Prospective observational study of dementia and delirium in the acute hospital setting

Travers, Catherine; Byrne, Gerard; Pachana, Nancy A.; Klein, Kerenaftali; Gray, Leonard C.

doi:10.1111/j.1445-5994.2012.02962.x

Cited by 84 publications

(80 citation statements)

References 27 publications

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“…Comprehensive details regarding participants and methods have been published elsewhere [14] and are briefly reiterated here.…”

Section: Methodsmentioning

confidence: 99%

“…The majority of cases were reviewed and complete details regarding case selection have been described elsewhere [14]. Physicians were asked to determine whether patients met the criteria common to the various types of dementia listed in DSM-IV (criteria A and B, and the criterion indicating that “the deficits do not occur exclusively during the course of a delirium”) [24], in which case dementia was considered likely.…”

Section: Methodsmentioning

confidence: 99%

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Delirium in Australian Hospitals: A Prospective Study

Travers

Byrne

Pachana

et al. 2013

Current Gerontology and Geriatrics Research

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Objectives. Australian data regarding delirium in older hospitalized patients are limited. Hence, this study aimed to determine the prevalence and incidence of delirium among older patients admitted to Australian hospitals and assess associated outcomes. Method. A prospective observational study (n = 493) of patients aged ≥70 years admitted to four Australian hospitals was undertaken. Trained research nurses completed comprehensive geriatric assessments using standardized instruments including the Confusion Assessment Method to assess for delirium. Nurses also visited the wards daily to assess for incident delirium and other adverse outcomes. Diagnoses of dementia and delirium were established through case reviews by independent physicians. Results. Overall, 9.7% of patients had delirium at admission and a further 7.6% developed delirium during the hospital stay. Dementia was the most important predictor of delirium at (OR = 3.18, 95% CI: 1.65–6.14) and during the admission (OR = 4.82; 95% CI: 2.19–10.62). Delirium at and during the admission predicted increased in-hospital mortality (OR = 5.19, 95% CI: 1.27–21.24; OR = 31.07, 95% CI: 9.30–103.78). Conclusion. These Australian data confirm that delirium is a common and serious condition among older hospital patients. Hospital clinicians should maintain a high index of suspicion for delirium in older patients.

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“…Comprehensive details regarding participants and methods have been published elsewhere [14] and are briefly reiterated here.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Delirium in Australian Hospitals: A Prospective Study

Travers

Byrne

Pachana

et al. 2013

Current Gerontology and Geriatrics Research

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although dementia prevalence is high, the proportion undiagnosed or unrecognised by health care staff is approximately 56% (data in S1 Table) [6–8,12]. In older patients with delirium, only 36% of those with dementia had a recognised diagnosis [13].…”

Section: What Is the Problem?mentioning

confidence: 99%

Challenges and opportunities in understanding dementia and delirium in the acute hospital

et al. 2017

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“…Delirium is a neuropsychiatric syndrome characterised by a disturbance of consciousness which has an acute onset and fluctuating course, typically developing within hours and lasting for several days to weeks or even months [1-3]. …”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of haloperidol prophylaxis for delirium prevention in older medical and surgical at-risk patients acutely admitted to hospital through the emergency department: study protocol of a multicenter, randomised, double-blind, placebo-controlled clinical trial

et al. 2014

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BackgroundDelirium is associated with substantial morbidity and mortality rates in elderly hospitalised patients, and a growing problem due to increase in life expectancy. Implementation of standardised non-pharmacological delirium prevention strategies is challenging and adherence remains low. Pharmacological delirium prevention with haloperidol, currently the drug of choice for delirium, seems promising. However, the generalisability of randomised controlled trial results is questionable since studies have only been performed in selected postoperative hip-surgery and intensive care unit patient populations. We therefore present the design of the multicenter, randomised, double-blind, placebo-controlled clinical trial on early pharmacological intervention to prevent delirium: haloperidol prophylaxis in older emergency department patients (The HARPOON study).Methods/DesignIn six Dutch hospitals, at-risk patients aged 70 years or older acutely admitted through the emergency department for general medicine and surgical specialties are randomised (n = 390) for treatment with prophylactic haloperidol 1 mg or placebo twice daily for a maximum of seven consecutive days. Primary outcome measure is the incidence of in-hospital delirium within seven days of start of the study intervention, diagnosed with the Confusion Assessment Method, and the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria for delirium. Secondary outcome measures include delirium severity and duration assessed with the Delirium Rating Scale Revised 98; number of delirium-free days; adverse events; hospital length-of-stay; all-cause mortality; new institutionalisation; (Instrumental) Activities of Daily Living assessed with the Katz Index of ADL, and Lawton IADL scale; cognitive function assessed with the Six-item Cognitive Impairment Test, and the Dutch short form Informant Questionnaire on Cognitive Decline in the Elderly. Patients will be contacted by telephone three and six months post-discharge to collect data on cognitive- and physical function, home residency, all-cause hospital admissions, and all-cause mortality.DiscussionThe HARPOON study will provide relevant information on the efficacy and safety of prophylactic haloperidol treatment for in-hospital delirium and its effects on relevant clinical outcomes in elderly at-risk medical and surgical patients.Trial registrationEudraCT Number: 201100476215; ClinicalTrials.gov Identifier: NCT01530308; Dutch Clinical Trial Registry: NTR3207

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Prospective observational study of dementia and delirium in the acute hospital setting

Abstract: Background: Dementia and delirium appear to be common among older patients

Cited by 84 publications

References 27 publications

Delirium in Australian Hospitals: A Prospective Study

Delirium in Australian Hospitals: A Prospective Study

Challenges and opportunities in understanding dementia and delirium in the acute hospital

Efficacy and safety of haloperidol prophylaxis for delirium prevention in older medical and surgical at-risk patients acutely admitted to hospital through the emergency department: study protocol of a multicenter, randomised, double-blind, placebo-controlled clinical trial

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