Understanding our patients better will lead to better recognition of delirium: An opinion piece

Eeles, Eamonn; England, Renee; Armstrong, A. MacC.; Pinsker, Donna; Pandy, Shaun; Teodorczuk, Andrew

doi:10.1111/ajag.12585

Cited by 4 publications

(9 citation statements)

References 6 publications

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“…The presence or absence of delirium was classified as definite (meets DSM-5 criteria), possible (meets some DSM-5 criteria but not all), or no delirium. Motor subtype was classified by the Delirium Motor Subtype Scale (DMSS) [19] as hypoactive (reduced alertness), hyperactive (increased alertness or motor agitation), mixed (some features of both hypoactive and hyperactive), or no clear motor subtype.…”

Section: Methodsmentioning

confidence: 99%

“…Delirium remains underdiagnosed in up to three quarters of patients [15–18]. Incomplete understanding of delirium and resultant educational needs of healthcare professionals, alongside avoidant behaviours towards a challenging patient group, are likely contributory [19]. National Institute for Health and Care Excellence (NICE) Guidelines recommend that all patients aged 65 or over are screened for delirium upon hospital admission [20]; this can be done using the 4 A’s Test (4AT).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Delirium is prevalent in older hospital inpatients and associated with adverse outcomes: results of a prospective multi-centre study on World Delirium Awareness Day

Welch¹,

McCluskey²,

Wilson³

et al. 2019

BMC Med

110

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BackgroundDelirium is a common severe neuropsychiatric condition secondary to physical illness, which predominantly affects older adults in hospital. Prior to this study, the UK point prevalence of delirium was unknown. We set out to ascertain the point prevalence of delirium across UK hospitals and how this relates to adverse outcomes.MethodsWe conducted a prospective observational study across 45 UK acute care hospitals. Older adults aged 65 years and older were screened and assessed for evidence of delirium on World Delirium Awareness Day (14th March 2018). We included patients admitted within the previous 48 h, excluding critical care admissions.ResultsThe point prevalence of Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5) delirium diagnosis was 14.7% (222/1507). Delirium presence was associated with higher Clinical Frailty Scale (CFS): CFS 4–6 (frail) (OR 4.80, CI 2.63–8.74), 7–9 (very frail) (OR 9.33, CI 4.79–18.17), compared to 1–3 (fit). However, higher CFS was associated with reduced delirium recognition (7–9 compared to 1–3; OR 0.16, CI 0.04–0.77). In multivariable analyses, delirium was associated with increased length of stay (+ 3.45 days, CI 1.75–5.07) and increased mortality (OR 2.43, CI 1.44–4.09) at 1 month. Screening for delirium was associated with an increased chance of recognition (OR 5.47, CI 2.67–11.21).ConclusionsDelirium is prevalent in older adults in UK hospitals but remains under-recognised. Frailty is strongly associated with the development of delirium, but delirium is less likely to be recognised in frail patients. The presence of delirium is associated with increased mortality and length of stay at one month. A national programme to increase screening has the potential to improve recognition.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Delirium is prevalent in older hospital inpatients and associated with adverse outcomes: results of a prospective multi-centre study on World Delirium Awareness Day

Welch¹,

McCluskey²,

Wilson³

et al. 2019

BMC Med

110

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“…If delirium is a measure of the degree to which we as healthcare professionals practice with compassion, then the imperative will be to make continued headway on improving delirium care in all respects. [18] These guidelines on delirium are an important component of that future.…”

Section: Challenges and Opportunities For Culture Changementioning

confidence: 99%

The Scottish Intercollegiate Guidelines Network: risk reduction and management of delirium

2019

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Clinical and research interest in delirium has been rising over the last 15 years. The Scottish Intercollegiate Guidelines Network (SIGN) publication on delirium is a state-of-the-art synthesis of the field, and the first UK guideline since 2010. There is new guidance around delirium detection, particularly in recommending the 4 "A"s Test (4AT). The 4AT has the advantage of being brief, embeds and operationalises cognitive testing, and is

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“…For this we must first consider that consciousness is an emergent property indicative of complexity and key to understanding complex system failure in delirium. Complex system failure may also offer a deeper understanding of the archetypal volatility and non-linear relationships observed in delirium (Eeles, Teodorczuk, & Mitleton-Kelly, 2018). Such a biological model that provides insights into wider characteristics of delirium and response to treatment may aid understanding and practice in delirium care.…”

Section: Introductionmentioning

confidence: 99%

“…Other models of delirium including the neurotransmitter hypothesis, aberrant stress response (Maldonado, 2013), and disturbance in the glycolytic pathway (Haggstrom, Welschinger, & Caplan, 2017) are all attractive mechanisms but agreement on their respective roles is lacking. A reconceptualization of delirium as a disorder of complex system failure offers a fresh perspective (Eeles, Teodorczuk, & Mitleton-Kelly, 2018). For this we must first consider that consciousness is an emergent property indicative of complexity and key to understanding complex system failure in delirium.…”

Section: Introductionmentioning

confidence: 99%

Delirium Management: Anything’s Possible

et al. 2019

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RÉSUMÉLe délirium est un problème de santé majeur aux conséquences potentiellement graves. Malheureusement, la prise en charge de ce trouble est souvent sous-optimale. Nous considérons que les lacunes dans les soins offerts aux patients avec délirium sont liées aux particularités de cette condition, qui affecte la perception du « soi » de la personne qui en souffre. Cette atteinte entraîne un comportement hors de contrôle chez la personne avec délirium et l’expose à une déshumanisation mécaniste. Une solution consisterait à favoriser une vision élargie du « soi », inspirée de la philosophie et des sciences cognitives récentes, afin d’aider les cliniciens dans la compréhension du comportement pathologique en tant que manifestation de la perturbation de la pensée. Une approche centrée sur l’éthique des soins, intégrant un nouveau cadre pour la relation patient-soignant, est proposée. Considérées dans leur ensemble, les propositions novatrices émises pourraient faciliter l’élaboration d’un cadre de pratiques et de relations plus attentionnées et plus efficaces pour le traitement du délirium.

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Understanding our patients better will lead to better recognition of delirium: An opinion piece

Cited by 4 publications

References 6 publications

Delirium is prevalent in older hospital inpatients and associated with adverse outcomes: results of a prospective multi-centre study on World Delirium Awareness Day

Delirium is prevalent in older hospital inpatients and associated with adverse outcomes: results of a prospective multi-centre study on World Delirium Awareness Day

The Scottish Intercollegiate Guidelines Network: risk reduction and management of delirium

Delirium Management: Anything’s Possible

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