Increasing the Recognition of Delirium in Elderly Patients

Rockwood, Kenneth; Cosway, S; Stolee, Paul; Kydd, David M.; Carver, Daniel; Jarrett, Pamela; O’Brien, Brian

doi:10.1111/j.1532-5415.1994.tb01747.x

Cited by 154 publications

(130 citation statements)

References 21 publications

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“…Infection, cardiovascular diseases, metabolic disturbances, and drug use or withdrawal are the most frequent causes of delirium 4,5 . Only 33-64% of the patients with delirium are correctly identified by practicing physician [6][7][8][9][10] …”

Section: Resumo -O Presente Estudo Testou a Validade E Confiabilidadementioning

confidence: 99%

Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly

Fabbri

Moreira

Garrido

et al. 2001

Arq. Neuro-Psiquiatr.

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-This study has tested the validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM), a diagnostic assessment instrument for delirium developed by Inouye et al. (1990). The sample was formed by 100 patients with 60 and more years of age, admitted at the emergency service of Santa Casa de São Paulo, in the time periods between July and August, 1996, November and December, 1996 and February and March, 1997. The sensibility was 94.1% and specificity 96.4%. The assessors reliability in a sample of the 24 patients resulted in a kappa = 0.70. We have concluded that CAM is an adequate instrument to assess the presence of delirium, reliable to assess elderly patients at the emergency services.KEY WORDS: delirium ,elderly, emergency service, validity, CAM.Validação e confiabilidade da versão em língua portuguesa do confusion assessment method (CAM) para a detecção de delirium no idoso. RESUMO -O presente estudo testou a validade e confiabilidade da versão em língua portuguesa do ConfusionAssessment Method (CAM), instrumento de avaliação diagnóstica de delirium desenvolvido por Inouye e col. (1990). A amostra foi composta de 100 pacientes com idade igual ou superior a 60 anos atendidos no serviço de urgência da Santa Casa de São Paulo nos períodos de julho a agosto de 1996, novembro a dezembro de 1996 e fevereiro a março de 1997. Os resultados apontaram sensibilidade de 94,1% e especificidade de 96,4%. Confiabilidade entre avaliadores em subgrupos de 24 pacientes produziu kappa = 0,70. Concluimos que o CAM é um instrumento que afere a presença de delirium de forma adequada e que pode ser utilizado de forma confiável na avaliação de pacientes idosos atendidos em serviços de urgência. PALAVRAS-CHAVE: delirium, idoso, serviço de urgência, validação, CAM. Presently, delirium is defined as an organic brain syndrome without specific etiology, characterized by the simultaneous presence of disturbances related to consciousness and attention, perception, thinking, memory, psychomotor behavior, emotions and sleep-wake cycle 1 . Prevalence studies indicate that delirium is present in 10-24% of adults admitted to hospital and that another 32% will develop the disorder as inpatients 2,3 . Typical symptoms of delirium include reduced ability to focus and maintain attention, memory deficits, disorientation, language difficulties, illusions, hallucinations, and many other behavioral abnormalities. Infection, cardiovascular diseases, metabolic disturbances, and drug use or withdrawal are the most frequent causes of delirium 4,5 . Only 33-64% of the patients with delirium are correctly identified by practicing physician [6][7][8][9][10]

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Section: Resumo -O Presente Estudo Testou a Validade E Confiabilidadementioning

confidence: 99%

Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly

Fabbri

Moreira

Garrido

et al. 2001

Arq. Neuro-Psiquiatr.

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“…1 It is common in both elderly medical and surgical patients 1,2 and is associated with an increase in mortality, morbidity, rate of admission to long-term care institutions, and length of hospitalization. 3,4 Delirium is often not recognized, [5][6][7] and intervention benefits to date have shown to be limited. [8][9][10] Thus, prevention through identification of a high-risk group is indicated.…”

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confidence: 99%

Delirium risk factors in elderly hospitalized patients

et al. 1998

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OBJECTIVE: Delirium is frequent in elderly hospitalized patients. Many studies have examined its risk factors, but results have been quite variable. Thus, the goal of this study is to identify through systematic literature review the risk factors associated with the development of delirium in hospitalized geriatric patients. MEASUREMENTS AND MAIN RESULTS:First, MEDLINE / CURRENT CONTENTS databases were screened for relevant articles published from 1966 to December 1995, and from bibliographies of identified articles additional reports were selected. Second, the reports were screened by two different investigators and retained only if meeting the five following criteria: (1) original research in French or English; (2) prospective study; (3) patients over age 50; (4) minimum of one risk factor examined; (5) acceptable definition of delirium. Third, the methodology of each study was graded according to specific criteria for risk factor studies. Fourth, risk factors were identified and tabulated, unadjusted odds ratios (ORs) were computed, and where appropriate a combined OR with the Mantel-Haenszel estimator was calculated. Twenty-seven articles were retained meeting all of the above criteria. Among these studies, 11 were done on medical patients, 9 on surgical patients, 2 on medical and surgical patients, and 5 on psychiatric patients. In total 1,365 subjects with delirium were studied. Sixty-one different risk factors were examined, the five most common being dementia, medication, medical illness, age, and male gender. Mantel-Haenszel estimator was calculated for 10 risk factors, the most strongly associated being dementia (OR 5.2; 95% confidence interval [CI] 4.2, 6.3), medical illness (OR 3.8; 95% CI 2.2, 6.4), alcohol abuse (OR 3.3; 95% CI 1.9, 5.5), and depression (OR 1.9; 95% CI 1.3, 2.6). Methodologic weaknesses were present in many studies.

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“…However, along with educational programs and training [29][30][31], there is an urgent need for educational emphasis on delirium in medical and nursing schools. Given the prevalence of delirium among older patients, a change in hospital culture as well as in health care provider's training is needed.…”

Section: Discussionmentioning

confidence: 99%

Nursing Staff Knowledge on Postoperative Delirium in Older Inpatients: An Exploratory Survey

Mouchoux¹,

Fassier²,

Rippert³

et al. 2016

Adv Practice Nurs

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Background/Objectives: Postoperative delirium is common in the elderly and is associated with poor outcome. However, its diagnosis is often missed or delayed. Nursing staff is at the frontline and plays a crucial role in the early detection and management of delirium. This study was designed to explore the knowledge and attitudes of nursing staff about delirium in the scope of an educational program implementation. Methods:Qualitative and quantitative analyses conducted in four surgical wards and one intensive care unit in an Academic Hospital in France. A questionnaire was administered to 171 nurses and nursing assistants and semistructured interviews were conducted.Results: A total of 89 questionnaires were completed (response rate of 52%). Regarding symptoms, most of the nursing staff knew about disorientation and incoherent speech. However, few knew about acute onset and fluctuation, and the hypoactive form of delirium was virtually unknown. Regarding risk factors, while many knew about dehydration, drug use and the use of physical restraints, few knew about fecaloma, sensory impairment and infection. The staff globally knew about the main prevention measures, but knowledge on patient management was especially poor. Finally, no respondent knew about or used the Confusion Assessment Method. The qualitative analysis revealed a trivialization of delirium onset among older inpatients and the continuity of preconceived ideas on delirium, its diagnosis and its risk factors. Conclusions:On the whole, this study provides a clearer understanding of staff learning needs and identifies potential issues to be addressed in order to increase future intervention efficacy.

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Increasing the Recognition of Delirium in Elderly Patients

Abstract: A simple educational intervention aimed at house staff appears to be effective in changing house staff behavior. Improved recognition of delirium may lead to better patient outcomes.

Cited by 154 publications

References 21 publications

Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly

Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly

Delirium risk factors in elderly hospitalized patients

Nursing Staff Knowledge on Postoperative Delirium in Older Inpatients: An Exploratory Survey

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