Abstract
Background
Previously, we demonstrated a substantial reduction of delirium incidence among geriatric patients after relocating from old hospital buildings with multiple-bed rooms to a new hospital with single-bed rooms.
Aims
To investigate whether (1) the reduced incidence of delirium in single-bed rooms was associated with a simultaneous change in medication use, (2) the relocation had affected the incidence of falls, (3) the use of analgesics and psychoactive medications was associated with the risk of delirium and falls.
Methods
We included 461 admissions to the old wards and 553 admissions to the new wards. Delirium was assessed by the Confusion Assessment Method. Data on drug use and falls during hospitalization were extracted from medical records.
Results
There was no difference in drug use between the wards. In the new wards, patients who had experienced delirium had a much higher risk of falls than patients without delirium, while in the old wards this contrast was small. The risk of delirium was increased among patients who received antipsychotic drugs and anti-dementia drugs, Patients who received these drugs had an insignificantly increased risk of falls.
Conclusion
Medication of analgesics and psychoactive drugs was similar in the old and new wards. In single-bed rooms, but not in multiple-bed rooms there was a much higher risk of falls among inpatients that developed delirium than among other patients. Patients who had used antipsychotics and anti-dementia drugs during hospitalization had increased risk of developing delirium and an insignificantly higher risk of falls.
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References
Inouye SK, Westendorp RG, Saczynski JS (2014) Delirium in elderly people. Lancet 383:911–922
Siddiqi N, Harrison JK, Clegg A et al (2016) Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev 3:CD005563
Blandfort S, Gregersen M, Rahbek K et al (2019) Single-bed rooms in a geriatric ward prevent delirium in older patients. Aging Clin Exp Res. https://doi.org/10.1007/s40520-019-01173-y
Lakatos BE, Capasso V, Mitchell MT et al (2009) Falls in the general hospital: association with delirium, advanced age, and specific surgical procedures. Psychosomatics 50:218–226
Mazur K, Wilczynski K, Szewieczek J (2016) Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors. Clin Interv Aging 11:1253–1261
Stenvall M, Olofsson B, Lundstrom M et al (2006) Inpatient falls and injuries in older patients treated for femoral neck fracture. Arch Gerontol Geriatr 43:389–399
Morrison RS, Magaziner J, Gilbert M et al (2003) Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci 58:76–81
Sieber FE, Mears S, Lee H et al (2011) Postoperative opioid consumption and its relationship to cognitive function in older adults with hip fracture. J Am Geriatr Soc 59:2256–2262
Daoust R, Paquet J, Moore L et al (2018) Recent opioid use and fall-related injury among older patients with trauma. CMAJ 190:E500–E506
Marcantonio ER, Juarez G, Goldman L et al (1994) The relationship of postoperative delirium with psychoactive medications. JAMA 272:1518–1522
Danish Health Authority. National clinical guidelines for prevention of falls (2018), 1.0 Available at: https://www.sst.dk/da/udgivelser/2018/~/media/F54E919E2ABE48D992DD19A86CBA9361.ashx. Accessed Apr 2019
Danish Multidisciplinary Cancer Group for Palliative Efforts (2018) Clinical guideline on delirium. 2013; Available at: http://www.dmcgpal.dk/661/godkendteretningslinjer. Accessed 13 Aug 2018
WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD index. 2019; Available at: https://www.whocc.no/atc_ddd_index/, Accessed 01 June 2018
World Health Organization. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10 Version 2016). 2016; Available at: https://icd.who.int/browse10/2016/en. Accessed 01 June, 2018
Laurila JV, Laakkonen ML, Tilvis RS et al (2008) Predisposing and precipitating factors for delirium in a frail geriatric population. J Psychosom Res 65:249–254
Brouquet A, Cudennec T, Benoist S et al (2010) Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery. Ann Surg 251:759–765
Holdensen AG, Fredholm LM (2017) Private rooms and prevention of delirium. Eur Geriatr Med 8:S240–S247
Bitsch M, Foss N, Kristensen B et al (2004) Pathogenesis of and management strategies for postoperative delirium after hip fracture: a review. Acta Orthop Scand 75:378–389
Juliebø V, Bjøro K, Krogseth M et al (2009) Risk factors for preoperative and postoperative delirium in elderly patients with hip fracture. J Am Geriatr Soc 57:1354–1361
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The cost of data collection, analysis, and preparation of the manuscript was covered by the Department of Geriatrics, Aarhus University Hospital.
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On behalf of all authors, the corresponding author states that there is no conflict of interest.
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It was a quality development project with no intervention, the study was exempted from notification to the Central Denmark Region Ethical Committee (Inquiry number 200/2017). The study protocol was approved by the Danish Data Protection Agency, case no. 1-16-02-254-16. The study was registered at ClinicalTrials.gov (Identifier NCT03199768).
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Blandfort, S., Gregersen, M., Rahbek, K. et al. Analgesic and psychoactive medications and the risk of falls in relation to delirium in single-bed rooms compared to multiple-bed rooms in geriatric inpatients. Aging Clin Exp Res 32, 1493–1499 (2020). https://doi.org/10.1007/s40520-019-01335-y
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DOI: https://doi.org/10.1007/s40520-019-01335-y