Italian intersociety consensus on prevention, diagnosis, and treatment of delirium in hospitalized older persons

Bellelli, Giuseppe; Morandi, Alessandro; Trabucchi, Marco; Caironi, Guido; Coen, Daniele; Fraticelli, Carlo; Paolillo, Ciro; Prevaldi, Carolina; Riccardi, A.; Cervellin, Gianfranco; Carabellese, Corrado; Putignano, Salvatore; Maggi, Stefania; Cherubini, Antonio; Gnerre, Paola; Fontanella, Andrea; Latronico, Nicola; Tommasino, Concezione; Corcione, Antonio; Ricevuti, Giovanni; Ferrara, Nicola; Filippi, Francesco De; Ferrari, Alberto; Guarino, Mario; Ruggieri, Maria Pia; Modesti, Pietro Amedeo; Locatelli, Carlo; Hrelia, Patrizia; M, Toscano; Bondi, Emi; Tarasconi, Antonio; Ansaloni, Luca; Perticone, Francesco

doi:10.1007/s11739-017-1705-x

Cited by 28 publications

(26 citation statements)

References 63 publications

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“…It is also important to recognize the potential role of family and caregivers in supporting the patient. Flexibility of visiting hours, and the use of investigative tools to determine the patient’s needs and preferences, should be encouraged [ 146 ].…”

Section: Postoperative Carementioning

confidence: 99%

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

et al. 2020

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Background Surgical outcomes in geriatric patients may be complicated by factors such as multiple comorbidities, low functional performance, frailty, reduced homeostatic capacity, and cognitive impairment. An integrated multidisciplinary approach to management is, therefore, essential in this population, but at present, the use of such an approach is uncommon. The Perioperative Management of Elderly patients (PriME) project has been established to address this issue. Aims To develop evidence-based recommendations for the integrated care of geriatric surgical patients. Methods A 14-member Expert Task Force of surgeons, anesthetists, and geriatricians was established to develop evidence-based recommendations for the pre-, intra-, and postoperative care of hospitalized older patients (≥ 65 years) undergoing elective surgery. A modified Delphi approach was used to achieve consensus, and the strength of recommendations and quality of evidence was rated using the U.S. Preventative Services Task Force criteria. Results A total of 81 recommendations were proposed, covering preoperative evaluation and care (30 items), intraoperative management (19 items), and postoperative care and discharge (32 items). Conclusions These recommendations should facilitate the multidisciplinary management of older surgical patients, integrating the expertise of the surgeon, the anesthetist, the geriatrician, and other specialists and health care professionals (where available) as needed. These roles may vary according to the phase and setting of care and the patient’s conditions.

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Section: Postoperative Carementioning

confidence: 99%

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

et al. 2020

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“…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]. Early identification of older patients at high risk of delirium due to the presence of predisposing and precipitating risk factors allows the implementation of multifactorial intervention that can reduce delirium incidence by more than 30% in hospital settings [11,12].…”

Section: Introductionmentioning

confidence: 99%

A Point Prevalence Study of Delirium in Italian Nursing Homes

Morichi

Fedecostante

Morandi

et al. 2018

Dement Geriatr Cogn Disord

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Background: Delirium is a common geriatric syndrome. Few studies have been conducted in nursing home (NH) residents. The aim of this project was to perform a point prevalence study of delirium in Italian NHs. Methods: Data collected in 71 NHs are presented. Inclusion criteria were age ≥65 years and native Italian speaker. Exclusion criteria were coma, aphasia, and end-of-life status. Sociodemographic and medical data were recorded. Delirium was assessed using the Assessment Test for Delirium and Cognitive Impairment (4-AT). Patients with a 4-AT score ≥4 were considered to have delirium. Motor subtype was evaluated using the Delirium Motor Subtype Scale (DMSS). Results: A total of 1,454 patients were evaluated (mean age 84.4 ± 7.4 years, 70.2% female), of whom 535 (36.8%) had delirium. In multivariate logistic regression analysis, variables significantly associated with delirium were education (OR 0.94, 95% CI 0.91–0.97), dementia (OR 3.12, 95% CI 2.38–4.09), functional dependence (OR 6.13, 95% CI 3.08–12.19 for ADL score 0; OR 1.99, 95% CI 1.03–3.84 for ADL score 1–5), malnutrition (OR 4.87, 95% CI 2.68–8.84), antipsychotics (OR 2.40, 95% CI 1.81–3.18), and physical restraints (OR 2.48, 95% CI 1.71–3.59). Conclusion: Delirium is common in older NH residents. Simple assessment tools might facilitate its recognition in this vulnerable population.

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“…Recently, many Italian scientific societies produced a report to emphasize the importance of recognizing, understanding, and managing delirium in hospitalized older persons [26]. In detail, they convened to develop a collaborative multidisciplinary initiative report on delirium in elderly hospitalized patients.…”

Section: Diagnostic Framework Of Delirium In Older Personsmentioning

confidence: 99%

“…In detail, they convened to develop a collaborative multidisciplinary initiative report on delirium in elderly hospitalized patients. An estimated 30%-40% of cases of delirium are preventable, and prevention is the most effective strategy to minimize the manifestation of delirium and its adverse outcomes [26].…”

Section: Diagnostic Framework Of Delirium In Older Personsmentioning

confidence: 99%

“…The additional role of psychological causes, including hospitalization, depression, pain, fear, sensory deprivation, and disruption of sleep should not be neglected. In most cases, especially in intensive care units, the effects can be reduced by preventive interventions in the environment and education of the staff [26].…”

Section: Diagnostic Framework Of Delirium In Older Personsmentioning

confidence: 99%

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Treatment of Delirium in Older Persons: What We Should Not Do!

Lauretani

Bellelli

Pelà

et al. 2020

IJMS

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The presentation of common acute diseases in older age is often referred to as “atypical”. Frequently, the symptoms are neither single nor tissue related. In most cases, the onset of symptoms and diseases is the expression of a diminished reserve with a failure of the body system and imbalance of brain function. Delirium is one of the main devastating and prevalent atypical symptoms and could be considered as a geriatric syndrome. It encompasses an array of neuropsychiatric symptoms and represents a disarrangement of the cerebral function in response to one or more stressors. The most recent definition, reported in the DSM-V, depicts delirium as a clear disturbance in attention and awareness. The deficit is to be developed in a relatively short time period (usually hours or days). The attention disorder must be associated with another cognitive impairment in memory, orientation, language, visual-spatial or perception abilities. For the treatment, it is imperative to remove the potential causes of delirium before prescribing drugs. Even a non-pharmacological approach to reducing the precipitating causes should be identified and planned. When we are forced to approach the pharmacological treatment of hyperactive delirium in older persons, we should select highly cost-effective drugs. High attention should be devoted to the correct balance between improvement of psychiatric symptoms and occurrence of side effects. Clinicians should be guided in the correct choice of drugs following cluster symptoms presentation, excluding drugs that could potentially produce complications rather than advantages. In this brief point-of-view, we propose a novel pharmacological flow-chart of treatment in relation to the basic clusters of diseases of an older patient acutely admitted to the hospital and, in particular, we emphasize “What We Should Not Do!”, with the intention of avoiding possible side effects of drugs used.

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Italian intersociety consensus on prevention, diagnosis, and treatment of delirium in hospitalized older persons

Cited by 28 publications

References 63 publications

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

A Point Prevalence Study of Delirium in Italian Nursing Homes

Treatment of Delirium in Older Persons: What We Should Not Do!

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