Subsyndromal Delirium in Older Long‐Term Care Residents: Incidence, Risk Factors, and Outcomes

Cole, Martín G.; McCusker, Jane; Voyer, Philippe; Monette, Johanne; Champoux, Nathalie; Ciampi, Antonio; Vu, Minh; Belzile, Éric

doi:10.1111/j.1532-5415.2011.03595.x

Cited by 47 publications

(60 citation statements)

References 46 publications

(120 reference statements)

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“…Previous studies used populations in other settings (long-term care, hip surgery or intensive care units), with a lower mean age and complexity. Moreover, our definition of SSD was less strict than that of the studies in which 2 delirium criteria or core symptoms were required [25]. This may partially explain the higher SSD prevalence rates in our study, and also the lack of relations between SSD and severe health outcomes such as death.…”

Section: Discussionmentioning

confidence: 73%

Different Functional Outcomes in Patients with Delirium and Subsyndromal Delirium One Month after Hospital Discharge

Velilla

Bouzón

Cambra³

et al. 2012

Dement Geriatr Cogn Disord

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Background: Subsyndromal delirium has an increasing relevance in the medical literature. There are only three studies in hospitalized elderly patients. Our goal is to demonstrate the importance of this syndrome in a population with more complexity and cognitive impairment than in previous studies. Methods: Prospective multicentre study in three tertiary hospitals. The health outcomes recorded in the follow-up at 1 month were the persistence of delirium, hospital readmission, discharge destination, death, Barthel index and the Delirium Rating Scale Revised 98. To assess the impact of delirium in the Barthel index at 30 days, we adjusted univariate and multivariate linear regression models. Results: 85 patients were enrolled; 75.3% of the patients had at least 1 positive item in the Confusion Assessment Method; 45 patients (53%) were diagnosed with delirium and 19 (22.3%) with subsyndromal delirium (SSD). The 30-day risk of death was associated with lower levels of albumin (p = 0.021) and the Cumulative Illness Rating Scale in Geriatrics (CIRS-G; p = 0.003). Adjusting for CIRS-G and the initial Barthel index, the diagnosis of delirium appears to be related to a lower Barthel index at 30 days (p = 0.019), showing a significant linear gradient (p < 0.005). Conclusion: SSD could help get more accurate diagnoses as well as improve patient management.

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Section: Discussionmentioning

confidence: 73%

Different Functional Outcomes in Patients with Delirium and Subsyndromal Delirium One Month after Hospital Discharge

Velilla

Bouzón

Cambra³

et al. 2012

Dement Geriatr Cogn Disord

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“…The costs of delirium include increased lengths of stay of 3 to 12 additional days (Robinson et al, 2009), nursing home placements, and higher mortality rates (Ely et al, 2004; Robinson et al, 2009, Leslie, Marcantonio, Zhang, Leo-Summers, & Inouye, 2008; Leslie, Zhang, Boganrdus, Holford, Leo-Summers, & Inouye, 2005; Robinson et al, 2009). While subsyndromal symptoms are less severe than those seen in delirium, they are predictors for adverse outcomes, increased falls postoperatively, including increased lengths of hospital stays and long-term care admissions, and higher mortality rates (Cole, McCusker, Dendukuri, & Han, 2003; Cole et al, 2011; DeCrane, Culp, & Wakefield, 2012). Some have concluded that the presence of even one core symptom of delirium in an older adult is sufficient enough to result in an increase in the length of hospital stay and/or a decline in functional status (Shim, DePalma, Sands, & Leung, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…The small number of studies available also provide early evidence for cognitive impairment as a risk factor for subsyndromal delirium in both hospitalized medical patients (Cole et al, 2011; Levkoff et al, 1996) and surgical patients (Marcantonio et al, 2002). …”

Section: Introductionmentioning

confidence: 99%

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Preoperative Risk Factors for Subsyndromal Delirium in Older Adults Who Undergo Joint Replacement Surgery

Denny

Lindseth

2017

Orthopaedic Nursing

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Background Older adults with subsyndromal delirium have similar risks for adverse outcomes following joint replacement surgery as those who suffer from delirium. Purpose This study examined relationships among subsyndromal delirium and select preoperative risk factors in older adults following major orthopaedic surgery. Methods Delirium assessments of a sample of 62 adults age 65 or older were completed on postoperative day 1, 2, and 3 following joint replacement surgery. Data were analyzed for relationships among delirium symptoms and the following preoperative risk factors: increased comorbidity burden, cognitive impairment, fall history, and preoperative fasting time. Results Postoperative subsyndromal delirium occurred in 68% of study participants. A recent fall history and a longer preoperative fasting time were associated with delirium symptoms (p ≤ .05). Conclusions Older adults with a recent history of falls within the past 6 months or a longer duration of preoperative fasting time may be at higher risk for delirium symptoms following joint replacement surgery.

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“…Subsyndromal delirium will be diagnosed when one or more new bCAM/CAM-ICU core symptoms, that did not meet CAM/CAM-ICU criteria for delirium and do not progress to delirium, will be present [34]. …”

Section: Methodsmentioning

confidence: 99%

PRospective Observational POLIsh Study on post-stroke delirium (PROPOLIS): methodology of hospital-based cohort study on delirium prevalence, predictors and diagnostic tools

Klimiec

Dziedzic

Kowalska³

et al. 2015

BMC Neurol

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BackgroundBetween 10 % to 48 % of patients develop delirium in acute phase of stroke. Delirium determinants and its association with other neuropsychiatric disturbances in stroke are poorly understood. The wildly accepted predictive model of post-stroke delirium is still lacking.Methods/designThis is a prospective, observational, single-center study in patients with acute phase of stroke. We aim to include 750 patients ≥18 years with acute stroke or transient ischemic attack admitted to the stroke unit within 48 hours after stroke onset. The goals of the study are: 1) to determine frequency of delirium and subsyndromal delirium in Polish stroke patients within 7 days after admission to the hospital; 2) to determine factors associated with incidence, severity and duration of delirium and subsyndromal delirium and to create a predictive model for post-stroke delirium; 3) to determine the association between delirium and its cognitive, psychiatric, behavioral and functional short and long-term consequences; 4) to validate scales used for delirium diagnosis in stroke population.Patients will be screened for delirium on daily basis. The diagnosis of delirium will be based on DSM-V criteria. Abbreviated version of Confusion Assessment Method and Confusion Assessment Method for the Intensive Care Unit will be used for delirium and sub-delirium screening. Severity of delirium symptoms will be assessed by Delirium Rating Scale Revised 98 and Cognitive Test for Delirium. Patients who survive will undergo extensive neuropsychological, neuropsychiatric and functional assessment 3 and 12 months after the stroke.DiscussionThis study is designed to provide information on clinical manifestation, diagnostic methods and determinants of delirium spectrum disorders in acute stroke phase and their short and long-term consequences. Collected information allow us to create a predictive model for post-stroke delirium.

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Subsyndromal Delirium in Older Long‐Term Care Residents: Incidence, Risk Factors, and Outcomes

Abstract: SSD2 appears to be a clinically important disorder in older LTC residents. Despite limited statistical power, these findings have potentially important implications for clinical practice and research in LTC settings.

Cited by 47 publications

References 46 publications

Different Functional Outcomes in Patients with Delirium and Subsyndromal Delirium One Month after Hospital Discharge

Different Functional Outcomes in Patients with Delirium and Subsyndromal Delirium One Month after Hospital Discharge

Preoperative Risk Factors for Subsyndromal Delirium in Older Adults Who Undergo Joint Replacement Surgery

PRospective Observational POLIsh Study on post-stroke delirium (PROPOLIS): methodology of hospital-based cohort study on delirium prevalence, predictors and diagnostic tools

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