Clinical significance of delirium subtypes in older people

Abstract

Objective: to examine the relative frequency and outcome of clinical subtypes of delirium in older hospital patients. Design: prospective observational study. Setting: acute geriatric unit in a teaching hospital. Subjects: 94 patients with delirium from a prospective study of 225 admissions. Measurements: clinical subtypes of delirium were determined according to predefined criteria. Characteristics examined in these subgroups included illness severity on admission, prior cognitive impairment, mortality, duration of hospital stay and hospital-acquired complications. Results: of the 94 patients, 20 (21%) had a hyperactive delirium, 27 (29%) had a hypoactive delirium, 40 (43%) had a mixed hypoactive-hyperactive psychomotor pattern and seven (7%) had no psychomotor disturbance. There were significant differences between the four groups in illness severity (P < 0.05), length of hospital stay (P < 0.005) and frequency of falls (P < 0.05). Patients with hypoactive delirium were sicker on admission, had the longest hospital stay and were most likely to develop pressure sores. Patients with hyperactive delirium were most likely to fall in hospital. There were no differences in aetiological factors between the groups. Conclusion: outcomes of hospitalization differ in different clinical subtypes of delirium.

Validation of the Confusion Assessment Method in Detecting Postoperative Delirium in Cardiac Surgery Patients

“…In our study, most patients were classified as having a hypoactive symptom profile, confirming the results of previous studies. 1,13,19 In the early postoperative period, more patients had emotional rather than psychotic symptoms. The sensitivity of the CAM in detecting various subtypes of delirium was tested.…”

“…12 Delirium is associated with a disturbance in psychomotor activity, which can be classified into various clinical types, such as hyperactive, hypoactive, and mixed hyperactive and hypoactive. 13,14 Psychotic and emotional signs and symptoms are also common in older patients with delirium. 14,15 Delirium develops rapidly, within a few hours or days, and fluctuates.…”

Delirium: The 21st century health care challenge for bedside clinicians

“…[22,23] Effective management of modifiable risk factors is an integral component of a successful delirium prevention program.…”

“…[5] A study conducted in post-surgical patients found a more pronounced association of long-acting benzodiazepines with delirium compared with shorter-acting benzodiazepines. [23] Moreover, higher doses of benzodiazepine medications during a 24-hour period appear to be associated with an increased risk of delirium compared with lower doses. If benzodiazepines cannot be avoided, a suggestion is to use the lowest dose and shortest acting formulation possible to re-duce the risk of adverse effects such as delirium.…”

Understanding terminology of delirium and long-term cognitive impairment in critically ill patients

“…In the past, delirium was considered as a transitory syndrome. Several studies [37][38][39][40] in non-ICU setting have shown that delirium symptoms can persist up to 1 month after the first diagnosis. 41 Pisani et al, 12 analysing the effect of delirium on mortality, reported the persistence of delirium up to 10 days after the first diagnosis in ICU patients.…”