Prevalence of Delirium and Urinary Tract Infection in a Psychogeriatric Unit

Manepalli, Jothika; Grossberg, George T.; Mueller, Cindy

doi:10.1177/089198879000300404

Cited by 43 publications

(30 citation statements)

References 16 publications

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“…(14) The studies ranged in size from 14 to 1,285 subjects. Four of the studies were in hospital settings (8,11,12,13) and one had community dwelling and institutionalized participants. (14) Of those with delirium, UTI rates ranged from 25.9% to 32%, compared to 13% in those without delirium.…”

Section: Resultsmentioning

confidence: 99%

“…The five studies identified were comprised of one case series (8) and four cross-sectional observational studies. (11,12,13,14) All were conducted in the United States except one, which was conducted in Scandinavia.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, it is reasonable to conclude that there is an association between delirium and sufficiently symptomatic UTI, just as there is for other conditions such as presence of dementia, (8,14) depression, (8,14) heart failure, (14) chronic kidney disease, (11) use of psychotropic medications or multiple medications, (8) and advanced age. (8,15) On the other hand, it is also reasonable to conclude that asymptomatic bacteriuria-without dysuria, frequency, bladder discomfort, or fever-is unlikely to cause a patient to become delirious, as reported in the study by Gau et al, (12) and that factors other than an abnormal urinalysis play a more dominant role in the development of delirium.…”

Section: Standards Metmentioning

confidence: 99%

“…(4,5) While delirium has multiple etiologies, it is widely viewed as one of the atypical symptoms of UTI in the elderly, (6,7) and some physicians believe that the relationship between delirium and UTI is one of causation. (8,9) They therefore initiate workup for urinary tract infection (UTI) whenever delirium occurs in a patient. However, there is the possibility that this association is overestimated, since there is also a high prevalence of asymptomatic bacteriuria in the elderly, particularly among those in nursing homes.…”

Section: Introductionmentioning

confidence: 99%

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Delirium, A Symptom of UTI in the Elderly: Fact or Fable? A Systematic Review

Balogun

Philbrick

2013

Journal of the American Medical Directors Association

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BackgroundIn geriatrics, delirium is widely viewed as a consequence of and, therefore, a reason to initiate workup for urinary tract infection (UTI). There is a possibility that this association is overestimated. To determine the evidence behind this clinical practice, we undertook a systematic review of the literature linking delirium with UTI. MethodsA MEDLINE search was conducted from 1966 through 2012 using the MESH terms "urinary tract infection" and "delirium", limited to humans, age 65 and older. The search identified 111 studies. Of these, five met our inclusion criteria of being primary studies that addressed the association of UTI and delirium. The studies were four cross-sectional observational studies and one case series. No randomized control trials were identified. All studies were published between 1988 and 2011. Four collected data retrospectively and one prospectively, with study sizes ranging from 14 to 1,285. The methodological strength of the studies was evaluated using six standards adapted from a previous systematic review. ResultsOnly two of the five studies adequately matched or statistically adjusted for differences in comparison groups. None of the studies evaluated subjects with equal intensity for the presence of delirium and UTI, nor did they have objective criteria for either diagnosis. In subjects with delirium, UTI rates ranged from 25.9% to 32% compared to 13% in those without delirium. In subjects with UTI, delirium rates ranged from 30% to 35%, compared to 7.7% to 8% in those without UTI. ConclusionsFew studies have examined the association between UTI and delirium. Though the studies examined conclude that there is an association between UTI and delirium, all of them had significant methodological flaws that likely led to biased results. Therefore, it is difficult to ascertain the degree to which urinary tract infections cause delirium. More research is needed to better define the role of UTI in delirium etiology.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Standards Metmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Delirium, A Symptom of UTI in the Elderly: Fact or Fable? A Systematic Review

Balogun

Philbrick

2013

Journal of the American Medical Directors Association

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“…7 Studies have shown that elderly population is prone for delirium, especially during hospital stay and in the setting of UTI. [2][3][4][5]10 Meningitis is an infection of the subarachnoid space. It may be bacterial, viral, fungal or rickettsial.…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal meningitis - a silent culprit behind delirium in a patient with Parkinson’s disease, on levodopa, presenting with urinary tract infection

Manappallil

2016

Ital J Med

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Patients with Parkinson’s disease are prone to mental disturbances like psychosis and delirium. Psychosis has been attributed to drugs like dopamine agonists, while delirium is commonly seen during the days of hospital stay and infections. This is a case of a 62-year-old lady, a known case of Parkinson’s disease on levodopa therapy, who has had repeated episodes of delirium over the past year. Her delirium episodes were usually associated with urinary tract infection and hyponatremia or as a part of levodopa therapy. However, this time on further evaluation, she was found to have cryptococcal meningitis as the culprit for her delirium.

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Outcomes of Pharmacological Management of Violent Behavioural Disturbances in Older Hospital Patients

Cheh

Selby

Abarno

et al. 2010

Pharmacy Practice and Res

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Background Violent behaviour displayed by hospital patients that are a physical and personal threat to patients, visitors and staff is an emergency situation. Aim To evaluate medications used to manage violent behavioural disturbances; to explore patients' antecedent characteristics; and to assess concordance with hospital guidelines. Method Retrospective analysis (March 2008 to August 2009) of a convenience sample of hospital patients who displayed violent behaviour requiring an emergency response. Patient data were extracted from case notes and the Australian Incident Monitoring System, and included baseline demographics, medication used during admission, details of the behavioural disturbance and outcomes of the emergency response. Results Of the 28 patients analysed, 23 (82%) were male. Mean age was 81.5 years and 50% were aged 80 to 89 years. 17 (61%) patients were admitted for cognitive decline and 24 (86%) had a history of neuropsychiatric disorders. Clonazepam was the most frequently used drug and the intramuscular route was the most popular mode. Patients with poorly controlled pain were more likely to display violent behaviour (p < 0.01). Initiating antipsychotics or dose increases during admission was significantly associated with multiple violent episodes (p < 0.001). Opioids were most likely to be charted before a violent episode (n = 10; 36%) and ceased after an episode (n = 5; 18%). Concordance with hospital guidelines was observed in 18 (64%) cases. Non‐concordance with hospital guidelines was not predictive of multiple violent episodes. Conclusion Better assessment of at‐risk patients and early intervention are required. Concordance with hospital guidelines was low. Effective implementation, monitoring and adjustment of protocols used in emergency responses require interdisciplinary collaboration.

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Prevalence of Delirium and Urinary Tract Infection in a Psychogeriatric Unit

Cited by 43 publications

References 16 publications

Delirium, A Symptom of UTI in the Elderly: Fact or Fable? A Systematic Review

Delirium, A Symptom of UTI in the Elderly: Fact or Fable? A Systematic Review

Cryptococcal meningitis - a silent culprit behind delirium in a patient with Parkinson’s disease, on levodopa, presenting with urinary tract infection

Outcomes of Pharmacological Management of Violent Behavioural Disturbances in Older Hospital Patients

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