Delirium is associated with increased mortality in the geriatric population

Taşar, Pınar Tosun; Şahin, Sevnaz; Akcam, Nur Ozge; Dinçkal, Çiğdem; Ulusoy, Merve Gülşah; Sarıkaya, Ozan Fatih; Duman, Soner; Akçiçek, Fehmi; Noyan, Ayşın

doi:10.1080/13651501.2017.1406955

Cited by 21 publications

(9 citation statements)

References 35 publications

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“…Delirium incidences increase in patients over 65 years, and in selected patients, haloperidol or second-generation antipsychotics can be used to reduce agitation and hyperactivity. 35,36 In this study, quetiapine was ranked first among medications with the highest possible DRP count among nervous system drugs and was also found to almost always (97.5%) cause possible drug interactions when prescribed. As polypharmacy is a factor known to increase mortality in patients with delirium, 36 pharmacists should control quetiapine orders for interactions and other DRPs.…”

Section: Discussionmentioning

confidence: 63%

“…35,36 In this study, quetiapine was ranked first among medications with the highest possible DRP count among nervous system drugs and was also found to almost always (97.5%) cause possible drug interactions when prescribed. As polypharmacy is a factor known to increase mortality in patients with delirium, 36 pharmacists should control quetiapine orders for interactions and other DRPs. Depression is common in older individuals and selective serotonin reuptake inhibitors (SSRIs) are prescribed as first-line treatment, though drug interactions are common in patients with polypharmacy.…”

Section: Discussionmentioning

confidence: 63%

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<p>Evaluation of pharmacist interventions and commonly used medications in the geriatric ward of a teaching hospital in Turkey: a retrospective study</p>

Ertuna

Arun

et al. 2019

CIA

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Aging increases the prevalence of diseases. The elderly population is consequently often exposed to complex medication regimens. Increased drug use is one of the main reasons for drug-related problems (DRPs). The primary objective of this study was to define and classify DRPs, pharmacist interventions, and frequently prescribed medications in relation to possible DRPs in patients admitted to the geriatric ward of a teaching hospital in Turkey. Patients and methods: Pharmacist medication review reports for 200 orders of 91 patients (mean age: 80.33±0.46) were analyzed retrospectively. Results: A total of 1,632 medications were assessed and 329 interventions were proposed for possible DRPs in 156 orders. A total of 87.5% of the patients used five or more drugs (mean: 8.17±0.23). The number of DRPs per order was higher when polypharmacy was present (1.04±0.15 vs 1.66±0.11, P,0.05). In 71.31% of the cases, adverse drug events were recognized as the problem. The principal cause of possible DRPs was determined as drug interactions (40.12%). Only 22 potentially inappropriate medications were prescribed. The most common interventions included monitoring drug therapy (31.0%), stopping the drug (20.06%), and changing dosage (13.98%). The acceptance rate of pharmacist interventions by treating geriatrician was 85.41%. The most frequently prescribed drugs were for the nervous system, alimentary tract and metabolism, and cardiovascular system (n=358, 314, and 304, respectively). The pharmaceutical forms of 23 drugs were deemed inappropriate by pharmacists. Conclusion: Clinical pharmacy services are still not properly implemented in Turkey. The study highlights ways in which clinical pharmacy services can be instrumental in a geriatric ward. The high acceptance rates of pharmacist recommendations concerning a wide variety of DRPs and different classes of drugs indicate that advanced collaboration among geriatricians and pharmacists is possible in interdisciplinary geriatric assessment teams in Turkey.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 63%

<p>Evaluation of pharmacist interventions and commonly used medications in the geriatric ward of a teaching hospital in Turkey: a retrospective study</p>

Ertuna

Arun

et al. 2019

CIA

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“…Moreover, the prevalence of delirium in terminally ill patients can increase up to 90% (Casarett and Inouye, 2001; Hosie et al, 2013). Delirium is associated with an unfavorable short- and long-term prognosis, including prolonged hospital length of stay (LOS), cognitive decline, and increased morbidity, need for long-term care institutionalization, and mortality (Lawlor et al, 2014; Boettger et al, 2015; Dani et al, 2017; Diwell et al, 2018; Tosun Tasar et al, 2018; Harris et al, 2019). In addition, delirium in palliative care patients is associated with a lower median overall survival relative to those without delirium (de la Cruz et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Predisposing and precipitating risk factors for delirium in palliative care patients

Seiler

Schubert

Hertler³

et al. 2019

Pall Supp Care

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Objective Delirium is a common complication in palliative care patients, especially in the terminal phase of the illness. To date, evidence regarding risk factors and prognostic outcomes of delirium in this vulnerable population remains sparse. Method In this prospective observational cohort study at a tertiary care center, 410 palliative care patients were included. Simple and multiple logistic regression models were used to identify associations between predisposing and precipitating factors and delirium in palliative care patients. Results The prevalence of delirium in this palliative care cohort was 55.9% and reached 93% in the terminally ill. Delirium was associated with prolonged hospitalization (p < 0.001), increased care requirements (p < 0.001) and health care costs (p < 0.001), requirement for institutionalization (OR 0.11; CI 0.069–0.171; p < 0.001), and increased mortality (OR 18.29; CI 8.918–37.530; p < 0.001). Predisposing factors for delirium were male gender (OR 2.19; CI 1.251–3.841; p < 0.01), frailty (OR 15.28; CI 5.885–39.665; p < 0.001), hearing (OR 3.52; CI 1.721–7.210; p < 0.001), visual impairment (OR 3.15; CI 1.765–5.607; p < 0.001), and neoplastic brain disease (OR 3.63; CI 1.033–12.771; p < 0.05). Precipitating factors for delirium were acute renal failure (OR 6.79; CI 1.062–43.405; p < 0.05) and pressure sores (OR 3.66; CI 1.102–12.149; p < 0.05). Significance of results Our study identified several predisposing and precipitating risk factors for delirium in palliative care patients, some of which can be targeted early and modified to reduce symptom burden.

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“…PND is associated with several poor prognosis, such as higher mortality, long-term cognitive decline, dementia, re-admission and prolonged length of hospitalization. It also increases the financial burdens to the public, reaching up to $ 16 billion for US health care cost every year [5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Effects of electroencephalography and regional cerebral oxygen saturation monitoring on perioperative neurocognitive disorders: a systematic review and meta-analysis

Ding

Chen

2020

BMC Anesthesiol

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Background Perioperative neurocognitive disorders (PND) is a common postoperative complication including postoperative delirium (POD), postoperative cognitive decline (POCD) or delayed neurocognitive recovery. It is still controversial whether the use of intraoperative cerebral function monitoring can decrease the incidence of PND. The purpose of this study was to evaluate the effects of different cerebral function monitoring (electroencephalography (EEG) and regional cerebral oxygen saturation (rSO2) monitoring) on PND based on the data from randomized controlled trials (RCTs). Methods The electronic databases of Ovid MEDLINE, PubMed, EMBASE, Cochrane Library database were systematically searched using the indicated keywords from their inception to April 2020. The odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) were employed to analyze the data. Heterogeneity across analyzed studies was assessed with chi-square test and I2 test. Results Twenty two RCTs with 6356 patients were included in the final analysis. Data from 12 studies including 4976 patients were analyzed to assess the association between the EEG-guided anesthesia and PND. The results showed that EEG-guided anesthesia could reduce the incidence of POD in patients undergoing non-cardiac surgery (OR: 0.73; 95% CI: 0.57–0.95; P = 0.02), but had no effect on patients undergoing cardiac surgery (OR: 0.44; 95% CI: 0.05–3.54; P = 0.44). The use of intraoperative EEG monitoring reduced the incidence of POCD up to 3 months after the surgery (OR: 0.69; 95% CI: 0.49–0.96; P = 0.03), but the incidence of early POCD remained unaffected (OR: 0.61; 95% CI: 0.35–1.07; P = 0.09). The remaining 10 studies compared the effect of rSO2 monitoring to routine care in a total of 1380 participants on the incidence of PND. The results indicated that intraoperative monitoring of rSO2 could reduce the incidence of POCD (OR 0.53, 95% CI 0.39–0.73; P < 0.0001), whereas no significant difference was found regarding the incidence of POD (OR: 0.74; 95% CI: 0.48–1.14; P = 0.17). Conclusions The findings in the present study indicated that intraoperative use of EEG or/and rSO2 monitor could decrease the risk of PND. Trial registration PROSPREO registration number: CRD42019130512.

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Delirium is associated with increased mortality in the geriatric population

Abstract: Independent of all other factors, delirium is associated with higher mortality risk.

Cited by 21 publications

References 35 publications

<p>Evaluation of pharmacist interventions and commonly used medications in the geriatric ward of a teaching hospital in Turkey: a retrospective study</p>

<p>Evaluation of pharmacist interventions and commonly used medications in the geriatric ward of a teaching hospital in Turkey: a retrospective study</p>

Predisposing and precipitating risk factors for delirium in palliative care patients

Effects of electroencephalography and regional cerebral oxygen saturation monitoring on perioperative neurocognitive disorders: a systematic review and meta-analysis

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