Risk Factors for Delirium in Hospitalized Elderly

Schor, Joshua D.; Levkoff, Sue E.; Lipsitz, Lewis A.; Reilly, Catherine H.; Cleary, Paul D.; Rowe, John W.; Evans, Dennis A.

doi:10.1001/jama.1992.03480060073033

Cited by 398 publications

(201 citation statements)

References 26 publications

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“…Various studies have indicated the multifactorial nature of delirium and have found that between two and six factors may be present in any single case 3031. Next to increasing age, pre-existing cognitive decline is the most confirmed risk factor 32.…”

Section: Aetiology and Risk Factorsmentioning

confidence: 99%

Delirium in the elderly: a clinical review

Saxena

Lawley

2009

Postgraduate Medical Journal

151

169

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Delirium is a common condition in the elderly, affecting up to 30% of all older patients admitted to hospital. There is a particularly high risk of delirium in surgical inpatients, especially following operations for hip fracture or vascular surgery, but also for patients in the intensive care unit. Patients with delirium have higher morbidity and mortality rates, higher re-admission rates, and a greater risk of long term institutionalisation care, thereby having a significant impact on both health and social care expenditure. Delirium frequently goes unrecognised by clinicians and is often inadequately managed. Recent evidence suggests that a better understanding and knowledge of delirium among health care professionals can lead to early detection, the reduction of modifiable risk factors, and better management of the condition in the acute phase. Many cases of delirium are potentially preventable, and primary and secondary care services should be taking active steps in order to do prevent this condition.

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Section: Aetiology and Risk Factorsmentioning

confidence: 99%

Delirium in the elderly: a clinical review

Saxena

Lawley

2009

Postgraduate Medical Journal

151

169

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“…23 The risk factors of increasing age and baseline cognitive or functional impairment for development of delirium also reflect the risk in general medical inpatients. 6,22,30,36 Alcohol abuse and marked abnormalities in preoperative sodium, potassium, or glucose levels (which may be a reflection of diuretic use and dehydration) have been reported as predictors of POCD. 23,[37][38][39] Finally, low educational levels have also predicted POCD, 5,34 as subjects with higher levels of education may perform relatively better on tests with a high learned component (e.g., language and secondary memory) than on tests measuring attention, implicit memory, and visual-spatial analysis.…”

Section: Risk Factorsmentioning

confidence: 99%

“…4,23,48 In other studies, opioids other than meperidine and anticholinergic agents have not been associated with delirium. 23,30 Although deliberate hypotension per se does not appear to influ- ence development of POCD, a postoperative hematocrit less than 30% (odds ratio ϭ 1.7) was independently associated with a higher incidence of postoperative delirium in patients older than 50 years undergoing major elective noncardiac surgery. 14 In addition, the presence of postoperative infections and respiratory complications has been shown to significantly correlate with development of POCD.…”

Section: Risk Factorsmentioning

confidence: 99%

Postoperative cognitive function as an outcome of regional anesthesia and analgesia

Hsu

Richman

et al. 2004

Regional Anesthesia and Pain Medicine

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“…Most agents in this class affect basic CNS functions and can cause transient periods of dizziness with balance or visual impairment, in addition to confusion and transient memory loss. [28] Patients with impaired hepatic metabolism and impaired renal elimination may be more sensitive to usual recommended adult doses. To prevent fall events associated with urgency, pharmacological factors should be evaluated along with environmental adjustments.…”

Section: Discussionmentioning

confidence: 99%

A multidisciplinary assessment instrument to predict fall risk in hospitalized patients: A prospective matched pair case study

Chung

Coralic

2016

JNEP

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Objective: To identify fall risk for hospitalized patients utilizing a multidisciplinary assessment tool based on patients' physical, mental, pharmacological, and metabolic data. Methods: A prospective case-control design comparing 48 patients who fell (incidence group) and 48 patients who did not experience fall (control group), based on patients' age, gender, and hospital unit location. The study was conducted over an 8-month period at a large academic hospital. Setting: The Methodist Hospital, tertiary care academic referral center with 824 operating beds in Houston, TX. Participants: One hundred and twenty patients, sixty patients who fell, and sixty control subjects. Main Outcome Measures: The sensitivity and specificity of variables identified in logistic regression are able to distinguish patients who fell from patients who did not fall. Results: Logistic regression results identified six variables (2 summary variables and 4 individual variables) that correctly classified patients with 90% sensitivity (patients who fell) and 90% specificity (patients who did not fall). The first variable was an 11-item summary variable that included history, weakness or balance problem, altered mental status or confusion, visual impairment, dizziness or vertigo, urinary tract infection or abnormal urinary analysis (UA), diuretics/IV drips, continence, acute renal failure (ARF), antihypertensives and narcotics. The second variable represented the combination of 3 medication classes: neuroleptic, anticonvulsant and antidepressant. The third variable that had a negative impact on fall risk was the presence of a therapeutic anticoagulant. The other 3 significant variables were hypoglycemia, vital sign abnormality, and low hemoglobin. Conclusions: A multidisciplinary fall-risk assessment tool that screens combinations of physiological, pharmacological and metabolic patient factors improves the probability of correctly distinguishing patients who were more likely to fall from those patients who were less likely to fall.

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Risk Factors for Delirium in Hospitalized Elderly

Cited by 398 publications

References 26 publications

Delirium in the elderly: a clinical review

Delirium in the elderly: a clinical review

Postoperative cognitive function as an outcome of regional anesthesia and analgesia

A multidisciplinary assessment instrument to predict fall risk in hospitalized patients: A prospective matched pair case study

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