Delirium in older hospitalized patients—signs and actions: a retrospective patient record review

Abstract

BackgroundDelirium is common in older hospitalized patients, and is associated with negative consequences for the patients, next of kin, healthcare professionals and healthcare costs. It is important to understand its clinical features, as almost 40% of all cases in hospitals may be preventable. Yet, delirium in hospitalized patients is often unrecognized and untreated. Few studies describe thoroughly how delirium manifests itself in older hospitalized patients and what actions healthcare professionals take in relation to these signs. Therefore, the aim of this study was to describe signs of delirium in older hospitalized patients and action taken by healthcare professionals, as reported in patient records.MethodsPatient records from patients aged ≥65 (n = 286) were retrospectively reviewed for signs of delirium, which was found in 78 patient records (27%). Additionally, these records were reviewed for action taken by healthcare professionals in relation to the patients’ signs of delirium. The identified text was analyzed with qualitative content analysis in two steps.ResultsHealthcare professionals responded only in part to older hospitalized patients’ needs of care in relation to their signs of delirium. The patients displayed various signs of delirium that led to a reduced ability to participate in their own care and to keep themselves free from harm. Healthcare professionals met these signs with a variation of actions and the care was adapted, deficient and beyond the usual care. A systematic and holistic perspective in the care of older hospitalized patients with signs of delirium was missing.ConclusionImproved knowledge about delirium in hospitals is needed in order to reduce human suffering, healthcare utilization and costs. It is important to enable older hospitalized patients with signs of delirium to participate in their own care and to protect them from harm. Delirium has to be seen as a preventable adverse event in all hospitals units. To improve the prevention and management of older hospitalized patients with signs of delirium, person-centered care and patient safety may be important issues.

Delirium Assessment in Older People in Emergency Departments. A Literature Review

“…In hospitalized older patients, delirium is the most frequent complication, with an approximate prevalence of 27% [13,14].…”

<p>Diverging Awareness of Postoperative Delirium and Cognitive Dysfunction in German Health Care Providers</p>

“…7,[40][41][42][43] A holistic and trans-sectoral perspective, especially for geriatric patients, seems to be missing. 10 Consequently, recommendations concerning delirium risk assessment as an indispensable part of the joint decision-making process for an elective procedure are usually missing too. Effective (risk) communication, however, is an ethical requirement of each patient-physician relationship, and deficits could even imply legal consequences.…”

“…7 Consequences of delirium include POCD, and both are associated with worse clinical outcomes (including increased length of hospital stays and long-term care utilization) and higher mortality. [8][9][10][11] Also, long-term cognitive impairment and dementia can be triggered and aggravated. 2,11,12 POCD, therefore, constitutes a significant burden to the healthcare system 13,14 as well as to patients and families.…”

Consolidated framework for advancing implementation science for the implementation process and adherence assessment of a non‐pharmacological delirium prevention program

“…Because of the evidence for their efficacy, many clinical guidelines and scientific societies promote routine use of these interventions in clinical practice 10,11 . However, despite evidence for the efficacy of these prevention tools going back more than 15 years, their global implementation remains insufficient 12–14 . nPPD consist of a complex transdisciplinary intervention, requiring efficient inter‐professional teamwork among physicians, nurses, physiotherapists, occupational therapists, patients and relatives that are difficult implement in daily clinical activities 15–18 .…”