Subdiagnóstico de delirium en adultos mayores hospitalizados

G, Marcela Carrasco; M, Trinidad Hoyl; L, Pedro Paulo Marín; A, Jaime Hidalgo; D, Carmen Lagos; B, Cristóbal Longton; B, Pamela Chávez; A, Eduardo Valenzuela; M, Domingo Arriagada

doi:10.4067/s0034-98872005001200006

Cited by 9 publications

(14 citation statements)

References 21 publications

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“…Previous studies have found that delirium is overlooked in up to 68% of patients. (27) It has been reported that untreated delirium increases mortality rates up to three-fold, increases the chance of discharge to nursing home and increases long-term cognitive impairment by up to ten times. (5,12,28,29) As age is a major predisposing factor for delirium, failing to diagnose delirium will increase the economic burden of caring for elderly patients in Singapore's ageing population.…”

Section: Discussionmentioning

confidence: 99%

Underdiagnosis of delirium on admission and prediction of patients who will develop delirium during their inpatient stay: a pilot study

Chin¹,

Koh

Tay

et al. 2016

smedj

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, MBChB, FRCP INTRODUCTION The study aimed to determine the prevalence and documentation of delirium among the elderly and if the Clock Drawing Test (CDT) can be used to predict which patients had delirium on admission and those who may develop delirium during their stay in acute medical wards. METHODSA single researcher performed the Mini-Mental State Examination (MMSE) and CDT on admission and discharge of 57 elderly adults at the National University Hospital, Singapore. Delirium was defined as a ≥ 3-point improvement or ≥ 2-point decline in MMSE scores from admission to discharge, where a fall denotes development of delirium and a rise denotes resolution. The case notes of the same patients were reviewed for documentation of delirium. All inpatients from two acute medical wards were examined. One CDT score and a pair of MMSE scores were collected from each patient. RESULTSA total of 57 patients (28 male, 29 female) were involved in the study. Their mean age was 76.0 ± 8.7 years.The prevalence of delirium based on MMSE scores was 40.4%; 16 patients had delirium on admission while seven developed delirium during their inpatient stay. However, delirium was documented in the case notes of only 7 (30%) of the 23 patients. CDT score was better than baseline MMSE score at predicting a decline in MMSE score. CONCLUSIONThe prevalence of delirium in the acute medical setting is high but underdiagnosed. The CDT may be a good screening tool to identify patients at risk of delirium during their inpatient stay. Baseline cognition screening should be performed in every elderly patient admitted to hospital.

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Section: Discussionmentioning

confidence: 99%

Underdiagnosis of delirium on admission and prediction of patients who will develop delirium during their inpatient stay: a pilot study

Chin¹,

Koh

Tay

et al. 2016

smedj

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“…En contraste con ellos, nuestro modelo incorpora a todos los pacientes, incluyendo aquellos que tengan deterioro cognitivo previo y aquellos que ingresen con delirium. Esto es una diferencia fundamental, considerando que hasta un tercio de los pacientes ingresan con delirium 2 y que existe un alto grado de subdiagnóstico de ambas condiciones, tanto del deterioro cognitivo como del delirium 4,30 . Esto le permite discriminar el nivel de riesgo de todos los pacientes en el momento de admisión, para así derivarlos a unidades con implementación de estrategias de prevención y manejo precoz de los casos de delirium, como recomienda la literatura 10 .…”

Section: Discussionunclassified

“…Diferentes estudios revelan que es una de las complicaciones intrahospitalarias más frecuentes, alcanzando una prevalencia de hasta 42% en pacientes hospitalizados por patologías médicas [2][3][4] . Uno de los factores que marcan la importancia del delirium es que afecta radicalmente el pro-nóstico del individuo.…”

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Riesgo de delirium durante la hospitalización en personas mayores: desarrollo y validación de un modelo de predicción clínica

et al. 2014

Rev. méd. Chile

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“…Puede ocurrir a cualquier edad, pero es mucho más frecuente en la población adulta mayor y, a la vez, subdiagnosticada (5,11,12) .…”

Section: Discussionunclassified

“…Estudios previos han determinado como factores de riesgo para desarrollar SCA a la demencia, polifarmacia o uso de psicofármacos (7)(8)(9)(10)(11)(12) .…”

Section: Introductionunclassified

Factores asociados a síndrome confusional agudo en adultos mayores internados en emergencia de un hospital terciario

Amado.Tineo

Ascencio

et al. 2013

An Fac med

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ResumenIntroducción: El síndrome confusional agudo es un problema frecuente en el adulto mayor, incrementado por patologías agudas. Objetivos: Determinar la frecuencia del síndrome confusional agudo en adultos mayores no críticos hospitalizados en un servicio de emergencia e identificar factores asociados. Diseño: Estudio transversal. Lugar: Servicio de Emergencia del Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú. Participantes: Pacientes de 60 años o más. Intervenciones: Siguiendo normas de buenas prácticas clínicas, se entrevistó entre mayo y agosto 2010 a paciente/cuidador de 172 pacientes de 60 años o más, hospitalizados en salas de emergencia; se revisó la historia clínica. Principales medidas de resultados: Detectar síndrome confusional agudo mediante el Confussion Assessment Method. Resultados: La frecuencia de síndrome confusional agudo fue 34,9%, según categoría de adulto mayor: enfermo 6%, frágil 28%, complejo 58% (p<0,001). Se encontró antecedente de demencia en 30% de pacientes con síndrome confusional, deterioro cognitivo previo en 45%, síndrome confusional previo en 40,2%, dependencia funcional parcial 46% y total 39%, deterioro cognitivo moderado 27% y severo 40%. El 41,7% de pacientes con síndrome confusional presentó deshidratación moderadasevera (p=0,001) y 20% sepsis, como diagnósticos de ingreso (p=0,003). Las patologías de ingreso más frecuentes fueron infecciosas, cardiovasculares y metabólicas. No se encontró diferencia significativa en sexo, grado de instrucción, estado civil, pluripatología, hospitalización previa, polifarmacia, estado nutricional, presencia de sonda urinaria o nasogástrica, destino al egreso de emergencia ni estancia hospitalaria. Conclusiones: Existe alta frecuencia de síndrome confusional agudo en adultos mayores hospitalizados en servicios de emergencia, siendo factores asociados la demencia, deterioro cognitivo previo, confusión previa, dependencia funcional, categoría geriátrico complejo, deshidratación moderada-severa y sepsis. Palabras clave: Adulto mayor hospitalizado, síndrome confusional agudo. Abstract Introduction: Acute confusional state is a frequent problem in the elderly and is increased by acute pathologies. Objectives: To determine the frequency of acute confusional state in non-critical elderly emergency service inpatients and to identify associated factors. Design: Cross sectional study. Setting: Emergency Unit, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru. Participants: Sixty-year-old or older patients hospitalized in an emergency unit. Interventions: Between May and August 2010 and according to procedures of good clinical practices, 172 60-year-old or older patients hospitalized in an emergency unit or their caregivers were interviewed and clinical records were reviewed. Main outcome measures: Acute confusional state detection with the Confusion Assessment Method. Results: The frequency of acute confusional state according to category of elderly was 34.9%: ill 6%, fragile 28% and complex 58% (p <0,001). There was history of d...

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Subdiagnóstico de delirium en adultos mayores hospitalizados

Abstract: Background: Delirium is a common underdiagnosed and undertreated problem in elderly inpatients (Rev Méd Chile 2005; 133: 1449-54).

Cited by 9 publications

References 21 publications

Underdiagnosis of delirium on admission and prediction of patients who will develop delirium during their inpatient stay: a pilot study

Underdiagnosis of delirium on admission and prediction of patients who will develop delirium during their inpatient stay: a pilot study

Riesgo de delirium durante la hospitalización en personas mayores: desarrollo y validación de un modelo de predicción clínica

Factores asociados a síndrome confusional agudo en adultos mayores internados en emergencia de un hospital terciario

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