Difficulties in diagnosing delirium in elderly patients in a general hospital

Merkin, A.; Borisov, Ilya V.; Shushkevitch, Alexandr; Dinov, E. N.; Brandt, Yekaterina I.; Cheremushkin, E.; Nikiforov, I. A.

doi:10.1016/j.ajp.2014.02.001

Cited by 5 publications

(2 citation statements)

References 10 publications

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“…In a PubMed literature search, we found only seven articles that are related to the prevalence of delirium in Russia 12 – 18 and only one of these was written in English. 15 …”

Section: Introductionmentioning

confidence: 99%

The diagnosis of delirium in an acute-care hospital in Moscow: what does the Pandora’s box contain?

Ткачева¹,

Runikhina²,

Верткин³

et al. 2017

CIA

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BackgroundDelirium, a common problem among hospitalized elderly patients, is not usually diagnosed by doctors for various reasons. The primary aim of this study was to evaluate the effect of a short training course on the identification of delirium and the diagnostic rate of delirium among hospitalized patients aged ≥65 years. The secondary aim was to identify the risk factors for delirium.MethodsA prospective study was conducted in an acute-care hospital in Moscow, Russia. Six doctors underwent a short training course on delirium. Data collected included assessment by the confusion assessment method for the intensive care units, sociodemographic data, functional state before hospitalization, comorbidity, and hospitalization indices (indication for hospitalization, stay in intensive care unit, results of laboratory tests, length of hospitalization, and in-hospital mortality).ResultsDelirium was diagnosed in 13 of 181 patients (7.2%) who underwent assessment. Cognitive impairment was diagnosed more among patients with delirium (30.0% vs 6.1%, P=0.029); Charlson comorbidity index was higher (3.6±2.4 vs 2.3±1.8, P=0.013); and Barthel index was lower (43.5±34.5 vs 94.1±17.0, P=0.000). The length of hospitalization was longer for patients with delirium at 13.9±7.3 vs 8.8±4.6 days (P=0.0001), and two of the 13 patients with delirium died during hospitalization compared with none of the 168 patients without delirium (P=0.0001).ConclusionAlthough the rate of delirium was relatively low compared with studies from the West, this study proves that an educational intervention among doctors can bring about a significant change in the diagnosis of the condition.

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“…In a PubMed literature search, we found only seven articles that are related to the prevalence of delirium in Russia 12 – 18 and only one of these was written in English. 15 …”

Section: Introductionmentioning

confidence: 99%

The diagnosis of delirium in an acute-care hospital in Moscow: what does the Pandora’s box contain?

Ткачева¹,

Runikhina²,

Верткин³

et al. 2017

CIA

View full text Add to dashboard Cite

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“…Even though delirium is classically described as a reversible condition, elderly patients have poorer outcomes. Its presence worsens the prognosis of the main condition and increases cognitive impairment, the length of hospital stays, institutionalization rates, functional disability, morbidity and mortality [12][13][14]. There are multiple risk factors for developing delirium, such as older age, functional disabilities, male gender, poor vision and hearing, medical and psychiatric pathology, cognitive impairment, laboratory abnormalities and alcohol abuse [15,16].…”

Section: Introductionmentioning

confidence: 99%

A Cross-Sectional, Retrospective, and Comparative Study between Delirium and Non-Delirium Psychiatric Disorders in a Psychogeriatric Inpatient Population Referred to Consultation-Liaison Psychiatry Unit

et al. 2023

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Background and objectives: Delirium is the most prevalent psychiatric disorder in inpatient older people. Its presence is associated with higher rates of institutionalization, functional disability and mortality. This study aims to evaluate delirium in a hospitalized psychogeriatric population, focusing on which factors predict the appearance of delirium, the impact it generates and the diagnostic concordance between non-psychiatric physicians and psychiatrists. Material and methods: This is an observational, cross-sectional, retrospective, and comparative study. We obtained data from a sample of 1017 patients (≥65 years) admitted to general hospital and referred from different services to the consultation-liaison psychiatry (CLP) unit. Logistic regression was performed using delirium as the dependent variable. To estimate the concordance of the diagnoses, the Kappa coefficient was used. To assess the impact of delirium, an ordinal regression, Wilcoxon median test and Fisher’s test were performed. Results: Delirium is associated with a higher number of visits, OR 3.04 (95% CI 2.38–3.88), longer length of stay and mortality, OR 2.07 (95% CI, 1.05 to 4.10). The model to predict delirium shows that being >75 years old has an OR of 2.1 (95% CI, 1.59–2.79), physical disability has an OR of 1.66 (95% CI, 1.25–2.20), history of delirium has an OR of 10.56 (95% CI, 5.26–21.18) and no use of benzodiazepines has an OR of 4.24 (95% CI, 2.92–6.14). The concordance between the referring physician’s psychiatric diagnosis and the psychiatrist CLP unit showed a kappa of 0.30. When analysing depression and delirium, the concordance showed Kappa = 0.46. Conclusions: Delirium is a highly prevalent psychiatric disorder, but it is still underdiagnosed, with low diagnostic concordance between non-psychiatric doctors and psychiatrists from CLP units. There are multiple risk factors associated with the appearance of delirium, which must be managed to reduce its appearance.

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Postoperative delirium after hysteroscopy in young woman

Liu¹,

Wang³

et al. 2019

Medicine

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Rationale: Postoperative delirium is extremely rare in young women and in minimally invasive endoscopic surgeries in gynecology and obstetrics. It greatly affects both physicians and patients. This report presents a special case of postoperative delirium after hysteroscopy in a young woman and a literature review of the associated etiology, diagnosis, and treatment. Patient concerns: A 39-year-old woman was admitted to the gynecology ward following irregular vaginal bleeding for 3 months and an intrauterine space-occupying lesion for 1 week. Hysteroscopy, endometrial polypectomy, and fractional curettage procedures were successfully performed; however, the patient became unresponsive after surgery. Diagnosis: Postoperative delirium. Interventions: Sedatives and vasoactive medicines, such as dexmedetomidine, midazolam, and dopamine were administered for maintenance treatment. Outcomes: The patients gradually regained consciousness. Lessons: Physicians should attach importance and improvise effective clinical management strategies for postoperative delirium based on clinical specialty characteristics and related guidelines.

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Difficulties in diagnosing delirium in elderly patients in a general hospital

Cited by 5 publications

References 10 publications

The diagnosis of delirium in an acute-care hospital in Moscow: what does the Pandora’s box contain?

The diagnosis of delirium in an acute-care hospital in Moscow: what does the Pandora’s box contain?

A Cross-Sectional, Retrospective, and Comparative Study between Delirium and Non-Delirium Psychiatric Disorders in a Psychogeriatric Inpatient Population Referred to Consultation-Liaison Psychiatry Unit

Postoperative delirium after hysteroscopy in young woman

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Difficulties in diagnosing delirium in elderly patients in a general hospital

Cited by 5 publications

References 10 publications

The diagnosis of delirium in an acute-care hospital in Moscow: what does the Pandora&rsquo;s box contain?

The diagnosis of delirium in an acute-care hospital in Moscow: what does the Pandora&rsquo;s box contain?

A Cross-Sectional, Retrospective, and Comparative Study between Delirium and Non-Delirium Psychiatric Disorders in a Psychogeriatric Inpatient Population Referred to Consultation-Liaison Psychiatry Unit

Postoperative delirium after hysteroscopy in young woman

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The diagnosis of delirium in an acute-care hospital in Moscow: what does the Pandora’s box contain?

The diagnosis of delirium in an acute-care hospital in Moscow: what does the Pandora’s box contain?