Delirium etiology subtypes and their effect on six-month function and cognition in older emergency department patients

Cirbus, J.; MacLullich, Alasdair M.J.; Noel, Christopher; Ely, E. Wesley; Chandrasekhar, Rameela; Han, Jin H.

doi:10.1017/s1041610218000777

Cited by 21 publications

(12 citation statements)

References 39 publications

(52 reference statements)

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“…Precipitating factors for delirium span a wide range of different kinds of insults, including, amongst others, acute medical illness (such as sepsis, hypoglycaemia, stroke and liver failure), trauma (such as fractures or head injury), surgery, dehydration and psychological stress 17,27 . Typically, more than one precipitating factor is present in patients 50,51 . In addition, drug use and withdrawal and medication changes are associated with delirium.…”

Section: Prevalence Estimatesmentioning

confidence: 99%

“…Another study found that the duration of hypoactive delirium but not that of hyperactive delirium was associated with worse long-term cognitive function among critically ill patients experiencing delirium 303 . The potential influence of delirium aetiology, such as medications, infection or other causes, on outcomes has been explored in a small number of studies, with mixed findings 51,81 . However, these adverse outcomes all have a major role in a patient's QOL.…”

Section: Quality Of Lifementioning

confidence: 99%

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Delirium

Wilson

Mart

Cunningham

et al. 2020

Nat Rev Dis Primers

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602

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Section: Prevalence Estimatesmentioning

confidence: 99%

Section: Quality Of Lifementioning

confidence: 99%

Delirium

Wilson

Mart

Cunningham

et al. 2020

Nat Rev Dis Primers

Self Cite

610

602

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“…Frailty and delirium would appear to be two clinically distinct geriatric syndromes; however, their simultaneous onset has often been documented in the scientific literature [20, 24, 25]. Few studies have explored the associations between frailty and delirium on admission to Swiss ED [31, 32, 33, 34, 35]. Highlighting an association between frailty and delirium could lead to a better understanding of both these geriatric syndromes and their interdependence, to prevent and detect them more consequently in the ED [33, 35].…”

Section: Introductionmentioning

confidence: 99%

“…Few studies have explored the associations between frailty and delirium on admission to Swiss ED [31, 32, 33, 34, 35]. Highlighting an association between frailty and delirium could lead to a better understanding of both these geriatric syndromes and their interdependence, to prevent and detect them more consequently in the ED [33, 35]. Nevertheless, few authors have sought to evidence any relationship between frailty and the initiation of other geriatric syndromes in the ED [20, 21].…”

Section: Introductionmentioning

confidence: 99%

Associations between Frailty and Delirium among Older Patients Admitted to an Emergency Department

Choutko-Joaquim

Tacchini-Jacquier²,

D'Alessio

et al. 2019

Dement Geriatr Cogn Disord Extra

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Background: Switzerland’s demographic trends show, as elsewhere on the planet, increasing numbers of older and very old adults. This suggests that its healthcare system will suffer serious repercussions, including in the use of care and especially the use of emergency services. Significant numbers of older adults will be at risk of developing multiple chronic conditions including one or more geriatric syndromes, such as frailty and delirium. Few studies to date have documented associations between frailty and delirium. Aim: To explore the relationships between frailty and delirium in older adult patients consulting (n = 114) at an emergency department (ED) in Switzerland. Method: A cross-sectional study was conducted in a peripheral hospital ED in the French-speaking part of Switzerland. Frailty was assessed using the Tilburg Frailty Indicator (TFI). Delirium was assessed using the Confusion Assessment Method (CAM). Participants’ cognitive states were assessed using the 6-item Cognitive Impairment Test (6CIT) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQ-CODE), completed by the participant’s most significant informal caregiver. Results: The mean participant age was 77.6 years (SD = 7.7); the majority of the subjects were women (54%). The participants took an average of 4.7 different medications a day (SD = 3.2, median = 4). More than half (62%) of the participants were frail; 2 and 14% presented signs and symptoms of delirium and subsyndromal delirium, respectively. A weak but significant association between scores for frailty and delirium (p < 0.05) was demonstrated, and clinical observation confirmed this. A 4-h follow-up measurement of delirium in the ED revealed no significant or clinical difference. Conclusion: Although the literature describes strong associations between frailty and delirium in surgical units and community care settings, the present study only demonstrated a weak-to-moderate association between frailty and delirium in our ED.

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“…Another psychiatric condition encountered in cognitive disorders is delirium. [23,24] Prevalence of delirium, a clinical syndrome characterized by sudden-onset dysfunction of attention and cognitive function, is 11-16% among inpatients hospitalized due to physical illness with a more widespread distribution between 4-31%. [25] According to a systematic review of eight studies by Hosie et al, [26] 98.9% of inpatients receiving palliative care were cancer patients, delirium incidence was 3-35%, and delirium prevalence ranged between 13.3-42.3% at hospital admission.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the psychiatry consultations of inpatients in Palliative Care Unit of Adiyaman Training and Research Hospital: 2018 data

Örüm¹,

Kara

Örüm

et al. 2019

FNG & Demiroğlu Bilim Tıp Dergisi

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Objectives: This study aims to evaluate the psychiatric consultations requested in the inpatients of the palliative care unit. Patients and methods: Data such as age, gender, main disease diagnosis, psychiatric diagnosis, and the date of consultation from the patient registry system in the Palliative Care Unit of Adıyaman Training and Research Hospital were retrospectively evaluated. In this study, 53 patients (26 males, 27 females; mean age 64.7±15.7 years; range, 29 to 92 years) who were requested consultation between January 1, 2018 and December 31, 2018 were evaluated. Results: The mean age of men and women was similar (p=0.272). The main diagnoses of the patients were: cancer-leukemia-lymphoma (n=35, 66.2%), infections (n=7, 13.4%), cerebrovascular accident (n=5, 9.1%), diabetes mellitus (n=4, 7.6%), chronic obstructive pulmonary disease (n=2, 3.8%). Decubitus ulcers were present in all of these patients. According to DSM-V criteria, the most frequent psychiatric diagnoses were as follows: major depressive disorder in 17 patients (32.1%), sleep disorder in 17 patients (32.1%), delirium 16 patients (30.2%). The number of seasonal consultation requests were similar (p=0.345). Principal diagnoses were similar in both genders (p=0.329). Psychiatric diagnoses were similarly distributed in both genders (p=0.467). Major depressive disorder was significantly more frequent in younger patients compared to other psychiatric diagnostic groups (p=0.008). Conclusion: The most important psychiatric diagnoses of patients in palliative care units are delirium, sleep disorders, and major depressive disorder. Primary or secondary psychiatric disorders added to the burden of severe disease negatively affect patient compliance to treatment. For these reasons, it is recommended that patients are under close follow-up and treatment.Adıyaman Eğitim ve Araştırma Hastanesi Palyatif Bakım Ünitesinde yatarak tedavi gören hastalara istenen psikiyatri konsültasyonlarının değerlendirilmesi: 2018 yılı verileri ÖZ Amaç: Bu çalışmada palyatif bakım ünitesinde yatarak tedavi gören hastalara istenen psikiyatri konsültasyonları değerlendirildi. Hastalar ve yöntemler: Adıyaman Eğitim ve Araştırma Hastanesi Palyatif Bakım Ünitesi'nde yatarak tedavi gören hastaların yaş, cinsiyet, ana hastalık tanısı, psikiyatrik tanı, konsültasyon isteminin yapıldığı tarih gibi veriler hasta kayıt sisteminden geriye dönük olarak incelendi. Bu çalışmada, 1 Ocak 2018 ve 31 Aralık 2018 tarihleri arasında konsültasyon istemi olan 53 hasta (26 erkek, 27 kadın; ort. yaş 64.7±15.7 yıl; dağılım 29-92 yıl) değerlendirildi. Bulgular: Erkek ve kadın yaş ortalamaları benzerdi (p=0.272). Hastaların ana yatış tanıları şunlardı: kanser-lösemi-lenfoma (n=35, %66.2), enfeksiyonlar (n=7, %13.4), serebrovasküler olay (n=5, %9.1), diabetes mellitus (n=4,%7.6) ve kronik obstrüktif akciğer hastalığı (n=2, %3.8). Bu hastaların tamamında dekübitus ülseri mevcuttu. Hastalara DSM-5 tanı kriterlerine göre en sık konulan psikiyatrik tanılar şöyleydi: Majör depresif bozukluk 17 hasta (%32.1)...

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Delirium etiology subtypes and their effect on six-month function and cognition in older emergency department patients

Abstract: Delirium is heterogeneous and different etiologies may have different prognostic implications. Furthermore, the effect of these delirium etiologies on outcome may be dependent on the patient's pre-illness functional status and cognition.

Cited by 21 publications

References 39 publications

Delirium

Delirium

Associations between Frailty and Delirium among Older Patients Admitted to an Emergency Department

Evaluation of the psychiatry consultations of inpatients in Palliative Care Unit of Adiyaman Training and Research Hospital: 2018 data

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