Delirium and functionality: the impact of delirium on the level of functioning

Abstract

-Background and Objectives: Studies have shown showed that delirium affects the long-term functional status, however, the acute effect of delirium on functioning has been less documented. The purpose of this analysis was to examine the acute impact of delirium on the level of functioning.Methods: All patients were recruited at the Memorial Sloan Kettering Cancer Center (MSKCC). The Memorial Delirium Assessment Scale (MDAS) and Karnofsky scale of Performance Status (KPS) were recorded at baseline (T1), 2-3 days (T2) and 4-7 days (T3). A secondary analysis in respect to sociodemographic and medical variables, aspects of delirium, and level of functioning was performed.Results: Delirium severity at baseline did not affect the level of functioning, however, resolved delirium resulted in substantial functional recovery compared to persistent delirium at T2 (30.2 and 23.5) and T3 (35.1 and 26.2). Patients with persistent functional impairment were not different in age, pre-existing dementia or brain metastasis compared to those with functional recovery. However, brain cancer, terminal illness, hypoxia and multiple etiologies caused persistent functional decline. Although delirium severity was not different at baseline, delirium was more severe in the functionally-impaired at T2 and T3. Similarly, delirium resolution was inferior in these patients in contrast to the functionally-recovered at T2 (25% and 65.4%) and T3 (62.5% and 83.3%). On the contrary, the duration of delirium affected functional recovery; shorter delirium predicted faster functional recovery.Conclusions: Delirium caused an acute functional decline and appropriate management of delirium with antipsychotics reversed this decline. On the contrary, shorter duration of delirium was associated with faster functional recovery. Brain cancer, terminal illness, hypoxia, and multiple etiologies were confounders for persistent delirium and functional impairment.

Expert opinions on the first-line pharmacological treatment for delirium in Japan: a conjoint analysis

“…Because most atypical antipsychotics such as risperidone can be administered only by the oral route, it may not be surprising that experts recommended the use of haloperidol preferentially, given that it is known that oral administration is not suitable for some patients. In addition, the preference for atypical antipsychotics could result from safety concerns, as several studies have shown that atypical antipsychotics might have a lower propensity than haloperidol to induce extrapyramidal symptoms (Miyaji et al, 2007;Boettger et al, 2015). Second, more than 88% of experts recommended the use of quetiapine over risperidone in the treatment of hyperactive delirium in patients with renal dysfunction who did not also have diabetes.…”

A systematic review of studies reporting on neuropsychological and functional domains used for assessment of recovery from delirium in acute hospital patients

“…Ten papers (five studies) 25,35,40,42,56–61 analysed functional recovery over time in the context of delirium, with nine (four studies) observing improvement. Boettger et al 25,56–61 .…”

“…As our inclusion criteria did not exclude studies involving interventions, some studies reported change within symptom domains as a result of drug intervention for example, aripiprazole, haloperidol. 25,[56][57][58][59][60] This may have affected the recovery trajectories of symptom domains, for example, functional recovery in the Boettger et al study. 25,[56][57][58][59][60] In these instances, conclusions of symptom recovery may not be entirely generalisable to an acute hospital delirious population, as although haloperidol in small doses is administered in clinical settings to manage severe symptoms (e.g., distress and agitation), use of aripiprazole is not common practice (in the UK), nor is it advised by the NICE guidelines.…”

“…Ten papers (five studies) 25,35,40,42,[56][57][58][59][60][61] analysed functional recovery over time in the context of delirium, with nine (four studies) observing improvement. Boettger et al 25,[56][57][58][59][60][61] analysed change in KPS scores over time and found an improvement in functional performance.…”

Prevalence And Associated Factors Of Delirium Among Hospitalized Patients In Mekelle Public Hospitals, Mekele, Tigray, Ethiopia, a cross sectional study

“…The main impacts of delirium includes it increases treatment cost by causing prolonged hospital stay, increases mortality rate, increase burden for nurse and caregivers (11), acute functional decline, causes cognitive declining in older adults, cause falls, ongoing need for care in long term institution, economical impact, distress. (12,19,25,27,(30)(31)(32) Mostly delirium affects for ICU and ICU burn patients 32.3% and 77% respectively. (33,34) delirium also affects more for older people who had surgery.…”