Nursing Activities and Acute Confusional States

Williams, Margaret A.; Holloway, Janet R.; Winn, Mary C.; Wolanin, Mary Opal; Lawler, Mariea L.; Westwick, Carmen R.; Chin, Marguerite H.

doi:10.1097/00006199-197901000-00007

Cited by 92 publications

(56 citation statements)

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“…All patients but 3 met ACS criteria within 3 days after admission, which is in line with earlier findings [2,[27][28][29]. The trigger factors seemed to be strongly related to the time of surgery: 31 patients met ACS criteria within 48 h after surgery.…”

Section: Onset and Duration Of Acute Confusionsupporting

confidence: 88%

Acute Confusional States in Patients Undergoing Hip Surgery

Duppils

Wikblad²

1999

Gerontology

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Background: There is general agreement that acute confusional state (ACS) is common among elderly patients admitted to hospital, although exact figures are difficult to obtain. The objective of the current study was to investigate the onset of ACS during hospital stay and to isolate possible predisposing, facilitating and precipitating factors associated with the onset of ACS. Methods: Non-confused patients, ≥65 years of age, undergoing orthopedic hip surgery, were consecutively included in the study (n = 225). Of these, 149 patients were operated on because of acute hip fracture and 76 underwent elective hip-replacement surgery. ACS was diagnosed by the DSM-IV criteria for delirium. Structured observations of ACS onset were performed every 2nd to every 4th hour during the patients’ entire hospital stay. A protocol was used to document the observations on sleep, activities, well being and behavior. The Mini-Mental State Examination was used to measure cognitive functioning. Results: Of 225 patients 20% were diagnosed with ACS. The incidence of ACS was 24.3% in the group of hip-fractured patients and 11.7% in the hip-replacement surgery patients. The onset of ACS was postoperative (mean 24 ± 21 h after surgery) in all but 8 patients. The duration of ACS among recovered patients was generally less than 48 h (mean 42 ± 43 h). Predisposing factors were older age, cognitive impairment and pre-existing cerebrovascular or other brain diseases. Facilitating factors related to ACS were associated with communication and social isolation, e.g. impaired hearing and sight, reticence and passivity. One precipitating factor, besides surgery, may be the use of psychopharmacological drugs. Conclusion: The incidence of ACS was 20% among hip surgery patients. Older age and social isolation were factors associated with ACS. Increased attention and interaction with older patients could be of value in avoiding ACS during hospitalization.

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Section: Onset and Duration Of Acute Confusionsupporting

confidence: 88%

Acute Confusional States in Patients Undergoing Hip Surgery

Duppils

Wikblad²

1999

Gerontology

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“…In previous prospective studies, in which investigators actively assessed for the presence of delirium, delirium has been estimated to occur in 14% to 56% of hospitalized elderly patients. 1 Our results are likely both a reflection of the consistent underrecognition and underreporting (and thus underrecording) of delirium by physicians and nurses found in previous studies 14,[30][31][32] and a possible warning that the problem of poor recognition may be widespread as indicated by the low rates of recorded delirium and related diagnoses found in the VA national health care system. The finding of 53% of study patients with delirium/other related confusional diagnoses being assigned a diagnosis of chronic organic brain syndrome is puzzling.…”

Section: Discussionsupporting

confidence: 67%

Recorded Delirium in a National Sample of Elderly Inpatients: Potential Implications for Recognition

Kales

Kamholz

Visnic

et al. 2003

J Geriatr Psychiatry Neurol

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This retrospective study examined delirium and related confusional diagnoses recorded in patients older than age 60 discharged from Veterans Affairs (VA) acute inpatient units nationally in 1996 (n = 267,947). Only 4% of patients had delirium or related confusional diagnoses recorded. Patients with recorded delirium had significantly higher mortality than did those without recorded delirium or those with other confusional diagnoses ("organic psychoses"); the most common delirium types were dementia with delirium and alcohol intoxication/withdrawal delirium. Organic psychoses patients had the longest lengths of stay and significantly more admissions to nonmedical/surgical units and discharges to nursing homes; almost 20% were African American. The recorded rate of delirium in the VA health system likely underestimates true prevalence and possibly reflects nonrecognition of delirium in many older veterans. Certain motoric and etiologic types of delirium may be more commonly diagnosed and recorded. Future research should prospectively examine recognition of motoric and etiologic delirium subtypes and racial differences in delirium diagnoses.

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“…Bright light (2.500 lux) was administered two hours daily between 10 and 12 a.m. for 14 days. Changes in delusion or agitation were recorded using the confusion rating scale (CRS) (Williams et al, 1979).…”

Section: Methodsmentioning

confidence: 99%