“Delirium Day”: a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Abstract

BackgroundTo date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy.MethodsThis is a point prevalence study (called “Delirium Day”) including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints.ResultsThe mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01–1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12–1.27), dementia (OR 3.25, 95 % CI 2.41–4.38), malnutrition (OR 2.01, 95 % CI 1.29–3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45–2.82), feeding tubes (OR 2.51, 95 % CI 1.11–5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06–1.87), urinary catheters (OR 1.73, 95 % CI 1.30–2.29), and physical restraints (OR 1.84, 95 % CI 1.40–2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29–3.14), while admission to other settings was not.ConclusionsDelirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The “Delirium Day” project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0649-8) contains supplementary material, which is available to authorized users.

A Point Prevalence Study of Delirium in Italian Nursing Homes

“…It is likely that the majority of NH residents in the present study were long-term users. Moreover, our findings are consistent with those obtained in the hospital setting [15], showing no association between benzodiazepines and delirium.…”

“…Advanced age, dementia, functional impairment, undernutrition, use of antipsychotics, and physical restraints were confirmed to be associated with delirium, consistent with data from the literature [2,14] and with the results obtained in the Delirium Day study evaluating older patients admitted to acute and rehabilitation hospital wards [15].…”

“…Materials and methods of the 2015 Delirium Day were previously described in detail [15]. Briefly, the Delirium Day was the result of the collaboration of four Italian scientific associations: the Italian Psychogeriatric Association (AIP), the Italian Society of Gerontology and Geriatrics (SIGG), the Italian Society of Hospital and Community Geriatrics (SIGOT), and the Italian Society of Neurology for Dementia (SINDEM).…”

Protocol for the Delirium and Cognitive Impact in Dementia (DECIDE) study: A nested prospective longitudinal cohort study

“…Delirium is common, affecting at least 20% of older hospital inpatients [1]. Delirium is particularly common in older people and those with cognitive impairment.…”

The use of dexmedetomidine and intravenous acetaminophen for the prevention of postoperative delirium in cardiac surgery patients over 60 years of age: a pilot study

“…Delirium is defined as a change in mental status, characterized by acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness 1,2 . Delirium increases the risk of mortality, readmissions, and accelerated cognitive decline [2][3][4][5][6] .…”