Delirium og kognitiv svikt blant eldre i norske akuttmottak

Evensen, Sigurd; Saltvedt, Ingvild; Ranhoff, Anette Hylen; Myrstad, Marius; Myrstad, Christian; Mellingsæter, Marte; Wang-Hansen, Marte Sofie; Neerland, Bjørn Erik

doi:10.4045/tidsskr.18.0578

Cited by 17 publications

(19 citation statements)

References 20 publications

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“…Kun tilfeller hvor det forelå tydelig dokumentasjon av endring i kognitiv funksjon, bevissthet eller oppmerksomhet basert på opplysninger fra pårørende eller helsepersonell, ble klassifisert som akutt forvirring, delirium eller subsyndromalt delirium. I andre pasientgrupper er det godt dokumentert at tidlig oppdagelse av delirium og ikkemedikamentelle tiltak kan bedre prognosen (32), og det geriatriske fagmiljøet i Norge har tidligere tatt til orde for å innføre systematisk deliriumscreening blant pasienter innlagt på sykehus (33), for eksempel ved hjelp av screeningverktøyet 4AT. Dette verktøyet er enkelt og tar kort tid å bruke, men opplaering er nødvendig for å oppnå god kvalitet (34).…”

Section: Diskusjonunclassified

Komplikasjoner og dødelighet blant pasienter innlagt med covid-19

Ihle‐Hansen¹,

Berge²,

Ernø³

et al. 2020

Tidsskriftet

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Section: Diskusjonunclassified

Komplikasjoner og dødelighet blant pasienter innlagt med covid-19

Ihle‐Hansen¹,

Berge²,

Ernø³

et al. 2020

Tidsskriftet

Self Cite

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“…Eldre, kronisk syke pasienter tåler dårlig travle, uoversiktlige og skiftende miljø. Våre informanter bekreftet bekymringen som Evensen og medarbeidere i en originalartikkel har uttrykt for at overbelegg, kort liggetid og lav bemanning bidrar til dårligere pasientbehandling (14). Informantene beskrev videre at utskrivningsprosessen ble påvirket av kapasitetspress, med hyppigere og tidligere utskrivninger, hvor kommunikasjonen med kommunen var formalisert og forhandlingspreget.…”

Section: Diskusjonunclassified

Helsepersonells oppfattelse av kapasitetspress i spesialisthelsetjenesten

Nilsen¹,

Asheim²,

Tøndel³

2019

Tidsskriftet

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“…Cognitive impairment and delirium are highly prevalent among acutely ill older people, and might further complicate the diagnostic evaluation. The incidence of delirium increases with increasing age [6][7][8][9], and infections are among the most common precipitating factors [9,10]. Delirium refers to a clinical state characterized by an acute alteration in alertness and attention, with an additional disturbance in cognition (i.e., memory de cit, disorientation, perception or language) that develops over a short period of time.…”

Section: Introductionmentioning

confidence: 99%

Delirium screening with 4AT in patients aged 65 years and older admitted to the Emergency Department with suspected sepsis – a prospective cohort study

Myrstad

Kuwelker

Haakonsen

et al. 2021

Preprint

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Background Cognitive impairment is common among acutely ill older patients admitted to hospital. The quick Sequential Organ Failure Assessment (qSOFA) is recommended as a tool to predict poor outcome in patients with suspected sepsis, but assesses cognitive function crudely. We aimed to study the feasibility of The 4 'A's test (4AT), a rapid delirium screening tool, performed upon Emergency Department (ED) admission by nurses and doctors inexperienced with this tool, and to characterize patients aged ≥ 65 years admitted to the ED with suspected sepsis. Methods In this prospective cohort study, we included patients aged ≥ 65 years, admitted to the EDs of two Norwegian general hospitals, with suspected sepsis. ED nurses and doctors performed delirium screening with 4AT within two hours after ED admission, and registered the time spent on the screening in each case. Sepsis and delirium during the hospital stay were diagnosed retrospectively, according to recommended diagnosis criteria. Results Out of the 196 patients included (mean age 81 years), 100 patients fulfilled the sepsis diagnosis criteria. Mean 4AT screening time was 2.5 minutes (median two minutes). While qSOFA identified 48 patients (24%) with altered mental status, 114 patients (58%) had a 4AT score ≥ 1, indicating cognitive impairment, upon ED admission. Sepsis patients more often had a 4AT score ≥ 4, indicating delirium, than patients without sepsis (40% vs. 26%, p < 0.05). The prevalence of delirium any time during the hospital stay was 44% in patients aged 65–80 years, 57% in patients aged ≥ 80 years, and 76% in patients aged ≥ 80 years with sepsis. Conclusions Delirium screening upon ED admission, with 4AT performed by nurses and doctors inexperienced with this tool, was feasible among patients aged ≥ 65 years admitted with suspected sepsis. Features of delirium were common upon ED admission, particularly in patients with sepsis. The prevalence of delirium anytime during the hospital stay was highest among patients aged 80 years and older with sepsis. Our findings suggest increased awareness of delirium in older patients admitted to the ED with suspected sepsis, but the added value of systematic delirium screening with 4AT needs to be addressed in future studies.

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Delirium og kognitiv svikt blant eldre i norske akuttmottak

Cited by 17 publications

References 20 publications

Komplikasjoner og dødelighet blant pasienter innlagt med covid-19

Komplikasjoner og dødelighet blant pasienter innlagt med covid-19

Helsepersonells oppfattelse av kapasitetspress i spesialisthelsetjenesten

Delirium screening with 4AT in patients aged 65 years and older admitted to the Emergency Department with suspected sepsis – a prospective cohort study

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