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

Manni, Barbara; Federzoni, Lucia; Zucchi, Patrizia; Mussi, Chiara; Inzitari, Marco; Carda, Cristina Arnal; Fabbo, Andrea; Morandi, Alessandro

doi:10.1007/s40520-020-01753-3

Cited by 9 publications

(6 citation statements)

References 37 publications

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“…Mean age was 84.9 ± 7.9 (50-97) years-old and average education was 6.1 ± 2.0 (5-13) years [Verhage education score [19] The 4AT scale could be administered to all patients [4.6 ± 4.0 (0-12)] and a score suggesting delirium (i.e., ≥ 4) was obtained in almost half of them [n = 45 (44.1%)]; all cases were subsequently confirmed by GP clinical impression. The CCI was 4.8 ± 2.3 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) and the SPPB score was 3.1 ± 2.9 (0-12), accordingly to the expected decrease in the functional status of this selected population.…”

Section: Resultsmentioning

confidence: 82%

“…In fact, pre-existing dementia is a wellknown risk factor for delirium occurrence [11]. Recently, Manni and colleagues reported a retrospective cohort study of 2995 older patients referred to a Memory Clinic, finding that the rate of delirium was 3.64%, worsening functional and cognitive status at 6 months compared to baseline [12]. This apparent rarity of delirium in the extramural setting might be ascribed to the absence of hospital precipitating factors, such as being in an unfamiliar place or the change in the personal daily routine.…”

Section: Introductionmentioning

confidence: 99%

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Delirium in your house: a survey during General Practitioner-programmed home visits

Tremolizzo

Bargossi²,

Storti

et al. 2021

Aging Clin Exp Res

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Objectives To assess the prevalence of delirium (DEL) among older patients living at home and periodically visited by their General Practitioners (GPs). Design Observational study. Setting In Italy, programmed home visits by the GPs are regularly scheduled for their vulnerable and frail patients who are often on poly-drug regimens and suffering from dementia. Participants N = 102 patients among those receiving programmed home visits by n = 6 GP based in the Brianza area (Lombardy). Measurements Patients were screened for delirium with the Italian version of the 4AT, with a score ≥ 4 considered as a positive indicator for DEL. The Charlson Comorbidity Index (CCI), the Short Physical Performance Battery (SPPB), the presence of dementia, and benzodiazepine (BZD) use were recorded. Results DEL+ was detected in almost half of the recruited sample (44.1%), and it was clearly associated with increased comorbidity and decreased motor abilities. Pre-existing dementia was documented in most of DEL+ patients (71.1%), while this was the case for only a minority of DEL- (5.2%, p < 0.00001). Analogously, BZD use was over-represented in the DEL+ group with respect to the DEL− one (73.3% vs. 22.8%, p < 0.00001). Conclusions DEL prevalence as detected by GP during programmed home visits is surprisingly high, and related to motor impairment, comorbidities (among which dementia), and BZD use. DEL prompt recognition should be one of the goals of GP-programmed home visits, since this treatable and preventable condition is associated to an elevated burden of frailty and risk of death.

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Section: Resultsmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Delirium in your house: a survey during General Practitioner-programmed home visits

Tremolizzo

Bargossi²,

Storti

et al. 2021

Aging Clin Exp Res

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“…89 The onset of delirium can speed up the progression of dementia, and some people never fully return to their previous cognitive ability. 90,91 Furthermore, the rate of mortality is high in PwD following acute illness; 92 indeed, the recent Coronavirus 2019 (COVID-19) pandemic has shown that PwD are at an increased risk from contracting the virus, including an increased risk of hospitalisation, psychological and cognitive decline and mortality. [93][94][95] The results from this scoping review found that comorbidity and multimorbidity definitions mainly included 'chronic' or 'long-term conditions', which can be defined as 'a condition that cannot, at present, be cured but is controlled by medication and/or other treatment or therapies'.…”

Section: Type Of Health Conditionsmentioning

confidence: 99%

Conceptualising comorbidity and multimorbidity in dementia: A scoping review and syndemic framework

Dunn

Clayton

Wolverson

et al. 2022

Journal of Multimorbidity and Comorbidity

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Background Older people and people with dementia experience a high prevalence of multiple health conditions. The terms ‘comorbidity’ and ‘multimorbidity’ are often used interchangeably to describe this, however there are key conceptual differences between these terms and their definitions. This has led to issues in the validity and comparability of research findings, potentially inappropriate intervention development and differences in quality of health care. Objective To review how the terms ‘comorbidity’ and ‘multimorbidity’ are defined within peer-reviewed dementia research and propose an operational framework. Design A scoping review of definitions within dementia research was carried out. Searches took place across five databases: Academic Search Premier, CINAHL Complete, MEDLINE, PsycARTICLES and PsycINFO. PRISMA-ScR guidelines were followed. Results Content analysis revealed five key themes, showing significant overlap and inconsistencies from both within, and between, the comorbidity and multimorbidity definitions; 1. Number of conditions; 2. Type of health conditions; 3. The co-occurrence of conditions; 4. The inclusion of an index disease (or not); 5. Use of medical language. The analysis also revealed gaps in how the underlying concepts of the definitions relate to people with dementia living with multiple health conditions. Conclusion This scoping review found that current definitions of comorbidity and multimorbidity are heterogeneous, reductionist and disease-focussed. Recommendations are made on the design of research studies including transparency and consistency of any terms and definitions used. A syndemic framework could be a useful tool for researchers, clinicians and policy makers to consider a more holistic picture of a person with dementia’s health and wellbeing.

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“…More recently, a study among 109 outpatients diagnosed with delirium in a memory clinic was published. 12 All patients had dementia or mild cognitive impairment. At 6 months of follow-up, 29% had died, and 28% had moved to a nursing home.…”

Section: Introductionmentioning

confidence: 99%

“…Both studies were based on a small number of patients with delirium, and also included nursing home residents, and none of them had a history of dementia. More recently, a study among 109 outpatients diagnosed with delirium in a memory clinic was published 12 . All patients had dementia or mild cognitive impairment.…”

Section: Introductionmentioning

confidence: 99%

The prognosis of delirium in older outpatients

Quispel‐Aggenbach,

Zuidema,

Luijendijk

2024

Psychogeriatrics

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BackgroundDelirium is a common and serious neuropsychiatric disorder. The prognosis of delirium in older patients living at home has not been studied often before. The aim of this study is to examine the prognosis of delirium in patients attending a memory clinic of a psychiatric hospital.MethodThe study population consisted of 85 outpatients diagnosed with delirium between October 2013 and October 2014. Seventeen patients had already been diagnosed as having dementia. Three months after the diagnosis, consenting patients underwent a follow‐up visit. We recorded delirium status (remitted or not), new dementia diagnosis, subjective cognitive functioning compared to baseline and to before delirium, level of daily functioning, and place of residence.ResultsAfter 3 months, 45 (53%) had recovered from delirium, 19 (22,4%) had persistent/recurrent delirium, 12 (14%) patients had died, and another nine (11%) could not be revisited for other reasons than death. None of the 64 re‐examined patients reported that their cognitive functioning had recovered to the pre‐delirium level, and the mean level of daily functioning did not substantially improve either. The rate of diagnosed dementia increased to 63.8%, and 18 patients (28.1%) had moved to a nursing home.ConclusionsDelirium in older outpatients has a poor prognosis. A larger study on the risk factors of the prognosis of delirium in older persons living at home is advised.

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

Cited by 9 publications

References 37 publications

Delirium in your house: a survey during General Practitioner-programmed home visits

Delirium in your house: a survey during General Practitioner-programmed home visits

Conceptualising comorbidity and multimorbidity in dementia: A scoping review and syndemic framework

The prognosis of delirium in older outpatients

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