Delirium in elderly patients: Prospective prevalence across hospital services

Fuchs, Simon; Bode, Leonie; Ernst, Jutta; Marquetand, Justus; Känel, Roland von; Böttger, Sönke

doi:10.1016/j.genhosppsych.2020.08.010

Cited by 29 publications

(24 citation statements)

References 52 publications

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“…[1] In the ICU, delirium is a syndrome manifesting as an acute disturbance and fluctuation of cognition and consciousness characterized by inattention and confusion. [2] It is estimated that delirium could occur in 13% to 66% [3][4][5] of the elderly patients admitted to ICUs, and delirium itself is a known risk factor for poor outcomes, including prolonged ICU and hospital stay, [5] and in-hospital mortality. [3,6] The elderly have been found with brain frailty and less physiologic reserve accompanied by infection, surgery and medication, and thus older patients are more vulnerable to ICU stressors and have a poorer prognosis together with higher medical cost in ICU.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9] Unfortunately, although previous studies have found that age is an independent predictor for ICU delirium, [10] there is still a lack of literature addressing the role of aging on delirium outcomes. Despite the considerable studies focusing on risk factors for ICU delirium [10] and the clear impact of delirium on patient in-hospital mortality, [4,11] only a few studies have further explored the relationship between aging and outcomes with limited sample sizes and inconsistent findings. One study conducted in the cardiac ICU found that age interacted with sex was associated with patient prognosis, [12] whereas another study with groups (≥65 years) and very elderly (≥80 years) patients showed that the 30-day mortality of delirium patients was not increased signifi cantly.…”

Section: Introductionmentioning

confidence: 99%

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Poor outcomes of delirium in the intensive care units are amplified by increasing age: A retrospective cohort study

Gao

Zhang

Jin

2021

World Journal of Emergency Medicine

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BACKGROUND: Delirium in patients in intensive care units (ICUs) is an acute disturbance and fl uctuation of cognition and consciousness. Though increasing age has been found to be related to ICU delirium, there is limited evidence of the effect of age on delirium outcomes. The aim of this study is to investigate the relationship between age categories and outcomes among ICU delirium patients. METHODS: Data were extracted from the electronic ICU (eICU) Collaborative Research Database with records from 3,931 patients with delirium. Patients were classifi ed into non-aged (<65 years), youngold (65-74 years), middle-old (75-84 years), and very-old (≥85 years) groups. A Cox regression model was built to examine the role of age in death in ICU and in hospital after controlling covariates. RESULTS: The sample included 1,667 (42.4%) non-aged, 891 (22.7%) young-old, 848 (21.6%) middle-old, and 525 (13.3%) very-old patients. The ICU mortality rate was 8.3% and the hospital mortality rate was 15.4%. Compared with the non-aged group, the elderly patients (≥65 yeras) had higher mortality at ICU discharge (χ 2 =13.726, P=0.001) and hospital discharge (χ 2 =56.347, P<0.001). The Cox regression analysis showed that age was an independent risk factor for death at ICU discharge (hazard ratio [HR]=1.502, 1.675, 1.840, 95% confi dence interval [CI] 1.138-1.983, 1.250-2.244, 1.260-2.687; P=0.004, 0.001, 0.002 for the young-, middle-and very-old group, respectively) as well as death at hospital discharge (HR=1.801, 2.036, 2.642, 95% CI 1.454-2.230, 1.638-2.530, 2.047-3.409; all P<0.001). CONCLUSIONS: The risks of death in the ICU and hospital increase with age among delirious patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Poor outcomes of delirium in the intensive care units are amplified by increasing age: A retrospective cohort study

Gao

Zhang

Jin

2021

World Journal of Emergency Medicine

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“…The severity of a medical disability, as indicated by the medical treatment setting, affects the risk of delirium: for intensive care units (ICU, 83.3%, odds ratio [OR] 12.34), and intermediate care units (IMC, 39.8%, OR 1.42) [10]. In that study, patients with delirium were hospitalized twice as long (14.3 vs. 7.7 days), were more likely to have pre-existing dementia, and were more likely to die in hospital [10]. A meta-analysis including almost 2,939 patients showed that delirium is associated with an increased risk of death after an average follow-up of 22.7 months (HR 1.95, 95% CI 1.51-2.52), and an increased risk of institutionalization (OR 2.41, 95% CI 1.77-3.29) [11].…”

Section: Introductionmentioning

confidence: 99%

“…A meta-analysis including almost 2,939 patients showed that delirium is associated with an increased risk of death after an average follow-up of 22.7 months (HR 1.95, 95% CI 1.51-2.52), and an increased risk of institutionalization (OR 2.41, 95% CI 1.77-3.29) [11]. In several studies, delirium was associated with an increased risk of postoperative cognitive dysfunction and dementia [10][11][12]. For example, a recent study showed an association between delirium severity and subsequent 3-year cognitive impairment [13].…”

Section: Introductionmentioning

confidence: 99%

“…Recent data suggests an age-dependent incidence of post-cardiac surgery delirium: 21.4% of patients aged ≥ 65 suffered from POD, and POD was observed in 33.5% of patients aged > 80 [1]. The severity of a medical disability, as indicated by the medical treatment setting, affects the risk of delirium: for intensive care units (ICU, 83.3%, odds ratio [OR] 12.34), and intermediate care units (IMC, 39.8%, OR 1.42) [10]. In that study, patients with delirium were hospitalized twice as long (14.3 vs. 7.7 days), were more likely to have pre-existing dementia, and were more likely to die in hospital [10].…”

Section: Introductionmentioning

confidence: 99%

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Identification of Risk Factors for Delirium, Cognitive Decline, And Dementia After Cardiac Surgery (FINDERI - Find Delirium Risk Factors): A Study Protocol of A Prospective Monocentric Observational Pilot Trial

Sadlonova

Vogelgsang

Lange

et al. 2021

Preprint

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BACKGROUND: Postoperative delirium is a common complication of cardiac surgery associated with higher morbidity, longer hospital stay, risk of cognitive decline, dementia, and mortality. Geriatric patients, patients undergoing cardiac surgery, and intensive care patients are at a high risk of developing a postoperative delirium. A gold standard assessment or biomarkers to predict risk factors for delirium, cognitive decline, and dementia in patients undergoing cardiac surgery are not yet available. METHODS: The FINDERI trial (FINd DElirium RIsk factors) is a prospective, single-center, observational pilot study. In total, 500 patients aged ≥ 50 years undergoing cardiac surgery at the Department of Cardiovascular and Thoracic Surgery of the University of Göttingen Medical Center will be recruited. Our primary aims are to validate a delirium screening questionnaire and to identify specific preoperative risk factors and perioperative exposition factors for postoperative delirium, cognitive decline, and accelerated dementia after cardiac surgery. Our secondary aim is to identify blood-based biomarkers that predict the incidence of postoperative delirium, cognitive decline, or dementia in the context of cardiac surgery. CONCLUSION: This prospective, observational pilot trial might help to identify pre- and perioperative risk factors and biomarkers for postoperative delirium, cognitive decline, and dementia. The predictive value of a delirium screening questionnaire in cardiac surgery might also be revealed.TRIAL REGISTRATION: Ethics approval for this study was obtained from the IRB of the University of Göttingen Medical Center. The investigators registered this study in German Clinical Trials Register (DRKS) (DRKS00025095) on April, 19th 2021 https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00025095.

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Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) for the diagnosis of delirium in adults in critical care settings

Miranda,

Gonzalez,

Plana

et al. 2023

Cochrane Database of Systematic Reviews

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Delirium in elderly patients: Prospective prevalence across hospital services

Cited by 29 publications

References 52 publications

Poor outcomes of delirium in the intensive care units are amplified by increasing age: A retrospective cohort study

Poor outcomes of delirium in the intensive care units are amplified by increasing age: A retrospective cohort study

Identification of Risk Factors for Delirium, Cognitive Decline, And Dementia After Cardiac Surgery (FINDERI - Find Delirium Risk Factors): A Study Protocol of A Prospective Monocentric Observational Pilot Trial

Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) for the diagnosis of delirium in adults in critical care settings

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