Delirium superimposed on dementia: A quantitative and qualitative evaluation of patient experience

Abstract

Objective Delirium superimposed on dementia is common and is associated with adverse outcomes. Yet little is known about the patients’ personal delirium experiences. We used quantitative and qualitative methods to assess the delirium superimposed on dementia experience among older patients. Methods We conducted a prospective cohort study among patients with delirium superimposed on dementia who were admitted to a rehabilitation ward. Delirium was diagnosed using DSM-IV-TR criteria. Delirium severity and symptoms were evaluated with the Delirium-O-Meter (D-O-M). The experience of delirium was assessed after delirium resolution (T0) and one month later (T1) with a standardized questionnaire and a qualitative interview. Level of distress was measured with the Delirium Experience Questionnaire. Results Of the 30 patients included in the study, 50% had mild dementia; 33% and 17% had moderate and severe dementia. Half of the patients had evidence of the full range of D-O-M delirium symptoms. We evaluated 30 patients at T0 and 20 at T1. At T0, half of the patients remembered being confused as part of the delirium episode, and reported an overall moderate level of related distress. Patients reported high distress related to memories of anxiety/fear, delusions, restlessness, hypokinesia, and impaired orientation. Qualitative interviews revealed six main aspects of patients delirium experiences: Emotions; Cognitive Impairment; Psychosis; Memories; Awareness of Change; and Physical Symptoms. Conclusions The study provides novel information on the delirium experience in patients with dementia. These findings are key for health care providers to improve the everyday care of this important group of frail older patients.

Detecting Delirium Superimposed on Dementia: Evaluation of the Diagnostic Performance of the Richmond Agitation and Sedation Scale

“…However, the negative and positive scores have also been used to characterize motor performances in patients with delirium. 18, 19, 23 Motor performances have indeed been shown in previous investigations to be useful for DSD detection. Bellelli reported a clear change in the functional status of older patients with DSD and with a recovery after delirium resolution.…”

“…This population has been previously described. 18, 19 The presence of dementia was determined by reviewing patient medical records. Additionally, two expert neuropsychologists confirmed and rated the severity of dementia by interviewing the caregivers at the time of enrollment using the Clinical Dementia Rating (CDR) Scale 20 and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), with a cut-off of 3.3 used to indicate cognitive impairment.…”

A Point Prevalence Study of Delirium in Italian Nursing Homes

“…It is associated with negative outcomes, such as decline in cognitive and functional status [3][4][5], prolonged hospitalization, increased morbidity and mortality, and finally higher health care costs [2,6,7]. It is also a major source of distress for patients, caregivers, and health care providers [8,9]. Despite this, it is often unrecognized by nurses and physicians during their usual practice [10], leading to a delay in identification of the delirium itself, as well as of potentially severe underlying medical conditions, and thus impairing the patient prognosis [2,6].…”

The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders

“…Delirium, characterized by acute impairment of attention and cognition, is common in seriously ill hospitalized older adults and associated with adverse outcomes . Older adults with Alzheimer disease and related disorders (ADRDs) are especially vulnerable to developing delirium . Delirium can be burdensome for patient and caregiver owing to the subjective distress (ie, fear, anxiety, suffering) associated with the experiential, emotional, and situational aspects of delirium .…”