Impairments in balance and mobility identify delirium in patients with comorbid dementia

Gual, Neus; Richardson, Sarah; Davis, Daniel; Bellelli, Giuseppe; Hasemann, Wolfgang; Meagher, David; Kreisel, Stefan H.; MacLullich, Alasdair M.J.; Cerejeira, Joaquim; Inzitari, Marco; Morandi, Alessandro

doi:10.1017/s1041610218001345

Cited by 19 publications

(19 citation statements)

References 14 publications

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“…A novelty in this study was the documentation of the decline of full abilities, which reached 50-90%. Although evidence for activity (Yang et al, 2008), mobility and balance (Gual et al, 2019), as well as nutritional status and nutrients (Sanford and Flaherty, 2014) is vague on regular floors, this study confirmed gait and balance disturbances as well as nutritional aspects. Regarding the former, we have to assume that delirium caused gait and balance disturbances, and for latter, the energy and nutrient requirement, as well as parenteral nutrition and additional calories were increased.…”

supporting

confidence: 67%

“…Surprisingly, the literature on functional status in the delirious is rare and studied regular floors rather than the intensive care setting. As summarized in the Introduction, there is vague evidence for activity (Yang et al, 2008), mobility and balance in delirium superimposed on dementia (Gual et al, 2019), and nutritional status and nutrients in delirium contribution (Sanford and Flaherty, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…Comparison to the existing literature Surprisingly, the literature on functional status in the delirious is rare and studied regular floors rather than the intensive care setting. As summarized in the Introduction, there is vague evidence for activity (Yang et al, 2008), mobility and balance in delirium superimposed on dementia (Gual et al, 2019), and nutritional status and nutrients in delirium contribution (Sanford and Flaherty, 2014). The most comprehensive study to date assessed nursing tools for delirium identification and showed the following domains relevant to this study: Problems with nutrition and elimination, as well as self-care and mobility (Sola-Miravete et al, 2018).…”

mentioning

confidence: 95%

“…Further, lacking regular activity has been identified as a potential risk factor for delirium (Yang et al, 2008). For patients with delirium superimposed on dementia, both impaired mobility and balance helped identify delirium (Gual et al, 2019). In addition, nutritional status and nutrients have been hypothesized to contribute to delirium (Sanford and Flaherty, 2014).…”

Section: Introductionmentioning

confidence: 99%

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The utility of nursing instruments for daily screening for delirium: Delirium causes substantial functional impairment

et al. 2019

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AbstractObjectiveNursing assessments have been recommended for the daily screening for delirium; however, the utility of individual items have not yet been tested. In a first step in establishing the potential of the electronic Patient Assessment-Acute Care (ePA-AC) as such, the impact of delirium on the functional domains was assessed.MethodIn this prospective observational cohort study, 277 patients were assessed and 118 patients were delirious. The impact of delirium on functional domains of the ePA-AC related to self-initiated activity, nutrition, and elimination was determined with simple logistic regressions.ResultsPatients with delirium were older, sicker, were more commonly sedated during the assessment, stayed longer in the intensive care unit (ICU) and floors, and less commonly discharged home. A general pattern was the loss of abilities and full functioning equivalent to global impairment. For self-initiated mobility, in and out of the bed sizable limitations were noted and substantial inability to transfer caused friction and shearing. Similarly, any exhaustion and fatigue were associated with delirium. For self-initiated grooming and dressing, the impairment was greater in the upper body. Within the nutritional domain, delirium affected self-initiated eating and drinking, the amount of food and fluids, energy and nutrient, as well as parenteral nutrition requirement. In delirious patients, the fluid demand was rather increased than decreased, tube feeding more often required and dysphagia occurred. For the elimination domain, urination was not affected — of note, most patients were catheterized, whereas abilities to initiate or control defecation were affected.Significance of resultsDelirium was associated with sizable impairment in the level of functioning. These impairments could guide supportive interventions for delirious patients and perspectively implement nursing instruments for delirium screening.

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confidence: 67%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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The utility of nursing instruments for daily screening for delirium: Delirium causes substantial functional impairment

et al. 2019

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“…In fact, when analyzing motor function, impairments of worse motor function can be identified in patients with delirium in comparison with those without delirium, independently of the presence of underlying dementia [67]. These features have been used to improve the diagnosis of delirium superimposed on dementia (DSD), using only motor tools like the Tinetti scale or the Hierarchical Assessment of Balance and Mobility (HABAM) [35,67].…”

Section: (A) Disorders In Physical Function As Risk Factors For Deliriummentioning

confidence: 99%

The role of physical exercise and rehabilitation in delirium

et al. 2020

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Key summary pointsAim Analyze the intersections between delirium, physical exercise and rehabilitation, to better understand their interrelation and to visualize future lines of research. Findings Delirium and physical function are closely related, since physical dysfunction is described as a risk factor and as a symptom of delirium, and there are also short-and long-term functional consequences related to delirium. Furthermore, physical therapy strategies included in multicomponent interventions to prevent delirium, have shown to be effective in managing delirium. Another important risk factor for delirium is frailty, that given its condition of being reversible basically through rehabilitation programs, begins to play an important role in the prevention and management of delirium, although more studies are needed. Message Although delirium is catalogued as a neurocognitive disorder, scientific evidence shows that it is also a motor disorder. The motor component of delirium should be taken into account when designing interventions or strategies to address delirium. These interventions may have a special importance in frail older adults. AbstractPurpose This article aims to analyze the intersections between delirium, physical exercise and rehabilitation, to better understand their interrelation and to visualize future lines of research. Methods In this narrative review, after an overview of brain neurophysiology and function, as common substrates to understand the relationship between delirium and physical function, we explore the scientific evidence in: (1) physical dysfunction as a risk factor for delirium; (2) physical dysfunction as a symptom of delirium and (3) functional consequences related to delirium. Later, we analyze the physical therapy as one of the main strategies in multicomponent interventions to prevent delirium, by examining intervention studies including rehabilitation, which have shown to be effective in managing delirium. Finally, we analyze how frailty, delirium and physical exercise interact with each other. Results This review confirms the close relationship between delirium and physical dysfunction; therefore, it is not surprising that physical exercise is widely used in delirium preventive strategies. Although delirium is catalogued as a neurocognitive disorder, scientific evidence shows that it is also a motor disorder, which is to be expected, since a vast body of literature already supports an interaction between motor and cognitive function. Conclusion The motor component of delirium should be taken into account when designing interventions or strategies to address delirium. These interventions may have a special importance in frail older adults.

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Prevalence and management of delirium in community dwelling older people with dementia referred to a memory clinic

et al. 2020

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Impairments in balance and mobility identify delirium in patients with comorbid dementia

Cited by 19 publications

References 14 publications

The utility of nursing instruments for daily screening for delirium: Delirium causes substantial functional impairment

The utility of nursing instruments for daily screening for delirium: Delirium causes substantial functional impairment

The role of physical exercise and rehabilitation in delirium

Prevalence and management of delirium in community dwelling older people with dementia referred to a memory clinic

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