Delirium in the Aged

Liston, Edward H.

doi:10.1016/s0193-953x(18)30887-6

Cited by 67 publications

(23 citation statements)

References 34 publications

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“…Although the exact mechanisms by which delirium leads to these poor hospital outcomes need further investigation, the effect is plausible because delirium has been hypothesized to contribute to aspiration pneumonia; daytime somnolence with immobilization, pressure ulcers, and pulmonary emboli; use of psychoactive medications to control agitation and insomnia (with their attendant complications); injury; and related problems. [45][46][47][48] Thus, delirium serves as an important prognostic variable for hospitalized older patients, and should potentially be considered in case-mix adjustment or risk stratification systems in hospitalized older populations. At a minimum, delirium should be included as a control variable in studies examining hospital outcomes in acutely ill older persons.…”

Section: Discussionmentioning

confidence: 99%

Does delirium contribute to poor hospital outcomes?

et al. 1998

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OBJECTIVE:To determine the independent contribution of admission delirium to hospital outcomes including mortality, institutionalization, and functional decline. DESIGN:Three prospective cohort studies. SETTING: Three university-affiliated teaching hospitals.PATIENTS: Consecutive samples of 727 patients, aged 65 years and older. MEASUREMENTS AND MAIN RESULTS: Delirium, defined as an acute disorder of attention and global cognitive functioning, has assumed increasing importance in the United States, with the burgeoning population of older citizens. In 1993, 35% of the population aged 65 years and older was hospitalized during the year, accounting for 36% of all hospital stays and 48% of all days of hospital care. 1 The oldest group ( Ͼ 75 years) is the most rapidly growing sector of the U.S. population, 1 and is particularly vulnerable to developing delirium during acute illness and hospitalization. 2 Previous studies have estimated that delirium occurs in 14% to 56% of elderly hospitalized patients, with associated hospital mortality rates of 10% to 65%. 2 Previous studies have documented that delirium is associated with poor outcomes, such as increased mortality rates, prolonged length of hospital stay, increased rates of institutional placement, and functional and cognitive decline. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] However, the unanswered question remains: Does delirium itself contribute to this poor prognosis, or does delirium simply serve as a marker identifying patients with poor prognostic features due to severe illness, dementia, functional impairment, advanced age, and the like? Unfortunately, many of the previous studies, which were not all designed to address this research question directly, were hindered by inadequate control for these potential confounders and by small numbers of relatively infrequent outcome events.The objective of the present study was to examine the independent contribution of baseline delirium to hospital mortality, institutionalization, functional decline, and length of stay in three large prospective cohort studies of elderly hospitalized patients. 20 Uniform prospective data collection for this project facilitated collection of standardized information on delirium, study outcomes, and potential confounders. Our underlying hypothesis was that baseline delirium (present at admission) would be an important prognostic predictor even after controlling for underlying illness severity, age, dementia and functional status.

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Section: Discussionmentioning

confidence: 99%

Does delirium contribute to poor hospital outcomes?

et al. 1998

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“…Consequently, a large variation in the reported incidence rates and prevalence data are reported and the data should thus be interpreted with caution [1].…”

mentioning

confidence: 99%

Epidemiology of Delirium

Bucht

Gustafson

Sandberg³

1999

Dement Geriatr Cogn Disord

118

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Delirium is one of the most frequent symptoms of disease in the elderly. A large variation of incidence and prevalence data is reported probably due to different patient populations and inconsistent diagnostic criteria. In medical and surgical elderly inpatients recent studies report a prevalence rate of approximately 15% and in postoperative patients the incidence and prevalence rates vary greatly, 7–52%, depending on patient population and clinical setting. In nursing homes the prevalence is even higher and delirium is often combined with dementia. Data supports the statement that delirium is most often found in hospitalized somatically ill elderly patients. As a consequence of the rising number of elderly in hospitals we have to expect an increase in the prevalence and incidence of delirium.

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“…Em uma pesquisa conceitual, Liston (1982) relatou o uso da palavra delirium para mais de 30 estados patológicos, entre eles encefalopatia metabólica, psicose tóxica, psicose exógena, alterações agudas do nível de consciência. O delirium só entrou na nosografia psiquiátrica de forma sistemática em 1980, com a publicação da terceira edição do "Diagnostic and Statistical Manual of Mental Disorders" (DSM-III), pela Associação Psiquiátrica Americana (American Psychiatric Association, 1980).…”

Section: Delirium: Um Panorama Históricounclassified

Delirium: uma perspectiva histórica

Wacker

Nunes

Forlenza

2005

Rev. psiquiatr. clín.

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ResumoO delirium corresponde a uma das primeiras doenças mentais descritas na literatura médica, há mais de 2.500 anos. Nas classificações psiquiátricas, permaneceu como categoria nosológica independente até o final do século XIX, quando foi redefinida com base nos seus aspectos fenomenológicos e etiológicos, precipitando a reclassificação das insanidades funcionais em psicoses. Os estados confusionais passaram a se referir a uma síndrome mais ampla que incluía o delirium, enfatizando a desorganização dos processos cognitivos e do pensamento, e tendo no turvamento da consciência e na desorientação temporoespacial a condição de base. Com o objetivo de descrever a evolução histórica do conceito de delirium, foram realizados levantamentos da literatura médica através do sistema Medline, além da pesquisa em publicações literárias específicas sobre os temas história da medicina e história da psiquiatria. Partiuse de algumas observações dogmáticas praticadas na Antigüidade e Idade Média, para atingir as definições e práticas atuais, oferecendo uma análise crítica dos critérios diagnósticos vigentes (DSM-III, DSM-IIIR, DSM-IV e CID-10). Não obstante a evolução conceitual, o delirium continua sendo mal compreendido, do ponto de vista fisiopatológico e são poucas as opções terapêuticas. O diagnós-tico de delirium é ato eminentemente clínico: baseia-se na observação cautelosa das manifestações psíquicas e comportamentais dos pacientes acometidos, além da análise dos fatores predisponentes e precipitantes. É freqüente o seu subdiagnóstico em contextos clínicos e cirúrgicos. O diagnóstico do delirium é estabelecido em apenas 30% a 50% dos pacientes, sendo a omissão diagnóstica menos freqüente em serviços que contam com a interconsulta psiquiátrica. O delirium é uma das complicações mais comuns entre pacientes idosos hospitalizados e está associado a maior morbimortalidade. Isso sustenta a importância do seu pronto reconhecimento e manejo.Palavras-chave: Delirium, transtorno mental orgânico, diagnóstico, aspectos históricos.

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Delirium in the Aged

Cited by 67 publications

References 34 publications

Does delirium contribute to poor hospital outcomes?

Does delirium contribute to poor hospital outcomes?

Epidemiology of Delirium

Delirium: uma perspectiva histórica

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