A Point Prevalence Study of Delirium in Italian Nursing Homes

Abstract

Background: Delirium is a common geriatric syndrome. Few studies have been conducted in nursing home (NH) residents. The aim of this project was to perform a point prevalence study of delirium in Italian NHs. Methods: Data collected in 71 NHs are presented. Inclusion criteria were age ≥65 years and native Italian speaker. Exclusion criteria were coma, aphasia, and end-of-life status. Sociodemographic and medical data were recorded. Delirium was assessed using the Assessment Test for Delirium and Cognitive Impairment (4-AT). Patients with a 4-AT score ≥4 were considered to have delirium. Motor subtype was evaluated using the Delirium Motor Subtype Scale (DMSS). Results: A total of 1,454 patients were evaluated (mean age 84.4 ± 7.4 years, 70.2% female), of whom 535 (36.8%) had delirium. In multivariate logistic regression analysis, variables significantly associated with delirium were education (OR 0.94, 95% CI 0.91–0.97), dementia (OR 3.12, 95% CI 2.38–4.09), functional dependence (OR 6.13, 95% CI 3.08–12.19 for ADL score 0; OR 1.99, 95% CI 1.03–3.84 for ADL score 1–5), malnutrition (OR 4.87, 95% CI 2.68–8.84), antipsychotics (OR 2.40, 95% CI 1.81–3.18), and physical restraints (OR 2.48, 95% CI 1.71–3.59). Conclusion: Delirium is common in older NH residents. Simple assessment tools might facilitate its recognition in this vulnerable population.

Delirium

“…Another review found a delirium prevalence of 59-88% among palliative care inpatients in the weeks approaching death 24 . Fewer data are available about delirium prevalence in community settings, with a prevalence of 4.3-38% reported in nursing homes 25 , whereas delirium prevalence outside of institutions is likely to be ≤2% 26,27 . Delirium prevalence is high in critical care settings, with a systematic review of studies from North and South America, Europe and Asia reporting a pooled prevalence of 31.8% in ventilated and non-ventilated intensive care unit (ICU) patients 28 .…”

Delirium Assessment in Older People in Emergency Departments. A Literature Review

“…Anticholinergics, antipsychotics, and neuroleptics may have been prescribed for the treatment of dementia and for the management of hyperactive or mixed delirium. However, this is an aspect to consider in these patients given the mortality associated with the use of these drugs [41,42]. Research in this area should be encouraged [43,44,45].…”

Pain and delirium: mechanisms, assessment, and management

“…Chronic pain rates are reported to be even higher [1]. The prevalence of delirium in the community is low, but a delirium prevalence of 36.8% has been reported in residential aged care settings [2] and the onset of delirium often precipitates presentation to the emergency department. Here, 8-17% of all older people and 40% of those residing in residential care have delirium.…”