Background Current literature does not identify the significance of underlying cognitive impairment and delirium on older adults during and 30 days following acute care hospitalization. Objective Describe the incidence, risk factors, and outcomes associated with incident delirium superimposed on dementia. Design 24-month prospective cohort study Setting community hospital Patients 139 older adults (>65 years) with dementia Methods This prospective study followed patients daily during hospitalization and one month post-hospital. Main measures included dementia (Modified Blessed Dementia Rating Score, IQ CODE), daily mental status change, dementia stage/severity (Clinical Dementia Rating, Global Deterioration Scale), delirium (Confusion Assessment Method), and delirium severity (Delirium Rating Scale-Revised-98). All statistical analysis was performed using SAS 9.3 and significance with an alpha level of 0.05. Logistic regression, analysis of covariance or linear regression was performed controlling for age, gender and dementia stage. Results The overall incidence of new delirium was 32% (44/140). Those with delirium had a 25% short term mortality rate, increased length of stay and poorer function at discharge. At one month follow-up, subjects with delirium had greater functional decline. Males were more likely to develop delirium and for every one unit increase in dementia severity (Global Deterioration Scale), subjects were 1.5 times more likely to develop delirium. Conclusions Delirium prolongs hospitalization for persons with dementia. Thus, interventions to increase early detection of delirium have the potential to decrease the severity and duration of delirium and to prevent unnecessary suffering and costs from the complications of delirium and unnecessary readmissions to the hospital.

Background/Objectives As the population ages, delirium superimposed on dementia is becoming a common problem. Family caregivers may provide critical information to assist with early detection. The purpose of this study was to explore agreement between the Family Confusion Assessment Method (FAM-CAM) for delirium identification and interviewer-rated CAM delirium ratings. Design Exploratory analysis of agreement. Setting Community. Participants 52 family caregivers and 52 elders with pre-existing impairment on standardized cognitive testing. Measurements The interviewer-rating for delirium was determined by fulfillment of the Confusion Assessment Method (CAM) algorithm. Results The total sample included 52 paired CAM:FAM-CAM assessments completed across 52 dyads of elders with pre-existing cognitive impairment and family caregivers. The point prevalence of delirium was (7/52)13%. Characteristics did not differ significantly between the delirium and non-delirium groups. The FAM-CAM questions that mapped directly to the original four-item CAM algorithm had the best overall agreement with the interviewer-rated CAM, kappa=0.85 (95% confidence interval, CI 0.65–1.0), sensitivity 88% (CI 47–99%) and specificity 98% (CI 86–100%). Conclusion The FAM-CAM is a sensitive screening tool for detection of delirium in elders with cognitive impairment utilizing family caregivers, with relevance for both research and clinical practice.

Delirium is a prevalent, costly, and global problem in older adults. This article is a systematic review of the literature on nurse recognition of delirium. Ten articles, reporting rates of nurse recognition ranging from 26% to 83%, were included in the review. The most compelling finding is that although related, the notions of nurse knowledge of delirium, nurse recognition of delirium, and nurses' assessment and documentation of delirium in older adults are different. Recommendations for practice are suggested at several levels, including education, guidelines, communication, health care system, and use of informatics.

Objective: The primary aim of this study is to examine the prevalence of and antecedents to missing incidents among community-dwelling persons with dementia. Methods: This prospective study used mailed surveys and telephone interviews. Results: The prevalence of having any incident was 0.46/year; the overall prevalence for missing incidents in this study was 0.65/year. Missing incidents had few antecedents and occurred largely when persons with dementia were performing everyday activities that they normally completed without incident. Conclusion: Given that a missing incident is relatively common among persons with dementia, health care professionals should assist caregivers with a missing incident plan early in the disease process. Also, as missing persons are found by persons other than the caregiver and caregivers underutilize identification devices, health care professionals may recommend the use of identification devices to facilitate a safe return.

Delirium is an acute, fluctuating confusional state that results in poor outcomes for older adults. Dementia causes a more convoluted course when coexisting with delirium. This study examined 128 days of documentation to describe what nurses document when caring for patients with dementia who experience delirium. Nurses did not document that they recognized delirium. Common descriptive terms included words and phrases indicating fluctuating mental status, lethargy, confusion, negative behavior, delusions, and restlessness. Delirium is a medical emergency. Nurses are in need of education coupled with clinical and decisional support to facilitate recognition and treatment of underlying causes of delirium in individuals with dementia.