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Delirium in elderly patients hospitalized in internal medicine wards

Internal and Emergency Medicine volume 9, pages 435–441 (2014)Cite this article

Abstract

A prospective observational study was conducted to evaluate the impact of delirium on geriatric inpatients in internal medical wards and to identify predisposing factors for the development of delirium. The study included all patients aged 65 years and older, who were consecutively admitted to the internal medicine wards of two public hospitals in Florence, Italy. On admission, 29 baseline risk factors were examined, cognitive impairment was evaluated by Short Portable Mental Status Questionnaire, and prevalent delirium cases were diagnosed by Confusion Assessment Method (CAM). Enrolled patients were evaluated daily with CAM to detect incident delirium cases. Among the 560 included patients, 19 (3 %) had delirium on admission (prevalent) and 44 (8 %) developed delirium during hospitalization (incident). Prevalent delirium cases were excluded from the statistical analysis. Incident delirium was associated with increased length of hospital stay (p < 0.01) and institutionalization (p < 0.01, OR 3.026). Multivariate analysis found that cognitive impairment on admission (p < 0.0002), diabetes (p < 0.05, OR 1.936), chronic kidney failure (p < 0.05, OR 2.078) and male gender (p < 0.05, OR 2.178) was significantly associated with the development of delirium during hospitalization. Results show that delirium impact is relevant to older patients hospitalized in internal medicine wards. The present study confirms cognitive impairment as a risk factor for incident delirium. The cognitive evaluation proved to be an important instrument to improve identification of patients at high risk for delirium. In this context, our study may contribute to improve application of preventive strategies.

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References

  1. Inouye SK (2006) Delirium in older persons. N Engl J Med 354:1157–1165

    CAS  PubMed  Article  Google Scholar 

  2. Morandi A, Jackson JC, Ely EW (2009) Delirium in the intensive care unit. Int Rev Psychiatry 21:43–58

    PubMed  Article  Google Scholar 

  3. Inouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME (1993) A predictive model for Delirium in hospitalized elderly medical patients based on admission characteristics. Ann Intern Med 119:474–481

    CAS  PubMed  Article  Google Scholar 

  4. Inouye SK, Charpentier PA (1996) Precipitating factors for Delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA 275:852–857

    CAS  PubMed  Article  Google Scholar 

  5. Van Rompaey B, Elseviers MM, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Bossaert L (2009) Risk factors for Delirium in intensive care patients: a prospective cohort study. Crit Care 13(3):R77

    PubMed Central  PubMed  Article  Google Scholar 

  6. Girard TD, Pandharipande PP, Ely EW (2008) Delirium in the intensive care unit. Crit Care 12(Suppl 3):S3

    PubMed Central  PubMed  Article  Google Scholar 

  7. Gross AL, Jones RN, Habtemariam DA, Fong TG, Tommet D, Quach L, Schmitt E, Yap L, Inouye SK (2012) Delirium and long-term cognitive trajectory among persons with Dementia. Arch Intern Med 172(17):1324–1331

    PubMed Central  PubMed  Article  Google Scholar 

  8. Leslie DL, Inouye SK (2011) The importance of Delirium: economic and societal costs. J Am Geriatr Soc 59(Suppl 2):S241–S243

    PubMed Central  PubMed  Article  Google Scholar 

  9. Rockwood K, Cosway S, Stolee P, Kydd D, Carver D, Jarrett P, O’Brien B (1994) Increasing the recognition of Delirium in elderly patients. J Am Geriatr Soc 42:252–256

    CAS  PubMed  Google Scholar 

  10. Quinlan N, Marcantonio ER, Inouye SK, Gill TM, Kamholz B, Rudolph JL (2011) Vulnerability: the crossroads of frailty and Delirium. J Am Geriatr Soc 59(Suppl 2):S262–S268

    PubMed Central  PubMed  Article  Google Scholar 

  11. Pfeiffer E (1975) A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 23:433–441

    CAS  PubMed  Google Scholar 

  12. Erkinjuntti T, Sulkava R, Wikström J, Autio L (1987) Short portable mental status questionnaire as a screening test for dementia and Delirium among the elderly. J Am Geriatr Soc 35(5):412–416

    CAS  PubMed  Google Scholar 

  13. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI (1990) Clarifying confusion: the confusion assessment method. A new method for detection of Delirium. Ann Intern Med 113:941–948

    CAS  PubMed  Article  Google Scholar 

  14. Wei LA, Fearing MA, Sternberg EJ, Inouye SK (2008) The confusion assessment method: a systematic review of current usage. J Am Geriatr Soc 56:823–830

    PubMed Central  PubMed  Article  Google Scholar 

  15. Elie M, Cole MG, Primeau FJ, Bellavance F (1998) Delirium risk factors in elderly hospitalized patients. J Gen Intern Med 13(3):204–212

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  16. Dobson AJ, Barnett A (2008) An introduction to generalized linear models, 3rd edn. Chapman & Hall, London

    Google Scholar 

  17. Siddiqi N, House AO, Holmes JD (2006) Occurrence and outcome of Delirium in medical in-patients: a systematic literature review. Age Ageing 35(4):350–364

    PubMed  Article  Google Scholar 

  18. National Institute for Health and Clinical Excellence (2010) Delirium: diagnosis, prevention and management. (Clinical guidline 103) www.nice.org.uk/CG103

  19. Teodorczuk A, Reynish E, Milisen K (2012) Improving recognition of Delirium in clinical practice: a call for action. BMC Geriatr 14(12):55

    Article  Google Scholar 

  20. Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS (2002) Confusion assessment method in the diagnostics of Delirium among aged hospital patients: would it serve better in screening than as a diagnostic instrument? Int J Geriatr Psychiatry 17(12):1112–1119

    CAS  PubMed  Article  Google Scholar 

  21. Boustani M, Baker MS, Campbell N, Munger S, Hui SL, Castelluccio P, Farber M, Guzman O, Ademuyiwa A, Miller D, Callahan C (2010) Impact and recognition of cognitive impairment among hospitalized elders. J Hosp Med 5:69–75

    PubMed Central  PubMed  Article  Google Scholar 

  22. McCusker J, Cole MG, Dendukuri N, Belzile E (2003) Does Delirium increase hospital stay? J Am Geriatr Soc 51:1539–1546

    PubMed  Article  Google Scholar 

  23. Murray AM, Levkoff SE, Wetle TT, Beckett L, Cleary PD, Schor JD, Lipsitz LA, Rowe JW, Evans DA (1993) Acute Delirium and functional decline in the hospitalized elderly patient. J Gerontol 48:M181–M186

    CAS  PubMed  Article  Google Scholar 

  24. Cole MG (2004) Delirium in elderly patients. Am J Geriatr Psychiatry 12:7–21

    PubMed  Article  Google Scholar 

  25. Franco JG, Valencia C, Bernal C, Ocampo MV, Trzepacz PT, Pablo J, Mejia MA (2010) Relationship between cognitive status at admission and incident Delirium in older medical inpatients. J Neuropsychiatry Clin Neurosci 22:329–337

    PubMed  Article  Google Scholar 

  26. Khurana PS, Sharma PS, Avasthi A (2002) Risk factors in delirious geriatric general medical inpatients. Indian J Psychiatry 44:266–272

    PubMed Central  PubMed  Google Scholar 

  27. Rudolph JL, Jones RN, Rasmussen LS, Silverstein JH, Inouye SK, Marcantonio ER (2007) Independent vascular and cognitive risk factors for postoperative Delirium. Am J Med 120:807–813

    PubMed  Article  Google Scholar 

  28. Chan D, Brennan NJ (1999) Delirium: making the diagnosis, improving the prognosis. Geriatrics 54(3):28–30

    CAS  PubMed  Google Scholar 

  29. McCusker J, Cole M, Abrahamowicz M, Han L, Podoba JE, Ramman-Haddad L (2001) Environmental risk factors for Delirium in hospitalized older people. J Am Geriatr Soc 49:1327–1334

    CAS  PubMed  Article  Google Scholar 

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Acknowledgments

The authors disclose any relationship with industry and financial associations and declare the absence of conflicts of interest.

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Affiliations

  1. Internal Medicine Unit, Serristori Hospital Figline Valdarno, Florence, Italy

    Alberto Fortini & Giuseppe Tavernese

  2. Internal Medicine Unit 1, Azienda Ospedaliera Universitaria Careggi, Florence, Italy

    Alessandro Morettini, Sofia Facchini, Lorenzo Tofani & Maddalena Pazzi

Authors
  1. Alberto Fortini
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  2. Alessandro Morettini
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  3. Giuseppe Tavernese
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  4. Sofia Facchini
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  5. Lorenzo Tofani
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  6. Maddalena Pazzi
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Correspondence to Alberto Fortini.

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Fortini, A., Morettini, A., Tavernese, G. et al. Delirium in elderly patients hospitalized in internal medicine wards. Intern Emerg Med 9, 435–441 (2014). https://doi.org/10.1007/s11739-013-0968-0

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  • DOI: https://doi.org/10.1007/s11739-013-0968-0

Keywords

  • Delirium
  • Elderly
  • Cognitive impairment
  • Risk factor