A.Z.); (A.M.A.A.)
- Internal Medicine Residency Training Program, Oman Medical Specialty Board, Muscat 130, Oman;
| | - Taif Al-Saadi
- College of Medicine, Royal College of Surgeons, D02 YN77 Dublin, Ireland
| | - Noof Al-Hamadani
- College of Medicine, Royal College of Surgeons, D02 YN77 Dublin, Ireland
| | - Abdullah M. Al Alawi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman; (A.R.A.H.); (K.A.Z.); (A.M.A.A.)
- Internal Medicine Residency Training Program, Oman Medical Specialty Board, Muscat 130, Oman;
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Pouw MA, Calf AH, Georg RR, de Rooij SE, Ter Maaten JC, van Munster BC. Diagnostic accuracy of the Dutch version of the 4AT for delirium detection in a mixed patient population and setting. Aging Clin Exp Res 2023:10.1007/s40520-023-02447-2. [PMID: 37285074 PMCID: PMC10363057 DOI: 10.1007/s40520-023-02447-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/17/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Delirium is an acute disturbance in attention, awareness and cognition. Immediate detection in older adults is recommended because delirium is associated with adverse outcomes. The 4 'A's Test (4AT) is a short screening instrument for delirium. The aim of this study is to evaluate diagnostic accuracy of the Dutch version of the screening tool 4AT for delirium detection in different settings. METHODS Prospective observational study conducted in two hospitals in patients aged ≥ 65 years in geriatric wards and the Emergency Department (ED). Each participant underwent two assessments; the index test 4AT, followed by the reference standard for delirium performed by a geriatric care specialist. The reference standard delirium is according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria. RESULTS A total of 71 geriatric inpatients and 49 older ED patients were included. The prevalence of delirium was 11.6% in the acute geriatric ward and 6.1% in the ED. The sensitivity and specificity of the 4AT in the acute geriatric ward were 0.88 and 0.69, respectively. In the ED, the sensitivity and specificity were 0.67 and 0.83, respectively. The area under the receiver operating characteristic curve was 0.80 for the acute geriatric ward setting and 0.74 for the ED setting. CONCLUSION The Dutch version of the 4AT is a reliable screening tool for delirium detection in both acute geriatric wards and ED. Due to its brevity and practicality (i.e., no special training is required to administer the tool), it is useful in clinical practice.
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Affiliation(s)
- Maaike A Pouw
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Agneta H Calf
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Rita R Georg
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Sophia E de Rooij
- Amstelland Hospital, Laan van de Helende Meesters 8, 1186 AM, Amstelveen, The Netherlands
| | - Jan C Ter Maaten
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Barbara C van Munster
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
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Dodsworth BT, Reeve K, Falco L, Hueting T, Sadeghirad B, Mbuagbaw L, Goettel N, Schmutz Gelsomino N. Development and validation of an international preoperative risk assessment model for postoperative delirium. Age Ageing 2023; 52:7192246. [PMID: 37290122 DOI: 10.1093/ageing/afad086] [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: 08/01/2022] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a frequent complication in older adults, characterised by disturbances in attention, awareness and cognition, and associated with prolonged hospitalisation, poor functional recovery, cognitive decline, long-term dementia and increased mortality. Early identification of patients at risk of POD can considerably aid prevention. METHODS We have developed a preoperative POD risk prediction algorithm using data from eight studies identified during a systematic review and providing individual-level data. Ten-fold cross-validation was used for predictor selection and internal validation of the final penalised logistic regression model. The external validation used data from university hospitals in Switzerland and Germany. RESULTS Development included 2,250 surgical (excluding cardiac and intracranial) patients 60 years of age or older, 444 of whom developed POD. The final model included age, body mass index, American Society of Anaesthesiologists (ASA) score, history of delirium, cognitive impairment, medications, optional C-reactive protein (CRP), surgical risk and whether the operation is a laparotomy/thoracotomy. At internal validation, the algorithm had an AUC of 0.80 (95% CI: 0.77-0.82) with CRP and 0.79 (95% CI: 0.77-0.82) without CRP. The external validation consisted of 359 patients, 87 of whom developed POD. The external validation yielded an AUC of 0.74 (95% CI: 0.68-0.80). CONCLUSIONS The algorithm is named PIPRA (Pre-Interventional Preventive Risk Assessment), has European conformity (ce) certification, is available at http://pipra.ch/ and is accepted for clinical use. It can be used to optimise patient care and prioritise interventions for vulnerable patients and presents an effective way to implement POD prevention strategies in clinical practice.
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Affiliation(s)
| | - Kelly Reeve
- Institute of Data Analysis and Process Design, Zurich University of Applied Sciences, Winterthur 8400, Switzerland
| | - Lisa Falco
- Zühlke Engineering AG, Zürcherstrasse 39J, Schlieren 8952, Switzerland
| | - Tom Hueting
- Evidencio, Irenesingel 19, Haaksbergen 7481 GJ, Netherlands
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton ON L8S 4L8, Canada
- Department of Anesthesia, McMaster University, Hamilton ON L8S 4L8, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton ON L8S 4L8, Canada
- Department of Anesthesia, McMaster University, Hamilton ON L8S 4L8, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON L8S 4L8, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé 12117, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town 7600, South Africa
| | - Nicolai Goettel
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville FL 32610, USA
- Department of Clinical Research, University of Basel, Basel 4031, Switzerland
| | - Nayeli Schmutz Gelsomino
- PIPRA AG, Zurich 8005, Switzerland
- Department of Anaesthesia, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
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Lozano-Vicario L, García-Hermoso A, Cedeno-Veloz BA, Fernández-Irigoyen J, Santamaría E, Romero-Ortuno R, Zambom-Ferraresi F, Sáez de Asteasu ML, Muñoz-Vázquez ÁJ, Izquierdo M, Martínez-Velilla N. Biomarkers of delirium risk in older adults: a systematic review and meta-analysis. Front Aging Neurosci 2023; 15:1174644. [PMID: 37251808 PMCID: PMC10213257 DOI: 10.3389/fnagi.2023.1174644] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Delirium is a neuropsychiatric syndrome associated with increased morbidity and mortality in older patients. The aim of this study was to review predictive biomarkers of delirium in older patients to gain insights into the pathophysiology of this syndrome and provide guidance for future studies. Two authors independently and systematically searched MEDLINE, Embase, Cochrane Library, Web of Science and Scopus databases up to August 2021. A total of 32 studies were included. Only 6 studies were eligible for the meta-analysis, pooled results showed a significant increase in some serum biomarkers (C-reactive protein [CRP], tumour necrosis factor alpha [TNF-α] and interleukin-6 [IL-6]) among patients with delirium (odds ratio = 1.88, 95% CI 1.01 to 1.637; I2 = 76.75%). Although current evidence does not favour the use of any particular biomarker, serum CRP, TNF-α, and IL-6 were the most consistent biomarkers of delirium in older patients.
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Affiliation(s)
| | - Antonio García-Hermoso
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | | | - Joaquín Fernández-Irigoyen
- Proteomics Unit, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain
| | - Enrique Santamaría
- Proteomics Unit, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain
| | | | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mikel L. Sáez de Asteasu
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | | | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Nicolás Martínez-Velilla
- Geriatric Unit, Hospital Universitario de Navarra (HUN), Pamplona, Spain
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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Ma R, Zhao J, Li C, Qin Y, Yan J, Wang Y, Yu Z, Zhang Y, Zhao Y, Huang B, Sun S, Ning X. Diagnostic accuracy of the 3-minute diagnostic interview for confusion assessment method-defined delirium in delirium detection: a systematic review and meta-analysis. Age Ageing 2023; 52:afad074. [PMID: 37211364 DOI: 10.1093/ageing/afad074] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Delirium is a common complication clinically and is associated with the poor outcomes, yet it is frequently unrecognised and readily disregarded. Although the 3-minute diagnostic interview for confusion assessment method-defined delirium (3D-CAM) has been used in a variety of care settings, a comprehensive evaluation of its accuracy in all available care settings has not been performed. OBJECTIVE This study aimed to evaluate the diagnostic test accuracy of the 3D-CAM in delirium detection through a systematic review and meta-analysis. METHODS We systematically searched PubMed, EMBASE, the Cochrane Library, Web of Science, CINAHL (EBSCO) and ClinicalTrials.gov published from inception to 10 July 2022. The quality assessment of the diagnostic accuracy studies-2 tool was applied to evaluate methodological quality. A bivariate random effects model was used to pool sensitivity and specificity. RESULTS Seven studies with 1,350 participants and 2,499 assessments were included, which were carried out in general medical wards, intensive care units, internal medical wards, surgical wards, recovery rooms and post-anaesthesia care units. The prevalence of delirium ranged from 9.1% to 25%. The pooled sensitivity and specificity were 0.92 (95% confidence interval [CI] 0.87-0.95) and 0.95 (95% CI 0.92-0.97), respectively. The pooled positive likelihood ratio was 18.6 (95% CI 12.2-28.2), the negative likelihood ratio was 0.09 (95% CI 0.06-0.14) and the diagnostic odds ratio was 211 (95% CI 128-349). Moreover, the area under the curve was 0.97 (95% CI 0.95-0.98). CONCLUSIONS The 3D-CAM has good diagnostic accuracy for delirium detection in different care settings. Further analyses illustrated that it had comparable diagnostic accuracy in older adults and patients with dementia or known baseline cognitive impairment. In conclusion, the 3D-CAM is recommended for clinical delirium detection.
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Affiliation(s)
- Rui Ma
- Department of Geriatrics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jin Zhao
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Cui Li
- Department of Geriatrics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yunlong Qin
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jipeng Yan
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yuwei Wang
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zixian Yu
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yumeng Zhang
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yueru Zhao
- Medicine School of Xi'an Jiaotong University, Xi'an, China
| | - Boyong Huang
- Department of Geriatrics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shiren Sun
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiaoxuan Ning
- Department of Geriatrics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Boucher EL, Gan JM, Rothwell PM, Shepperd S, Pendlebury ST. Prevalence and outcomes of frailty in unplanned hospital admissions: a systematic review and meta-analysis of hospital-wide and general (internal) medicine cohorts. EClinicalMedicine 2023; 59:101947. [PMID: 37138587 PMCID: PMC10149337 DOI: 10.1016/j.eclinm.2023.101947] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Abstract
Background Guidelines recommend routine frailty screening for all hospitalised older adults to inform care decisions, based mainly on studies in elective or speciality-specific settings. However, most hospital bed days are accounted for by acute non-elective admissions, in which the prevalence and prognostic value of frailty might differ, and uptake of screening is limited. We therefore did a systematic review and meta-analysis of frailty prevalence and outcomes in unplanned hospital admissions. Methods We searched MEDLINE, EMBASE and CINAHL up to 31/01/2023 and included observational studies using validated frailty measures in adult hospital-wide or general medicine admissions. Summary data on the prevalence of frailty and associated outcomes, measurement tools, study setting (hospital-wide vs general medicine), and design (prospective vs retrospective) were extracted and risk of bias assessed (modified Joanna Briggs Institute checklists). Unadjusted relative risks (RR; moderate/severe frailty vs no/mild) for mortality (within one year), length of stay (LOS), discharge destination and readmission were calculated and pooled, where appropriate, using random-effects models. PROSPERO CRD42021235663. Findings Among 45 cohorts (median/SD age = 80/5 years; n = 39,041,266 admissions, n = 22 measurement tools) moderate/severe frailty ranged from 14.3% to 79.6% overall (and in the 26 cohorts with low-moderate risk of bias) with considerable heterogeneity between studies (phet < 0.001) preventing pooling of results but with rates <25% in only 3 cohorts. Moderate/severe vs no/mild frailty was associated with increased mortality (n = 19 cohorts; RR range = 1.08-3.70), more consistently among cohorts using clinically administered tools (n = 11; RR range = 1.63-3.70; phet = 0.08; pooled RR = 2.53, 95% CI = 2.15-2.97) vs cohorts using (retrospective) administrative coding data (n = 8; RR range = 1.08-3.02; phet < 0.001). Clinically administered tools also predicted increasing mortality across the full range of frailty severity in each of the six cohorts that allowed ordinal analysis (all p < 0.05). Moderate/severe vs no/mild frailty was also associated with a LOS >8 days (RR range = 2.14-3.04; n = 6) and discharge to a location other than home (RR range = 1.97-2.82; n = 4) but was inconsistently related to 30-day readmission (RR range = 0.83-1.94; n = 12). Associations remained clinically significant after adjustment for age, sex and comorbidity where reported. Interpretation Frailty is common in older patients with acute, non-elective hospital admission and remains predictive of mortality, LOS and discharge home with more severe frailty associated with greater risk, justifying more widespread implementation of screening using clinically administered tools. Funding None.
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Affiliation(s)
- Emily L. Boucher
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Jasmine M. Gan
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Peter M. Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, UK
| | - Sarah T. Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
- NIHR Oxford Biomedical Research Centre and Departments of Acute General (Internal) Medicine and Geratology, Oxford University Hospitals NHS Foundation Trust, UK
- Corresponding author. Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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Cullinan RJ, Richardson SJ, Yarnall AJ, Burn DJ, Allan LM, Lawson RA. Documentation and diagnosis of delirium in Parkinson's disease. Acta Psychiatr Scand 2023; 147:527-535. [PMID: 35771186 PMCID: PMC10952625 DOI: 10.1111/acps.13470] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the accuracy of documentation of the symptoms and diagnosis of delirium in medical notes of inpatients with Parkinson's disease (PD). METHODS The DETERMINE-PD pilot study assessed PD inpatients over 4-months. Delirium prevalence was classified prospectively using a standardized assessment at a single visit on the basis of Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) criteria. Incident delirium was diagnosed retrospectively using detailed clinical vignettes and validated consensus method. Inpatient medical notes and discharge summaries of those with delirium were reviewed for documentation of symptoms, diagnosis and follow-up. RESULTS Forty-four PD patients consented to take part in the study, accounting for 53 admissions. We identified 30 cases (56.6%) of delirium during the participants' stay in hospital. Of those with delirium identified by the research team, delirium symptoms were documented in the clinical notes of 72.3%; 37.9% had a delirium diagnosis documented. Older patients were more likely to have delirium (p = 0.027) and have this diagnosis documented (p = 0.034). Time from documentation of symptoms to diagnosis ranged from <24 h to 7 days (mean 1.6 ± 4.4 days). Hypoactive delirium was significantly less likely to have been identified and formally diagnosed (63% of not documented were hypoactive vs. 37% hyperactive, mixed or unclear, p = 0.016). Only 11.5% of discharge summaries included diagnosis of delirium. CONCLUSION Delirium in PD is common. Documentation of symptoms of delirium was common; however, fails to lead to a documentation of diagnosis in over half of admissions with delirium and was even less commonly communicated in the Primary Care discharge summaries. This highlights the need for increased education about delirium symptomatology and diagnosis in PD.
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Affiliation(s)
- Rachel J. Cullinan
- CNTW NHS TrustNewcastle upon TyneUK
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Sarah J. Richardson
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
- Faculty of Medical Sciences, NIHR Newcastle Biomedical Research CentreNewcastle UniversityNewcastleUK
| | - Alison J. Yarnall
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
- Faculty of Medical Sciences, NIHR Newcastle Biomedical Research CentreNewcastle UniversityNewcastleUK
- Newcastle upon Tyne NHS Foundation TrustNewcastle upon TyneUK
| | - David J. Burn
- Faculty of Medical Sciences, Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Louise M. Allan
- Centre for Research in Ageing and Cognitive HealthUniversity of ExeterExeterUK
| | - Rachael A. Lawson
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
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Welch C, Wilson D, Sayer AA, Witham MD, Jackson TA. Development of a UK core dataset for geriatric medicine research: a position statement and results from a Delphi consensus process. BMC Geriatr 2023; 23:168. [PMID: 36959622 PMCID: PMC10035483 DOI: 10.1186/s12877-023-03805-5] [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: 02/14/2022] [Accepted: 02/07/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND There is lack of standardisation in assessment tools used in geriatric medicine research, which makes pooling of data and cross-study comparisons difficult. METHODS We conducted a modified Delphi process to establish measures to be included within core and extended datasets for geriatric medicine research in the United Kingdom (UK). This included three complete questionnaire rounds, and one consensus meeting. Participants were selected from attendance at the NIHR Newcastle Biomedical Research Centre meeting, May 2019, and academic geriatric medicine e-mailing lists. Literature review was used to develop the initial questionnaire, with all responses then included in the second questionnaire. The third questionnaire used refined options from the second questionnaire with response ranking. RESULTS Ninety-eight responses were obtained across all questionnaire rounds (Initial: 19, Second: 21, Third: 58) from experienced and early career researchers in geriatric medicine. The initial questionnaire included 18 questions with short text responses, including one question for responders to suggest additional items. Twenty-six questions were included in the second questionnaire, with 108 within category options. The third questionnaire included three ranking, seven final agreement, and four binary option questions. Results were discussed at the consensus meeting. In our position statement, the final consensus dataset includes six core domains: demographics (age, gender, ethnicity, socioeconomic status), specified morbidities, functional ability (Barthel and/or Nottingham Extended Activities of Daily Living), Clinical Frailty Scale (CFS), cognition, and patient-reported outcome measures (dependent on research question). We also propose how additional variables should be measured within an extended dataset. CONCLUSIONS Our core and extended datasets represent current consensus opinion of academic geriatric medicine clinicians across the UK. We consider the development and further use of these datasets will strengthen collaboration between researchers and academic institutions.
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Affiliation(s)
- Carly Welch
- Medical Research Council - Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, B15 2TT, Birmingham, UK.
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, B15 2TT, Birmingham, UK.
- University Hospitals Birmingham NHS Foundation Trust, B15 2GW, Birmingham, UK.
- Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge, London, SE1 7EH, UK.
| | - Daisy Wilson
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, B15 2TT, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, B15 2GW, Birmingham, UK
| | - Avan A Sayer
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Thomas A Jackson
- Medical Research Council - Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, B15 2TT, Birmingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, B15 2TT, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, B15 2GW, Birmingham, UK
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The Potential of the Remote Monitoring Digital Solutions to Sustain the Mental and Emotional Health of the Elderly during and Post COVID-19 Crisis in Romania. Healthcare (Basel) 2023; 11:healthcare11040608. [PMID: 36833143 PMCID: PMC9957364 DOI: 10.3390/healthcare11040608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
The COVID-19 pandemic amplified the elderly's aging-related dysfunctionalities and vulnerabilities. Research surveys, aimed at evaluating the socio-physical-emotional state of the elderly and obtaining data on their access to medical services and information media services during the pandemic, were carried out on Romanian respondents aged 65+. Identification and mitigation of the risk of emotional and mental long-term decline of the elderly after SARS-CoV-2 infection, based on the implementation of a specific procedure, can be performed through Remote Monitoring Digital Solutions (RMDSs). The aim of this paper is to propose a procedure for the identification and mitigation of the risk of emotional and mental long-term decline of the elderly after SARS-CoV-2 infection that comprises RMDS. The importance of using the knowledge obtained by COVID-19-related surveys corroborating the necessity of including personalized RMDS in the procedure is highlighted. The Non-invasive Monitoring System and Health Assessment of the Elderly in a Smart Environment (RO-SmartAgeing) is an RMDS designed to address the improved preventative and proactive support for diminishing this risk and to provide suitable assistance for the elderly through a safe and efficient smart environment. Its comprehensive functionalities targeted supporting primary healthcare assistance, specific medical conditions-as the mental and emotional disorders post-SARS-CoV-2 infection-and enlarged access to aging-related information, together with customizable features, illustrated the match with the requirements included in the proposed procedure.
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Ibitoye SE, Braude P, Carter B, Rickard F, Deakin H, Martin R, Thompson J, Walton B, Shipway D. Geriatric Assessment Is Associated With Reduced Mortality at 1 Year for Older Adults Admitted to a Major Trauma Center: A Prospective Observational Study. Ann Surg 2023; 277:343-349. [PMID: 36745762 DOI: 10.1097/sla.0000000000005092] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the effect of geriatrician review on 1-year mortality in older adults admitted with trauma. BACKGROUND Comprehensive geriatric assessment (CGA) has been associated with improved outcomes in older adults with hip fracture, but has not been evaluated in a broader trauma population. METHODS Trauma patients aged ≥ 65years admitted to an English Major Trauma Centre between November 2018 and September 2019 were included. Patients were divided into 3 cohorts: no geriatric assessment, reactive geriatric assessment, and proactive CGA. The primary outcome was time to mortality, secondary outcomes were time to discharge and frequency of complications. Analyses were adjusted for factors known to be associated with outcomes including age, frailty, injury severity, and complications. RESULTS Five hundred eighty-five patients were included (no geriatric assessment = 125; reactive geriatric assessment = 134; proactive CGA = 326): median age was 81 years (IQR 74-88); 326 (55.7%) were women; 297 (50.8%) were living with frailty (Clinical Frailty Scale ≥5). Median Injury Severity Score was 13 (IQR9-25). At 1-year follow-up, 147 (25.1%) patients had died. In multivariate analysis, both types of geriatric assessment were associated with reduced mortality [reactive aHR = 0.31, 95% CI 0.18-0.53; proactive adjusted hazard ratio (aHR) = 0.41, 95% CI 0.26-0.64]. There was no association between either type of geriatric assessment and length of stay (reactive aHR = 0.84, 95% CI 0.62-1.15; proactive aHR = 0.80, 95% CI 0.63-1.02). CONCLUSIONS Geriatrician assessment is associated with reduced mortality in older adults admitted following trauma. Further research should focus on defining optimal models of geriatrician intervention.
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Affiliation(s)
- Sarah E Ibitoye
- North Bristol NHS Trust and CLARITY (Collaborative Ageing Research) group, Bristol, UK
| | - Philip Braude
- North Bristol NHS Trust and CLARITY (Collaborative Ageing Research) group, Bristol, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Frances Rickard
- North Bristol NHS Trust and CLARITY (Collaborative Ageing Research) group, Bristol, UK
| | - Helen Deakin
- North Bristol NHS Trust and CLARITY (Collaborative Ageing Research) group, Bristol, UK
| | - Rebecca Martin
- North Bristol NHS Trust and CLARITY (Collaborative Ageing Research) group, Bristol, UK
| | - Julian Thompson
- North Bristol NHS Trust and CLARITY (Collaborative Ageing Research) group, Bristol, UK
| | - Benjamin Walton
- North Bristol NHS Trust and CLARITY (Collaborative Ageing Research) group, Bristol, UK
| | - David Shipway
- North Bristol NHS Trust and CLARITY (Collaborative Ageing Research) group, Bristol, UK.,University of Bristol, Bristol, UK
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Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study. Eur Geriatr Med 2023. [PMID: 36696045 PMCID: PMC10113325 DOI: 10.1007/s41999-022-00737-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. METHODS Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. RESULTS The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8-4.6) in CFS 4 vs 1-3; OR 12.4 (6.2-24.5) in CFS 8 vs 1-3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3-1.9) in CFS 4 compared to 0.2 (0.1-0.7) in CFS 8). These risks were both independent of age and dementia. CONCLUSION We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes.
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Poikajärvi S, Rauta S, Salanterä S, Junttila K. Delirium in a surgical context from a nursing perspective: A hybrid concept analysis. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100103. [PMID: 38745600 PMCID: PMC11080469 DOI: 10.1016/j.ijnsa.2022.100103] [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: 12/10/2021] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 10/14/2022] Open
Abstract
Background The term delirium has been defined in medical diagnosis criteria as a multidimensional disorder, and the term acute confusion is included in nursing classifications. Delirium can be a serious complication assessed in a patient after a surgical procedure. Still, the patient's delirium frequently remains unrecognised. Care of patients with delirium after surgical procedure is complex, and it challenges nursing expertise. From the nurses' viewpoint, delirium is associated with ambiguity of concepts and lack of knowledge. Therefore, reseach on how nurses perceive patients with delirium in a surgical context is needed. Objective The aim of this study was to describe the concepts of delirium and acute confusion, as well as the associated dimensions, in adult patients in a surgical context from the nursing perspective. Design The study used Schwartz and Barcott's hybrid concept analysis with theoretical, fieldwork, and final analytical phases. Settings Surgical wards, surgical intensive care units, and post-anaesthesia care units. Data sources A systematic literature search was performed through Pubmed (Medline), Cinahl, PsycInfo, and Embase. Participants Registered nurses and licensed practical nurses (n = 105) participated in the fieldwork phase. Methods In the theoretical phase, the concepts' working definitions were formulated based on a systematic literature search with the year limitations from 2000 until February 2021. At the fieldwork phase, the nurses' descriptions of patients with delirium were analysed using the deductive content analysis method. At the final analytical phase, findings were combined and reported. Results The concepts of delirium, subsyndromal delirium, and acute confusion are well defined in the literature. From the perspective of the nurses in the study, concepts were seen as a continuum not as individual diagnoses. Nurses described the continuum of delirium as a process with acute onset, duration, and recovery with the associated dimensions of symptoms, symptom severity, risk factors, and early signs. The acute phase of delirium was emphasised, and preoperative or prolonged disturbance did not seem to be relevant in the surgical care context. Patients' compliance with care may be decreased with the continuum of delirium, which might challenge both patients' recovery from surgery and the quality of nursing care. Conclusions In clinical practice the nurses used term confusion inaccurately. The term acute confusion might be used when illustrating an early stage of delirium. Nurses could benefit from further education where the theoretical knowledge is combined with the clinical practice. The discussion about the delirium, which covers the time both before surgery and after the acute phase should be increased.
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Affiliation(s)
- Satu Poikajärvi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Department of Perioperative, Intensive Care, and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Satu Rauta
- Department of Perioperative, Intensive Care, and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sanna Salanterä
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Kristiina Junttila
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Nursing Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Denk A, Müller K, Schlosser S, Heissner K, Gülow K, Müller M, Schmid S. Liver diseases as a novel risk factor for delirium in the ICU-Delirium and hepatic encephalopathy are two distinct entities. PLoS One 2022; 17:e0276914. [PMID: 36413529 PMCID: PMC9681112 DOI: 10.1371/journal.pone.0276914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/15/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Delirium prevalence is high in critical care settings. We examined the incidence, risk factors, and outcome of delirium in a medical intensive care unit (MICU) with a particular focus on liver diseases. We analyzed this patient population in terms of delirium risk prediction and differentiation between delirium and hepatic encephalopathy. METHODS We conducted an observational study and included 164 consecutive patients admitted to an MICU of a university hospital. Patients were assessed for delirium using the Confusion Assessment Method for ICUs and the Richmond Agitation-Sedation Scale (RASS). On admission and at the onset of delirium Sequential Organ Failure Assessment (SOFA) score was determined. A population of patients with liver disease was compared to a population with gastrointestinal diseases. In the population with liver diseases, hepatic encephalopathy was graded according to the West Haven classification. We analyzed the incidence, subtype, predisposing, precipitating, and health-care setting-related factors, treatment, outcome of delirium and the association between delirium and hepatic encephalopathy in patients with liver diseases. RESULTS The incidence of delirium was 32.5% (n = 53). Univariable binary regression analyses adjusted by the Holm-Bonferroni method showed that the development of delirium was significantly determined by 10 risk factors: Alcohol abuse (p = 0.016), severity of disease (Simplified Acute Physiology Score (SAPS) II, p = 0.016), liver diseases (p = 0.030) and sepsis (p = 0.016) compared to the control group (gastrointestinal (GI) diseases and others), increased sodium (p = 0.016), creatinine (p = 0.030), urea (p = 0.032) or bilirubin (p = 0.042), decreased hemoglobin (p = 0.016), and mechanical ventilation (p = 0.016). Of note, we identified liver diseases as a novel and relevant risk factor for delirium. Hepatic encephalopathy was not a risk factor for delirium. Delirium and hepatic encephalopathy are both life-threatening but clearly distinct conditions. The median SOFA score for patients with delirium at delirium onset was significantly higher than the SOFA score of all patients at admission (p = 0.008). Patients with delirium had five times longer ICU stays (p = 0.004) and three times higher in-hospital mortality (p = 0.036). Patients with delirium were five times more likely to be transferred to an intensive medical rehabilitation unit for post-intensive care (p = 0.020). Treatment costs per case were more than five times higher in patients with delirium than in patients without delirium (p = 0.004). CONCLUSIONS The 10 risk factors identified in this study should be assessed upon admission to ICU for effective detection, prevention, and treatment of delirium. Liver diseases are a novel risk factor for delirium with a level of significance comparable to sepsis as an established risk factor. Of note, in patients with liver diseases delirium and hepatic encephalopathy should be recognized as distinct entities to initiate appropriate treatment. Therefore, we propose a new algorithm for efficient diagnosis, characterization, and treatment of altered mental status in the ICU. This algorithm integrates the 10 risk factor prediction-model for delirium and prompts grading of the severity of hepatic encephalopathy using the West Haven classification if liver disease is present or newly diagnosed.
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Affiliation(s)
- Alexander Denk
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital Regensburg, Regensburg, Germany
| | - Karolina Müller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Sophie Schlosser
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital Regensburg, Regensburg, Germany
| | - Klaus Heissner
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital Regensburg, Regensburg, Germany
| | - Karsten Gülow
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital Regensburg, Regensburg, Germany
| | - Martina Müller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital Regensburg, Regensburg, Germany
| | - Stephan Schmid
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital Regensburg, Regensburg, Germany
- * E-mail:
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Cechinel C, Lenardt MH, Rodrigues JAM, Binotto MA, Aristides MM, Kraus R. Frailty and delirium in hospitalized older adults: A systematic review with meta-analysis. Rev Lat Am Enfermagem 2022; 30:e3687. [PMID: 36287400 PMCID: PMC9580989 DOI: 10.1590/1518-8345.6120.3687] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/17/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to estimate the prevalence and synthesize diverse evidence about the relationship between frailty and delirium in hospitalized older adults. METHOD a systematic review with meta-analysis in which observational studies conducted with older adults about frailty, delirium and hospitalization, were selected without time of language restrictions. The search was conducted in the MEDLINE, EMBASE, CINAHL, Scopus, Web of Science and CENTRAL databases during August 2021. The precepts set forth by the Joanna Briggs Institute (JBI) - Evidence Synthesis Groups were followed. The meta-analysis model estimated the relative risk corresponding to the prevalence of frailty and delirium. The inverse variance method for proportions was used to estimate the prevalence values and relative risks for binary outcomes. RESULTS initially, 1,244 articles were identified, of which 26 were included in the meta-analysis (n=13,502 participants), with 34% prevalence of frailty (95% CI:0.26-0.42; I 2=99%; t 2=0.7618, p=0) and 21% for delirium (95% CI:0.17-0,25; I 2=95%; t 2=0.3454, p<0.01). The risk for hospitalized older adults to develop delirium was 66% (RR: 1.66; 95% CI:1.23-2.22; I2=92%; t2=0.4154; p<0.01). CONCLUSION 34% prevalence of frailty and 21% of delirium in hospitalized older adults, with frailty being an independent risk factor for developing delirium, with an increased chance of 66% when compared to non-frail individuals.
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Affiliation(s)
- Clovis Cechinel
- Universidade Federal do Paraná, Curitiba, PR, Brazil.,Secretaria Municipal de Saúde, Hospital Municipal do Idoso Zilda Arns, Curitiba, PR, Brazil
| | | | | | - Maria Angélica Binotto
- Universidade Estadual do Centro-Oeste, Departamento de Educação Fisica, Irati, PR, Brazil
| | | | - Rosane Kraus
- Universidade Federal do Paraná, Curitiba, PR, Brazil., Fundação Estatal de Atencão a Saúde, Hospital Municipal do Idoso Zilda Arns, Curitiba, PR, Brazil
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Ghezzi ES, Greaves D, Boord MS, Davis D, Knayfati S, Astley JM, Sharman RLS, Goodwin SI, Keage HAD. How do predisposing factors differ between delirium motor subtypes? A systematic review and meta-analysis. Age Ageing 2022; 51:afac200. [PMID: 36153750 PMCID: PMC9509667 DOI: 10.1093/ageing/afac200] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/05/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Delirium is a common neurocognitive disorder in hospitalised older adults with vast negative consequences. The predominant method of subtyping delirium is by motor activity profile into hypoactive, hyperactive and mixed groups. OBJECTIVE This systematic review and meta-analysis investigated how predisposing factors differ between delirium motor subtypes. METHODS Databases (Medline, PsycINFO, Embase) were systematically searched for studies reporting predisposing factors (prior to delirium) for delirium motor subtypes. A total of 61 studies met inclusion criteria (N = 14,407, mean age 73.63 years). Random-effects meta-analyses synthesised differences between delirium motor subtypes relative to 22 factors. RESULTS Hypoactive cases were older, had poorer cognition and higher physical risk scores than hyperactive cases and were more likely to be women, living in care homes, taking more medications, with worse functional performance and history of cerebrovascular disease than all remaining subtypes. Hyperactive cases were younger than hypoactive and mixed subtypes and were more likely to be men, with better cognition and lower physical risk scores than all other subtypes. Those with no motor subtype (unable to be classified) were more likely to be women and have better functional performance. Effect sizes were small. CONCLUSIONS Important differences in those who develop motor subtypes of delirium were shown prior to delirium occurrence. We provide robust quantitative evidence for a common clinical assumption that indices of frailty (institutional living, cognitive and functional impairment) are seen more in hypoactive patients. Motor subtypes should be measured across delirium research. Motor subtyping has great potential to improve the clinical risk assessment and management of delirium.
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Affiliation(s)
- Erica S Ghezzi
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, Australia
| | - Danielle Greaves
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, Australia
| | - Monique S Boord
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, Australia
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing Unit at UCL, London, UK
| | - Sara Knayfati
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, Australia
| | - Jack M Astley
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, Australia
| | - Rhianna L S Sharman
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, Australia
| | - Stephanie I Goodwin
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, Australia
| | - Hannah A D Keage
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, Australia
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Koca M, Öztürk Y, Boğa İ, Bürkük S, Eşme M, Akyürek Y, Şimşek S, Aydın DD, Çiçek F, Karabulut E, Halil M, Cankurtaran M, Tanrıöver MD, Doğu BB. A Quality Improvement Study on Delirium Awareness Day: In Pursuit of Missed Delirium Diagnoses. J Gerontol Nurs 2022; 48:43-51. [PMID: 35914081 DOI: 10.3928/00989134-20220630-03] [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: 11/20/2022]
Abstract
The current study aimed to screen for delirium in hospitalized older adults and assess the validity of the Turkish version of the 4A's Test (4AT-TR) as a feasible tool to integrate in routine patient care. The point prevalence of delirium according to clinical evaluation in routine practice was detected among all patients aged ≥60 years in 12 pilot wards. Delirium screening was then conducted by two arms: (a) nurses using the 4AT-TR and (b) geriatricians according to Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria. Prevalence of delirium according to clinical impression was 3.3% (n = 4), whereas prevalence was 12.4% (n = 17) according to DSM-5 criteria and 13.8% (n = 17) according to the 4AT-TR. The 4AT-TR performed by nurses had a sensitivity of 66.6% and specificity of 93.5%. Area under the receiver operating characteristic curve for delirium diagnosis was 0.819 (p < 0.001). Most delirium cases remain undetected unless a routine and formal delirium assessment is integrated in hospital care of high-risk patients. The 4AT-TR performed by nurses seems to be a valid tool for determining delirium in hospitalized older adults. [Journal of Gerontological Nursing, 48(8), 43-51.].
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Callea A, Conti G, Fossati B, Carassale L, Zagaria M, Caporotundo S, Ziglioli E, Brunetti V, Della Marca G, Rollo E. Delirium in hospitalized patients with COVID-19 pneumonia: a prospective, cross-sectional, cohort study. Intern Emerg Med 2022; 17:1445-1452. [PMID: 35084645 PMCID: PMC8793095 DOI: 10.1007/s11739-022-02934-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/15/2022] [Indexed: 12/15/2022]
Abstract
Delirium is an acute confusional state characterized by altered level of consciousness and attention. Coronavirus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), can manifest itself with this neuropsychiatric disorder. The endpoints of our study were: the frequency of delirium in subjects with COVID-19 pneumonia; the risk factors that predispose to this condition; and the impact of delirium on mortality. Subjects were consecutively enrolled in a Geriatric Unit from January 5th to March 5th, 2021. Inclusion criteria were: diagnosis of SARS-CoV-2 infection, a radiologically documented pneumonia, and the ability of providing informed consent. Exclusion criteria were: absence of radiological evidence of pneumonia, sepsis, and the need of intensive care unit treatment. All subjects were evaluated by means of Richmond Agitation Sedation Scale (RASS) and Confusion Assessment Method-Intensive Care Unit (CAM-ICU) at least twice per day. In the study cohort (n = 71), twenty patients (28.2%) had delirium. Delirium was present on admission in 11.3%, and occurred during hospitalization in 19.0%. Compared to patients without delirium, patients who developed this neuropsychiatric disorder had a higher mortality rate (35% vs 5.9%) and an increased average hospital length of stay (21 days vs 17 days). In the multivariate analysis delirium was associated with frailty (OR = 2.81; CI = 1.4-5.8) and helmet ventilation (OR = 141.05; CI = 4.3-4663.9). Delirium was an independent predictor of mortality. Nearly a third of subjects (28.2%) had delirium during hospitalization for COVID-19. This finding supports the notion that delirium is a common complication of SARS-CoV2 infection. Since delirium is associated with longer hospital stay, and it is an independent marker of increased mortality, clinicians should assess and prevent it.
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Affiliation(s)
- Antonio Callea
- Department of Neurology, ASST Nord Milano, Ospedale Bassini, Via Massimo Gorki, 50, 20092, Milan, Cinisello Balsamo, Italy.
| | - Giancarlo Conti
- Department of Neurology, ASST Nord Milano, Ospedale Bassini, Via Massimo Gorki, 50, 20092, Milan, Cinisello Balsamo, Italy
| | - Barbara Fossati
- Department of Neurology, ASST Nord Milano, Ospedale Bassini, Via Massimo Gorki, 50, 20092, Milan, Cinisello Balsamo, Italy
| | - Laura Carassale
- Department of Geriatrics, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo, Milan, Italy
| | - Mariapia Zagaria
- Department of Geriatrics, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo, Milan, Italy
| | - Silvia Caporotundo
- Department of Geriatrics, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo, Milan, Italy
| | - Eleonora Ziglioli
- Department of Geriatrics, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo, Milan, Italy
| | - Valerio Brunetti
- Dipartimento Scienze Dell'Invecchiamento, Neurologiche, Ortopediche E Della Testa-Collo, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Della Marca
- Dipartimento Scienze Dell'Invecchiamento, Neurologiche, Ortopediche E Della Testa-Collo, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eleonora Rollo
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
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Baxter CT, Offord NJ. Frailty on the acute medical take. Clin Med (Lond) 2022; 22:298-301. [PMID: 35882496 DOI: 10.7861/clinmed.2022-0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Frailty is a prevalent condition in urgent care settings associated with an increased risk of adverse events. Frailty commonly presents on the acute medical take in the form of geriatric syndromes, which include falls, delirium and immobility. Comprehensive geriatric assessment is the evidence-based holistic approach to assessing and managing people with frailty. This multidimensional and interdisciplinary process is generally specialist led, however, acute medical teams can make important contributions through early identification and grading of frailty, and proactive management of geriatric syndromes.
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Affiliation(s)
- Conal T Baxter
- Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK
| | - Natalie J Offord
- Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK
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Sidoli C, Zambon A, Tassistro E, Rossi E, Mossello E, Inzitari M, Cherubini A, Marengoni A, Morandi A, Bellelli G, Tarasconi A, Sella M, Paternò G, Faggian G, Lucarelli C, De Grazia N, Alberto C, Porcella L, Nardiello I, Chimenti E, Zeni M, Romairone E, Minaglia C, Ceccotti C, Guerra G, Mantovani G, Monacelli F, Minaglia C, Candiani T, Santolini F, Minaglia C, Rosso M, Bono V, Sibilla S, Dal Santo P, Ceci M, Barone P, Schirinzi T, Formenti A, Nastasi G, Isaia G, Gonella D, Battuello A, Casson S, Calvani D, Boni F, Ciaccio A, Rosa R, Sanna G, Manfredini S, Cortese L, Rizzo M, Prestano R, Greco A, Lauriola M, Gelosa G, Piras V, Arena M, Cosenza D, Bellomo A, LaMontagna M, Gabbani L, Lambertucci L, Perego S, Parati G, Basile G, Gallina V, Pilone G, Giudice C, Pietrogrande L, Mosca M, Corazzin I, Rossi P, Nunziata V, D’Amico F, Grippa A, Giardini S, Barucci R, Cossu A, Fiorin L, Arena M, Distefano M, Lunardelli M, Brunori M, Ruffini I, Abraham E, Varutti A, Fabbro E, Catalano A, Martino G, Leotta D, Marchet A, Dell’Aquila G, Scrimieri A, Davoli M, Casella M, Cartei A, Polidori G, Basile G, Brischetto D, Motta S, Saponara R, Perrone P, Russo G, Del D, Car C, Pirina T, Franzoni S, Cotroneo A, Ghiggia F, Volpi G, Menichetti C, Bo M, Panico A, Calogero P, Corvalli G, Mauri M, Lupia E, Manfredini R, Fabbian F, March A, Pedrotti M, Veronesi M, Strocchi E, Borghi C, Bianchetti A, Crucitti A, DiFrancesco V, Fontana G, Geriatria A, Bonanni L, Barbone F, Serrati C, Ballardini G, Simoncelli M, Ceschia G, Scarpa C, Brugiolo R, Fusco S, Ciarambino T, Biagini C, Tonon E, Porta M, Venuti D, DelSette M, Poeta M, Barbagallo G, Trovato G, Delitala A, Arosio P, Reggiani F, Zuliani G, Ortolani B, Mussio E, Girardi A, Coin A, Ruotolo G, Castagna A, Masina M, Cimino R, Pinciaroli A, Tripodi G, Cassadonte F, Vatrano M, Scaglione L, Fogliacco P, Muzzuilini C, Romano F, Padovani A, Rozzini L, Cagnin A, Fragiacomo F, Desideri G, Liberatore E, Bruni A, Orsitto G, Franco M, Bonfrate L, Bonetto M, Pizio N, Magnani G, Cecchetti G, Longo A, Bubba V, Marinan L, Cotelli M, Turla M, Brunori M, Sessa M, Abruzzi L, Castoldi G, LoVetere D, Musacchio C, Novello M, Cavarape A, Bini A, Leonardi A, Seneci F, Grimaldi W, Seneci F, Fimognari F, Bambar V, Saitta A, Corica F, Braga M, Servi, Ettorre E, Camellini Bellelli CG, Annoni G, Marengoni A, Bruni A, Crescenzo A, Noro G, Turco R, Ponzetto M, Giuseppe L, Mazzei B, Maiuri G, Costaggiu D, Damato R, Fabbro E, Formilan M, Patrizia G, Santuar L, Gallucci M, Minaglia C, Paragona M, Bini P, Modica D, Abati C, Clerici M, Barbera I, NigroImperiale F, Manni A, Votino C, Castiglioni C, Di M, Degl’Innocenti M, Moscatelli G, Guerini S, Casini C, Dini D, DeNotariis S, Bonometti F, Paolillo C, Riccardi A, Tiozzo A, SamySalamaFahmy A, Riccardi A, Paolillo C, DiBari M, Vanni S, Scarpa A, Zara D, Ranieri P, Alessandro M, Calogero P, Corvalli G, Di F, Pezzoni D, Platto C, D’Ambrosio V, Ivaldi C, Milia P, DeSalvo F, Solaro C, Strazzacappa M, Bo M, Panico A, Cazzadori M, Bonetto M, Grasso M, Troisi E, Magnani G, Cecchetti G, Guerini V, Bernardini B, Corsini C, Boffelli S, Filippi A, Delpin K, Faraci B, Bertoletti E, Vannucci M, Crippa P, Malighetti A, Caltagirone C, DiSant S, Bettini D, Maltese F, Formilan M, Abruzzese G, Minaglia C, Cosimo D, Azzini M, Cazzadori M, Colombo M, Procino G, Fascendini S, Barocco F, Del P, D’Amico F, Grippa A, Mazzone A, Cottino M, Vezzadini G, Avanzi S, Brambilla C, Orini S, Sgrilli F, Mello A, Lombardi Muti LE, Dijk B, Fenu S, Pes C, Gareri P, Castagna A, Passamonte M, Rigo R, Locusta L, Caser L, Rosso G, Cesarini S, Cozzi R, Santini C, Carbone P, Cazzaniga I, Lovati R, Cantoni A, Ranzani P, Barra D, Pompilio G, Dimori S, Cernesi S, Riccò C, Piazzolla F, Capittini E, Rota C, Gottardi F, Merla L, Barelli A, Millul A, De G, Morrone G, Bigolari M, Minaglia C, Macchi M, Zambon F, D’Amico F, D’Amico F, Pizzorni C, DiCasaleto G, Menculini G, Marcacci M, Catanese G, Sprini D, DiCasalet T, Bocci M, Borga S, Caironi P, Cat C, Cingolani E, Avalli L, Greco G, Citerio G, Gandini L, Cornara G, Lerda R, Brazzi L, Simeone F, Caciorgna M, Alampi D, Francesconi S, Beck E, Antonini B, Vettoretto K, Meggiolaro M, Garofalo E, Bruni A, Notaro S, Varutti R, Bassi F, Mistraletti G, Marino A, Rona R, Rondelli E, Riva I, Cortegiani A, Pistidda L, D’Andrea R, Querci L, Gnesin P, Todeschini M, Lugano M, Castelli G, Ortolani M, Cotoia A, Maggiore S, DiTizio L, Graziani R, Testa I, Ferretti E, Castioni C, Lombardi F, Caserta R, Pasqua M, Simoncini S, Baccarini F, Rispoli M, Grossi F, Cancelliere L, Carnelli M, Puccini F, Biancofiore G, Siniscalchi A, Laici C, Mossello E, Torrini M, Pasetti G, Palmese S, Oggioni R, Mangani V, Pini S, Martelli M, Rigo E, Zuccalà F, Cherri A, Spina R, Calamai I, Petrucci N, Caicedo A, Ferri F, Gritti P, Brienza N, Fonnesu R, Dessena M, Fullin G, Saggioro D. Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study. Aging Clin Exp Res 2022; 34:1827-1835. [PMID: 35396698 DOI: 10.1007/s40520-022-02099-8] [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: 01/17/2022] [Accepted: 02/16/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation. AIM We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project". METHODS We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale. RESULTS Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17-1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08-2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62-2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10-1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02-1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68-3.36, p value < 0.0001). CONCLUSION This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.
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Welch C, Greig C, Majid Z, Masud T, Moorey H, Pinkney T, Jackson T. The feasibility of conducting acute sarcopenia research in hospitalised older patients: a prospective cohort study. Eur Geriatr Med 2022; 13:463-473. [PMID: 34608617 PMCID: PMC8490139 DOI: 10.1007/s41999-021-00565-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/17/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To assess feasibility of conducting acute sarcopenia research in complex populations of hospitalised older adults. METHODS Patients ≥ 70 years old were recruited to three cohorts: elective colorectal surgery, emergency (abdominal) surgery, medical patients with infections. Participants were recruited to the elective cohort in preoperative assessment clinic, and acutely admitted participants from surgical and medical wards at the Queen Elizabeth Hospital Birmingham. Serial measures of muscle quantity (ultrasound quadriceps, bioelectrical impedance analysis), muscle function (hand grip strength, physical performance), and questionnaires (mini-nutritional assessment, physical function) were performed at baseline, within 7 (± 2) days of admission/surgery, and 13 (± 1) weeks post-admission/surgery. Feasibility outcomes were assessed across timepoints including recruitment and drop-out rates, and procedure completion rates. RESULTS Eighty-one participants were recruited (mean age 79, 38.3% females). Recruitment rates were higher in elective (75%, 24/32) compared to emergency surgery (37.2%, 16/43), and medical participants (45.1%, 41/91; p = 0.003). Drop-out rates varied from 8.3 to 19.5% at 7 days, and 12.5-43.9% at 13 weeks. Age and gender did not differ between patients assessed for eligibility, approached, or recruited. Completion rates were highest for ultrasound quadriceps (98.8%, 80/81 across all groups at baseline). Gait speed completion rates were lower in medical (70.7%, 29/41) compared to elective participants (100%, 24/24) at baseline. CONCLUSION Higher participation refusal and drop-out rates should be expected for research involving recruitment of participants from the acute setting. Assessment of muscle quantity/quality through ultrasound is recommended in early-stage trials in the acute setting, where completion rates of physical performance testing are expected to be lower.
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Affiliation(s)
- Carly Welch
- Medical Research Council (MRC)-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham and Nottingham, UK.
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham and Nottingham, B152TT, UK.
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK.
| | - Carolyn Greig
- Medical Research Council (MRC)-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham and Nottingham, UK
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, B152TT, UK
- Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Zeinab Majid
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham and Nottingham, B152TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK
| | - Tahir Masud
- Medical Research Council (MRC)-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham and Nottingham, UK
- University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Hannah Moorey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, B152TT, UK
| | - Thomas Pinkney
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK
- Academic Department of Surgery, University of Birmingham, Birmingham, B152TT, UK
| | - Thomas Jackson
- Medical Research Council (MRC)-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham and Nottingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham and Nottingham, B152TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK
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Knight T, Lasserson D. Hospital at home for acute medical illness: The 21st century acute medical unit for a changing population. J Intern Med 2022; 291:438-457. [PMID: 34816527 DOI: 10.1111/joim.13394] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Recent trends across Europe show a year-on-year increase in the number of patients with acute medical illnesses presenting to hospitals, yet there are no plans for a substantial expansion in acute hospital infrastructure or staffing to address demand. Strategies to meet increasing demand need to consider the fact that there is limited capacity in acute hospitals and focus on new care models in both hospital and community settings. Increasing the efficiency of acute hospital provision by reducing the length of stay entails supporting acute ambulatory care, where patients receive daily acute care interventions but do not stay overnight in the hospitals. This approach may entail daily transfer between home and an acute setting for ongoing treatment, which is unsuitable for some patients living with frailty. Acute hospital at home (HaH) is a care model which, thanks to advances in point of care diagnostic capability, can provide a credible model of acute medical assessment and treatment without the need for hospital transfer. Investment and training to support scaling up of HaH are key strategic aims for integrated healthcare systems.
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Affiliation(s)
- Thomas Knight
- Department of Acute Medicine, Sandwell and West Birmingham Hospitals NHS Foundation Trust, Birmingham, UK
| | - Daniel Lasserson
- Acute Hospital at Home, Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Richardson S, Murray J, Davis D, Stephan BCM, Robinson L, Brayne C, Barnes L, Parker S, Sayer AA, Dodds RM, Allan L. Delirium and Delirium Severity Predict the Trajectory of the Hierarchical Assessment of Balance and Mobility in Hospitalized Older People: Findings From the DECIDE Study. J Gerontol A Biol Sci Med Sci 2022; 77:531-535. [PMID: 35239950 PMCID: PMC8893191 DOI: 10.1093/gerona/glab081] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Delirium is common, distressing, and associated with poor outcomes. Despite this, delirium remains poorly recognized, resulting in worse outcomes. There is an urgent need for methods to objectively assess for delirium. Physical function has been proposed as a potential surrogate marker, but few studies have monitored physical function in the context of delirium. We examined if trajectories of physical function are affected by the presence and severity of delirium in a representative sample of hospitalized participants older than 65 years. METHOD During hospital admissions in 2016, we assessed participants from the Delirium and Cognitive Impact in Dementia study daily for delirium and physical function, using the Hierarchical Assessment of Balance and Mobility (HABAM). We used linear mixed models to assess the effect of delirium and delirium severity during admission on HABAM trajectory. RESULTS Of 178 participants, 58 experienced delirium during admission. Median HABAM scores in those with delirium were significantly higher (indicating worse mobility) than those without delirium. Modeling HABAM trajectories, HABAM scores at first assessment were worse in those with delirium than those without, by 0.76 (95% CI: 0.49-1.04) points. Participants with severe delirium experienced a much greater perturbance in their physical function, with an even lower value at first assessment and slower subsequent improvement. CONCLUSIONS Physical function was worse in those with delirium compared to without. This supports the assertion that motor disturbances are a core feature of delirium and monitoring physical function, using a tool such as the HABAM, may have clinical utility as a surrogate marker for delirium and its resolution.
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Affiliation(s)
- Sarah Richardson
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - James Murray
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Blossom C M Stephan
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, Nottingham University, UK
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, UK
| | - Linda Barnes
- Cambridge Public Health, University of Cambridge, UK
| | - Stuart Parker
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Avan A Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Richard M Dodds
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Louise Allan
- Centre for Research in Ageing and Cognitive Health, University of Exeter, UK
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Anand A, Cheng M, Ibitoye T, Maclullich AMJ, Vardy ERLC. Positive scores on the 4AT delirium assessment tool at hospital admission are linked to mortality, length of stay and home time: two-centre study of 82,770 emergency admissions. Age Ageing 2022; 51:6548791. [PMID: 35292792 PMCID: PMC8923813 DOI: 10.1093/ageing/afac051] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Studies investigating outcomes of delirium using large-scale routine data are rare. We performed a two-centre study using the 4 'A's Test (4AT) delirium detection tool to analyse relationships between delirium and 30-day mortality, length of stay and home time (days at home in the year following admission). METHODS The 4AT was performed as part of usual care. Data from emergency admissions in patients ≥65 years in Lothian, UK (n = 43,946) and Salford, UK (n = 38,824) over a period of $\sim$3 years were analysed using logistic regression models adjusted for age and sex. RESULTS 4AT completion rates were 77% in Lothian and 49% in Salford. 4AT scores indicating delirium (≥4/12) were present in 18% of patients in Lothian, and 25% of patients in Salford. Thirty-day mortality with 4AT ≥4 was 5.5-fold greater than the 4AT 0/12 group in Lothian (adjusted odds ratio (aOR) 5.53, 95% confidence interval [CI] 4.99-6.13) and 3.4-fold greater in Salford (aOR 3.39, 95% CI 2.98-3.87). Length of stay was more than double in patients with 4AT scores of 1-3/12 (indicating cognitive impairment) or ≥ 4/12 compared with 4AT 0/12. Median home time at 1 year was reduced by 112 days (Lothian) and 61 days (Salford) in the 4AT ≥4 group (P < 0.001). CONCLUSIONS Scores on the 4AT used at scale in practice are strongly linked with 30-day mortality, length of hospital stay and home time. The findings highlight the need for better understanding of why delirium is linked with poor outcomes and also the need to improve delirium detection and treatment.
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Affiliation(s)
- Atul Anand
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Michael Cheng
- Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Temi Ibitoye
- Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Alasdair M J Maclullich
- Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- Address correspondence to: Alasdair MacLullich, Professor of Geriatric Medicine, Ageing and Health, Usher Institute, University of Edinburgh, Room S1642, Royal Infirmary of Edinburgh, Edinburgh, UK. Tel: 0131 650 1000. Email ; Emma Vardy, Consultant in Geriatric Medicine, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford, Manchester, UK. Tel: 0161 789 7373.
| | - Emma R L C Vardy
- Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford, UK
- NIHR Applied Research Collaboration Greater Manchester, University of Manchester, Manchester, UK
- Address correspondence to: Alasdair MacLullich, Professor of Geriatric Medicine, Ageing and Health, Usher Institute, University of Edinburgh, Room S1642, Royal Infirmary of Edinburgh, Edinburgh, UK. Tel: 0131 650 1000. Email ; Emma Vardy, Consultant in Geriatric Medicine, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford, Manchester, UK. Tel: 0161 789 7373.
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Eskandari M, Parvaneh S, Ehsani H, Fain M, Toosizadeh N. Frailty Identification using Heart Rate Dynamics: A Deep Learning Approach. IEEE J Biomed Health Inform 2022; 26:3409-3417. [PMID: 35196247 DOI: 10.1109/jbhi.2022.3152538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Previous research showed that frailty can influence autonomic nervous system and consequently heart rate response to physical activities, which can ultimately influence the homeostatic state among older adults. While most studies have focused on resting state heart rate characteristics or heart rate monitoring without controlling for physical activities, the objective of the current study was to classify pre-frail/frail vs non-frail older adults using heart rate response to physical activity (heart rate dynamics). Eighty-eight older adults (65 years) were recruited and stratified into frailty groups based on the five-component Fried frailty phenotype. Groups consisted of 27 non-frail (age=78.807.23) and 61 pre-frail/frail (age=80.638.07) individuals. Participants performed a normal speed walking as the physical task, while heart rate was measured using a wearable electrocardiogram recorder. After creating heart rate time series, a long-short term memory model was used to classify participants into frailty groups. In 5-fold cross validation evaluation, the long-short term memory model could classify the two above-mentioned frailty classes with a sensitivity, specificity, F1-score, and accuracy of 83.0%, 80.0%, 87.0%, and 82.0%, respectively. These findings showed that heart rate dynamics classification using long-short term memory without any feature engineering may provide an accurate and objective marker for frailty screening.
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Improving delirium screening and recognition in UK hospitals: results of a multi-centre quality improvement project. Age Ageing 2022; 51:6535927. [PMID: 35212730 PMCID: PMC8876302 DOI: 10.1093/ageing/afab243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 10/08/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND delirium is an acute severe neuropsychiatric condition associated with adverse outcomes, particularly in older adults. However, it is frequently under-recognised. METHODS this multi-centre quality improvement project utilised a collaborative approach to implementation of changes at sites, with the aim to improve delirium screening, recognition and documentation on discharge summaries. Resources, including delirium guidelines and presentations, were shared between sites, and broad details of local interventions were collected. Three timepoints of data collection (14 March 2018, 14 September 2018 and 13 March 2019) were conducted to assess screening, recognition and documentation of delirium in unscheduled admissions of adults aged ≥65 years old. The impact of local interventions and site-specific factors was assessed using logistic regression analysis, adjusting for patient factors. RESULTS a total of 3,013 patients (mean age 80.2, 53.8% females) were recruited across the three timepoints. Screening for delirium was associated with increased odds of recognition (aOR 4.75, CI 2.98-7.56; P < 0.001); this was not affected by grade/profession of screener. Rates of screening, recognition and discharge documentation improved across the three timepoints of data collection. The presence of a local delirium specialist team was associated with increased rates of screening for delirium (aOR 1.75, CI 1.41-2.18; P < 0.001), and the presence of a geriatric medicine team embedded into the admissions unit was associated with increased recognition rates (aOR 1.78, CI 1.09-2.92; P = 0.022). CONCLUSION delirium screening is associated with improved recognition. Interventions that strive to improve screening within a culture of delirium awareness are encouraged.
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Affiliation(s)
- Geriatric Medicine Research Collaborative
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Address correspondence to: Carly Welch.
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Najafi Ghezeljeh T, Rahnamaei F, Omrani S, Haghani S. The effects of interactive E-learning on delirium recognition ability and delirium-related strain of care among critical care nurses. J Intensive Care Soc 2022; 23:44-52. [PMID: 37593534 PMCID: PMC10427842 DOI: 10.1177/1751143720972627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Background Nursing care for patients with delirium is very complex and stressful and is associated with considerable care strain for nurses. Delirium recognition is the first step to the prevention and management of delirium and reduction of strain of care. Education is one of the strategies for improving nurses' delirium recognition ability. Objectives This study aimed to evaluate the effects of interactive E-learning on delirium recognition ability and delirium-related strain of care among critical care nurses. Methods This quasi-experimental study was conducted in 2019 using a two-group pretest-posttest design. Participants were 98 critical care nurses recruited through a census from two hospitals in Iran. They were non-randomly allocated to an intervention and a control group. Study intervention was an interactive E-learning program with four parts on delirium, its prevention, its treatment, and its diagnostic and screening procedures. The program was uploaded on a website and its link was provided to participants in the intervention group. Before and two months after the intervention, data were collected using the Strain of Care for Delirium Index and five case vignettes. For data analysis, the Chi-square, Fisher's exact, independent-sample t, and paired-sample t tests were performed usingthe SPSS software (v. 16.0). Findings Groups did not significantly differ from each other regarding the pretest mean scores of delirium recognition ability and strain of care. After the intervention, the mean score of delirium recognition ability in the intervention group was significantly greater and the mean score of strain of care was significantly lower than the control group (P < 0.05). Conclusion Interactive E-learning is effective in significantly improving critical care nurses' delirium recognition ability and reducing their strain of care. As nurses' heavy workload and limited free time are among the main barriers to their participation in face-to-face educational programs, interactive E-learning can be used for in-service education.
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Affiliation(s)
- Tahereh Najafi Ghezeljeh
- Nursing Care Research Center, Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rahnamaei
- Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Soghra Omrani
- Distance Education Planning, Iran University of Medical Sciences, Tehran, Iran
| | - Shima Haghani
- Statistic and Mathematics Department, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Zucchelli A, Manzoni F, Morandi A, Di Santo S, Rossi E, Valsecchi MG, Inzitari M, Cherubini A, Bo M, Mossello E, Marengoni A, Bellelli G, Tarasconi A, Sella M, Auriemma S, Paternò G, Faggian G, Lucarelli C, De Grazia N, Alberto C, Margola A, Porcella L, Nardiello I, Chimenti E, Zeni M, Giani A, Famularo S, Romairone E, Minaglia C, Ceccotti C, Guerra G, Mantovani G, Monacelli F, Minaglia C, Candiani T, Ballestrero A, Minaglia C, Santolini F, Minaglia C, Rosso M, Bono V, Sibilla S, Dal Santo P, Ceci M, Barone P, Schirinzi T, Formenti A, Nastasi G, Isaia G, Gonella D, Battuello A, Casson S, Calvani D, Boni F, Ciaccio A, Rosa R, Sanna G, Manfredini S, Cortese L, Rizzo M, Prestano R, Greco A, Lauriola M, Gelosa G, Piras V, Arena M, Cosenza D, Bellomo A, LaMontagna M, Gabbani L, Lambertucci L, Perego S, Parati G, Basile G, Gallina V, Pilone G, Giudice C, De F, Pietrogrande L, De B, Mosca M, Corazzin I, Rossi P, Nunziata V, D‘Amico F, Grippa A, Giardini S, Barucci R, Cossu A, Fiorin L, Arena M, Distefano M, Lunardelli M, Brunori M, Ruffini I, Abraham E, Varutti A, Fabbro E, Catalano A, Martino G, Leotta D, Marchet A, Dell‘Aquila G, Scrimieri A, Davoli M, Casella M, Cartei A, Polidori G, Basile G, Brischetto D, Motta S, Saponara R, Perrone P, Russo G, Del D, Car C, Pirina T, Franzoni S, Cotroneo A, Ghiggia F, Volpi G, Menichetti C, Bo M, Panico A, Calogero P, Corvalli G, Mauri M, Lupia E, Manfredini R, Fabbian F, March A, Pedrotti M, Veronesi M, Strocchi E, Bianchetti A, Crucitti A, Di Francesco V, Fontana G, Bonanni L, Barbone F, Serrati C, Ballardini G, Simoncelli M, Ceschia G, Scarpa C, Brugiolo R, Fusco S, Ciarambino T, Biagini C, Tonon E, Porta M, Venuti D, DelSette M, Poeta M, Barbagallo G, Trovato G, Delitala A, Arosio P, Reggiani F, Zuliani G, Ortolani B, Mussio E, Girardi A, Coin A, Ruotolo G, Castagna A, Masina M, Cimino R, Pinciaroli A, Tripodi G, Cannistrà U, Cassadonte F, Vatrano M, Cassandonte F, Scaglione L, Fogliacco P, Muzzuilini C, Romano F, Padovani A, Rozzini L, Cagnin A, Fragiacomo F, Desideri G, Liberatore E, Bruni A, Orsitto G, Franco M, Bonfrate L, Bonetto M, Pizio N, Magnani G, Cecchetti G, Longo A, Bubba V, Marinan L, Cotelli M, Turla M, Brunori M, Sessa M, Abruzzi L, Castoldi G, LoVetere D, Musacchio C, Novello M, Cavarape A, Bini A, Leonardi A, Seneci F, Grimaldi W, Fimognari F, Bambara V, Saitta A, Corica F, Braga M, Ettorre E, Camellini C, Marengoni A, Bruni A, Crescenzo A, Noro G, Turco R, Ponzetto M, Giuseppe L, Mazzei B, Maiuri G, Costaggiu D, Damato R, Fabbro E, Patrizia G, Santuari L, Gallucci M, Minaglia C, Paragona M, Bini P, Modica D, Abati C, Clerici M, Barbera I, NigroImperiale F, Manni A, Votino C, Castiglioni C, Di M, Degl‘Innocenti M, Moscatelli G, Guerini S, Casini C, Dini D, DeNotariis S, Bonometti F, Paolillo C, Riccardi A, Tiozzo A, SamySalamaFahmy A, Riccardi A, Paolillo C, DiBari M, Vanni S, Scarpa A, Zara D, Ranieri P, Calogero P, Corvalli G, Pezzoni D, Gentile S, Morandi A, Platto C, D‘Ambrosio V, Faraci B, Ivaldi C, Milia P, DeSalvo F, Solaro C, Strazzacappa M, Bo M, Panico A, Cazzadori M, Confente S, Bonetto M, Magnani G, Cecchetti G, Guerini V, Bernardini B, Corsini C, Boffelli S, Filippi A, Delpin K, Bertoletti E, Vannucci M, Tesi F, Crippa P, Malighetti A, Caltagirone C, DiSant S, Bettini D, Maltese F, Formilan M, Abruzzese G, Minaglia C, Cosimo D, Azzini M, Cazzadori M, Colombo M, Procino G, Fascendini S, Barocco F, Del P, D‘Amico F, Grippa A, Mazzone A, Riva E, Dell‘Acqua D, Cottino M, Vezzadini G, Avanzi S, Orini S, Sgrilli F, Mello A, Lombardi L, Muti E, Dijk B, Fenu S, Pes C, Gareri P, Castagna A, Passamonte M, De F, Rigo R, Locusta L, Caser L, Rosso G, Cesarini S, Cozzi R, Santini C, Carbone P, Cazzaniga I, Lovati R, Cantoni A, Ranzani P, Barra D, Pompilio G, Dimori S, Cernesi S, Riccò C, Piazzolla F, Capittini E, Rota C, Gottardi F, Merla L, Barelli A, Millul A, De G, Morrone G, Bigolari M, Minaglia C, Macchi M, Zambon F, D‘Amico F, D‘Amico F, Pizzorni C, DiCasaleto G, Menculini G, Marcacci M, Catanese G, Sprini D, DiCasalet T, Bocci M, Borga S, Caironi P, Cat C, Cingolani E, Avalli L, Greco G, Citerio G, Gandini L, Cornara G, Lerda R, Brazzi L, Simeone F, Caciorgna M, Alampi D, Francesconi S, Beck E, Antonini B, Vettoretto K, Meggiolaro M, Garofalo E, Bruni A, Notaro S, Varutti R, Bassi F, Mistraletti G, Marino A, Rona R, Rondelli E, Riva I, Scapigliati A, Cortegiani A, Vitale F, Pistidda L, D‘Andrea R, Querci L, Gnesin P, Todeschini M, Lugano M, Castelli G, Ortolani M, Cotoia A, Maggiore S, DiTizio L, Graziani R, Testa I, Ferretti E, Castioni C, Lombardi F, Caserta R, Pasqua M, Simoncini S, Baccarini F, Rispoli M, Grossi F, Cancelliere L, Carnelli M, Puccini F, Biancofiore G, Siniscalchi A, Laici C, Mossello E, Torrini M, Pasetti G, Palmese S, Oggioni R, Mangani V, Pini S, Martelli M, Rigo E, Zuccalà F, Cherri A, Spina R, Calamai I, Petrucci N, Caicedo A, Ferri F, Gritti P, Brienza N, Fonnesu R, Dessena M, Fullin G, Saggioro D. The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017. Aging Clin Exp Res 2022; 34:349-357. [PMID: 34417734 PMCID: PMC8847195 DOI: 10.1007/s40520-021-01950-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/31/2021] [Indexed: 01/22/2023]
Abstract
Introduction Delirium and sarcopenia are common, although underdiagnosed, geriatric
syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium. Methods The analyses were conducted employing the cross-sectional “Delirium Day” initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses. Results A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09–2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001]. Discussion and conclusion Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-01950-8.
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