Underreporting of Delirium in Statewide Claims Data: Implications for Clinical Care and Predictive Modeling

McCoy, Thomas H.; Snapper, Leslie A.; Stern, Theodore A.; Perlis, Roy H.

doi:10.1016/j.psym.2016.06.001

Cited by 50 publications

(47 citation statements)

References 62 publications

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“…Previous retrospective studies found a prevalence rate of delirium of 2% in an Irish hospital (Rooney et al, 2014), and 2.8% in a US hospital setting (McCoy et al, 2016). However, prospective studies showed that the prevalence of delirium in older hospitalized patients varies from 29% to 64%, depending on the hospital ward (Inouye et al, 2014).…”

Section: Discussionmentioning

confidence: 97%

Detection and management of hyperactive and hypoactive delirium in older patients during hospitalization: a retrospective cohort study evaluating daily practice

Velthuijsen

Zwakhalen

Mulder

et al. 2017

Int J Geriat Psychiatry

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ObjectivesThe objectives of the study are to study daily hospital practice regarding detection and management and to study hyperactive and hypoactive delirium of older patients during their hospitalization.MethodsA retrospective cohort study evaluating care as usual for older hospitalized patients with delirium at Maastricht University Medical Center+, a university hospital in the Netherlands, was performed. Inclusion criteria were older hospitalized patients (65+ years), diagnosed with delirium between 1 January and 31 December 2014. Data were retrieved from the patients' medical files. Delirium was categorized as hyperactive or hypoactive. Primary outcome measures were prevalence and management (pharmacological, reorientation, screening for delirium and delirium consultations, and physical restraints). Secondary outcomes were short‐term adverse outcomes.ResultsPrevalence of delirium was 5% (N = 401), of which 77% (n = 307) was hyperactive and 23% (n = 94) was hypoactive. Significantly, more patients with a hyperactive delirium received medication to manage the delirium than patients with a hypoactive delirium (89% vs. 77%, respectively, p = 0.004). No other significant differences between the subtypes were found.ConclusionThere was probably a strong under‐recognition of delirium. Drugs were the main intervention of choice, especially for patients with hyperactive delirium. The two subtypes did not differ on non‐pharmacological management. The retrospective nature of this study sheds light on the status quo of recognition, management, and care as usual for the different delirium subtypes in daily hospital practice, which may help in forming new guidelines and protocols for the detection and treatment of delirium for older patients in hospitals.

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Section: Discussionmentioning

confidence: 97%

Detection and management of hyperactive and hypoactive delirium in older patients during hospitalization: a retrospective cohort study evaluating daily practice

Velthuijsen

Zwakhalen

Mulder

et al. 2017

Int J Geriat Psychiatry

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“…10 We were not able to explore this mechanism, because only 5% of the cohort had ICD-9 codes indicating delirium, reflecting underreporting of delirium in claims records. 34 Another study examined the association of hospitalization with long-term cognitive decline and brain magnetic resonance imaging (MRI) changes; they found hospitalization was associated with higher odds of increasing ventricular size, and there was modest evidence of mediation of the association of hospitalization and cognitive decline when ventricular change was added to the model (there was little evidence of mediation by white matter hyperintensities). 2 Finally, a recent MRI study demonstrated a relationship between more frequent hospitalizations and smaller brain volumes and lower white matter integrity.…”

Section: Discussionmentioning

confidence: 99%

Hospitalization, Alzheimer's Disease and Related Neuropathologies, and Cognitive Decline

James

Wilson

Capuano

et al. 2019

Annals of Neurology

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Objective To test the hypothesis that Alzheimer's disease and related neuropathologies contribute to the association between hospitalization and cognitive decline in old age. Methods As part of a longitudinal clinical–pathologic cohort study, 526 older persons (mean age at death = 90.9 years, 71% female) without dementia at baseline completed annual cognitive testing and were autopsied at death. Hospitalization information was obtained from linked Medicare claims records. Neuropathologic examination assessed β‐amyloid burden, tau tangle density, neocortical Lewy bodies, hippocampal sclerosis, chronic gross and microscopic cerebral infarcts, and transactive response DNA binding protein 43 kDa. Results Over a mean of 5.1 years, a total of 1,383 hospitalizations occurred, and the mean annual rate of hospitalization was 0.5 (standard deviation = 0.6, median = 0.4). Higher rate of hospitalization was not directly related to higher burden for any of the neuropathologic markers. Higher rate of hospitalization was associated with more rapid cognitive decline (estimate = −0.042, standard error [SE] = 0.012, p < 0.001), and after controlling for all 7 neuropathologic markers, the association was essentially the same (estimate = −0.040, SE = 0.013, p = 0.002). In a multivariable model with 3‐way interactions of neuropathologic markers with hospitalization rate and time, the association between hospitalization rate and faster cognitive decline was greater in persons with more tangle pathology (estimate for interaction = −0.007, SE = 0.002, p = 0.002) and in persons with neocortical Lewy bodies (estimate for interaction = −0.117, SE = 0.042, p = 0.005). Interpretation Older persons with more hospitalizations experienced faster rates of cognitive decline, and this association was more pronounced in persons with more tau tangle density and with neocortical Lewy body pathologies. ANN NEUROL 2019;86:844–852

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“…The pathophysiology of delirium remains poorly understood, and there are no biomarkers to serve as diagnostic indicators or therapeutic targets . Although the number of measures for screening and diagnosis of delirium has increased in the past decade, the proportion of individuals with unrecognized delirium remains high …”

Section: Network For Investigation Of Delirium Across the Us (Nidusmentioning

confidence: 99%

Network for Investigation of Delirium across the U.S.: Advancing the Field of Delirium with a New Interdisciplinary Research Network

Fick

Auerbach

Avidan

et al. 2017

J American Geriatrics Society

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Underreporting of Delirium in Statewide Claims Data: Implications for Clinical Care and Predictive Modeling

Cited by 50 publications

References 62 publications

Detection and management of hyperactive and hypoactive delirium in older patients during hospitalization: a retrospective cohort study evaluating daily practice

Detection and management of hyperactive and hypoactive delirium in older patients during hospitalization: a retrospective cohort study evaluating daily practice

Hospitalization, Alzheimer's Disease and Related Neuropathologies, and Cognitive Decline

Network for Investigation of Delirium across the U.S.: Advancing the Field of Delirium with a New Interdisciplinary Research Network

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