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Castro E, Körver F, Merry A, van Moorsel F, Hazebroek M, Smid M, Ploux S, Bordachar P, Prinzen F, Sipers W, Strik M. Should we still monitor QTc duration in frail older patients on low-dose haloperidol? A prospective observational cohort study. Age Ageing 2020; 49:829-836. [PMID: 32614955 DOI: 10.1093/ageing/afaa066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Haloperidol at high dosage is associated with QTc prolongation and polymorphic ventricular arrhythmia but the effects of low-dose haloperidol remain unknown. OBJECTIVE To evaluate the effects of low-dose haloperidol on QTc-duration in frail hospitalized elderly patients with delirium. METHODS A prospective observational study including hospitalized patients aged ≥70 years with Groningen Frailty Index-score > 3. We included 150 patients who received haloperidol and 150 age- and frailty-matched control patients. Serial ECG recordings were performed at hospital admission and during hospitalization. QT-interval was corrected according to Framingham (QTc). Patients were grouped according to baseline QTc in normal (nQTc), borderline (bQTc) or abnormal (aQTc). Primary outcome was change in QTc-duration between first and second ECG. Potentially dangerous QTc was defined as QTc >500 ms or an increase of >50 ms. RESULTS Patients in the haloperidol group (48% male, mean age 85y, nQT n = 98, bQT n = 31, aQT n = 20) received an average dose of 1.5 mg haloperidol per 24 hours. QTc decreased in patients with borderline (mean - 15 ± 29 ms, P < 0.05) or abnormal (-19 ± 27 ms, P < 0.05) QTc at baseline, no patients developed dangerous QTc-duration. In the control group (41% male, mean age 84y, nQT n = 99 bQT n = 29, aQT n = 22) QTc decreased to a similar extent (bQT -7 ± 16 ms, aQTc -23 ± 20 ms). CONCLUSION A trend to QTc shortening was seen, especially in patients with borderline or abnormal QTc at baseline, regardless of haloperidol use. These findings suggest that ECG monitoring of frail elderly patients who receive low-dose haloperidol, may not be necessary.
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Affiliation(s)
- Ellen Castro
- Geriatrics and Cardiology Department, Zuyderland Medical Centre, 6162 BG Sittard-Geleen, The Netherlands
| | - Frank Körver
- Geriatrics and Cardiology Department, Zuyderland Medical Centre, 6162 BG Sittard-Geleen, The Netherlands
| | - Audrey Merry
- Geriatrics and Cardiology Department, Zuyderland Medical Centre, 6162 BG Sittard-Geleen, The Netherlands
| | - Fieke van Moorsel
- Geriatrics and Cardiology Department, Zuyderland Medical Centre, 6162 BG Sittard-Geleen, The Netherlands
| | - Mark Hazebroek
- Cardiology Department, Maastricht University Medical Centre, Maastricht 6229 HX, The Netherlands
| | - Machiel Smid
- Geriatrics and Cardiology Department, Zuyderland Medical Centre, 6162 BG Sittard-Geleen, The Netherlands
| | - Sylvain Ploux
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, F-33600 Pessac, Bordeaux, France
| | - Pierre Bordachar
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, F-33600 Pessac, Bordeaux, France
| | - Frits Prinzen
- Cardiology Department, Maastricht University Medical Centre, Maastricht 6229 HX, The Netherlands
| | - Walther Sipers
- Geriatrics and Cardiology Department, Zuyderland Medical Centre, 6162 BG Sittard-Geleen, The Netherlands
| | - Marc Strik
- Cardiology Department, Maastricht University Medical Centre, Maastricht 6229 HX, The Netherlands
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, F-33600 Pessac, Bordeaux, France
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Alvarez EA, Garrido M, Ponce DP, Pizarro G, Córdova AA, Vera F, Ruiz R, Fernández R, Velásquez JD, Tobar E, Salech F. A software to prevent delirium in hospitalised older adults: development and feasibility assessment. Age Ageing 2020; 49:239-245. [PMID: 31957783 DOI: 10.1093/ageing/afz166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND non-pharmacological interventions to prevent delirium are useful in hospitalised older adults. However, they are poorly implemented in clinical practice. We aimed to develop a software for bedside use by hospitalised older adults and to improve their access to these interventions. METHODS a transdisciplinary team composed of healthcare professionals, designers, engineers and older adults participated in the development of the software. Scrum methodology was used to coordinate the work of the team, and the software was evaluated in a feasibility study. RESULTS a software for touchscreen mobile devices that supports Android 5.0 or later was produced, including modules for time-spatial re-orientation, cognitive stimulation, early mobilisation, sensorial support use promotion, sleep hygiene and pain management optimisation. Horizontal disposition, use of colour contrast and large interaction areas were used to improve accessibility. The software's usability and accessibility were evaluated in 34 older adults (average age 73.2 ± 9.1 years) showing that 91.1% of them got access to all the software functions without previous instructions. The clinical feasibility assessment showed that 83.3% of the 30 enrolled hospitalised patients (76 ± 8 years) completed the 5-day protocol of software usage during hospitalisation. Software use was associated with a decreased trend in delirium incidence of 5 of 32 (15.6%) at baseline to 2 of 30 (6.6%) after its implementation. CONCLUSION a highly accessible and implementable software, designed to improve access to non-pharmacological interventions to prevent delirium in hospitalised older adults, was developed. The effectiveness of the software will be evaluated in a randomised clinical trial.
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Affiliation(s)
- Evelyn A Alvarez
- Escuela de Terapia Ocupacional, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago, Metropolitana, Chile
- Departamento de Terapia Ocupacional y Ciencia de la Ocupación, Facultad de Medicina, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Maricel Garrido
- Departamento de Medicina Interna Norte, Servicio Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
| | - Daniela P Ponce
- Centro de Investigación Clínica Avanzada (CICA), Universidad de Chile, Santiago, Metropolitana, Chile
| | - Gaspar Pizarro
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Andres A Córdova
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Felipe Vera
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Rocio Ruiz
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Raul Fernández
- Departamento de Medicina Interna Norte, Servicio Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
- Departamento de Medicina Interna Norte, Sección Geriatría, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
| | - Juan D Velásquez
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
- Instituto Sistemas Complejos de Ingeniería (ISCI), Universidad de Chile, Santiago, Metropolitana, Chile
| | - Eduardo Tobar
- Departamento de Medicina Interna Norte, Unidad de Pacientes Críticos, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
- Facultad de Medicina, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Felipe Salech
- Centro de Investigación Clínica Avanzada (CICA), Universidad de Chile, Santiago, Metropolitana, Chile
- Departamento de Medicina Interna Norte, Sección Geriatría, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
- Facultad de Medicina, Universidad de Chile, Santiago, Metropolitana, Chile
- Unidad de Cuidados Adulto Mayor, Clínica Las Condes, Santiago, Chile
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Yadav K, Boucher V, Carmichael PH, Voyer P, Eagles D, Pelletier M, Gouin É, Daoust R, Vu TTM, Berthelot S, Émond M. Serial Ottawa 3DY assessments to detect delirium in older emergency department community dwellers. Age Ageing 2019; 49:130-134. [PMID: 31755527 DOI: 10.1093/ageing/afz144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/11/2019] [Accepted: 10/07/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND delirium is associated with increased morbidity and mortality among older emergency department (ED) patients. When using physician gestalt, delirium is missed in the majority of patients. The Ottawa 3DY (O3DY) has been validated to detect cognitive dysfunction among older ED patients. OBJECTIVES to determine the sensitivity and specificity of serial O3DY assessments to detect delirium in older ED patients. DESIGN a prospective observational multicenter cohort study. SETTING four Quebec EDs. PARTICIPANTS independent or semi-independent older patients (age ≥ 65 years) with an ED stay of at least 8 hours that required hospitalisation. MEASUREMENTS eligible patients were evaluated using serial O3DY assessments at least 6 hours apart. The primary outcome was delirium after at least 8 hours in the ED. The reference standard for delirium assessment was the confusion assessment method (CAM). The sensitivity and specificity of the serial O3DY to detect delirium were calculated. RESULTS we enrolled 301 patients (mean age 77 years, 49.5% male, 3.0% with a history of mild dementia). Thirty patients (10.0%) were CAM positive for delirium. Patients had a median of three O3DY assessments. Serial O3DY evaluations to detect delirium among patients with at least one abnormal O3DY had a sensitivity of 86.7% (95% confidence interval-CI 69.3-96.2%) and a specificity of 44.3% (95%; CI 38.3-50.4%). CONCLUSION serial O3DY testing demonstrates good sensitivity as a screening tool to detect delirium among older adult patients with prolonged ED lengths of stay. Emergency physicians should consider the use of the serial O3DY over clinician gestalt to improve delirium detection.
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Affiliation(s)
| | - Valérie Boucher
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Faculté de Médecine, Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | | | - Philippe Voyer
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Faculté des sciences infirmières, Université Laval, Québec, Canada
| | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Mathieu Pelletier
- Centre Intégré de Santé et de Services Sociaux de Lanaudière, Joliette, Canada
| | - Émilie Gouin
- Centre Hospitalier Régional de Trois-Rivières, Trois-Rivières, Canada
- CIUSSS, Trois-Rivières, Canada
| | - Raoul Daoust
- Centre de recherche de l’Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
- Faculté de Médicine, Université de Montréal, Montréal, Canada
- Département Médecine d’Urgence, Hôpital Sacré-Cœur de Montréal, Montreal, Canada
| | - Thien Tuong Minh Vu
- Faculté de Médicine, Université de Montréal, Montréal, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, Canada
| | - Simon Berthelot
- Faculté de Médecine, Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de Médicine d’Urgence, CHU de Québec-Université Laval, Québec, Canada
| | - Marcel Émond
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Faculté de Médecine, Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de Médicine d’Urgence, CHU de Québec-Université Laval, Québec, Canada
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