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Episodes of psychomotor agitation among medical patients: findings from a longitudinal multicentre study

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Abstract

Background

The management of delirium among older in-hospital patients is a challenge, leading to worse outcomes, including death. Specifically, psychomotor agitation, one of the main characteristics of hyperactive delirium, requires a significant amount of medical and nursing surveillance. However, despite its relevance, to date incidence and/or prevalence of psychomotor agitation, its predictors and outcomes have not been studied among Italian older patients admitted in medical units.

Aims

To describe the incidence and the prevalence of psychomotor agitation among patients aged > 65 years admitted to medical units and identify predictors at the individual, nursing care and hospital levels.

Methods

A longitudinal multicentre study was conducted involving 12 medical units in 12 northern Italian hospitals. Descriptive, bivariate and multivariate logistic regression analyses were performed.

Results

Among the 1464 patients included in the study, two hundred (13.6%) have manifested episode(s), with an average of 3.46/patient (95% confidence of interval [CI] 2.73–4.18). In 108 (54.0%) patients, episode(s) were present also in the week prior to hospitalisation: therefore, in-hospital-acquired psychomotor agitation was reported in 92 patients (46%). The multivariate logistic regression analysis explained the 25.4% of the variance and identified the following variables as psychomotor agitation predictors: the risk of falls (relative risk [RR] 1.314, 95% CI 1.218–1.417), the amount of missed nursing care (RR 1.078, 95% CI 1.037–1.12) and the patient’s age (RR 1.018, 95% CI 1.002–1.034). Factors preventing the occurrence of episode(s) were: the amount of care received from graduated nurses (RR 0.978; 95% CI 0.965–0.992) and the lower functional dependence at admission (RR 0.987, 95% CI 0.977–0.997).

Conclusions

A considerable number of elderly patients admitted in medical units develop psychomotor agitation; its predictors need to be identified early to inform decisions regarding the personal care needed to prevent its occurrence, especially by acting on modifiable factors, such as the risk of falls, missed nursing care and functional dependence.

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Acknowledgements

ESAMED Team: Annamaria Guarnier, Paolo Barelli, Paola Zambiasi, Elisabetta Allegrini, Letizia Bazoli, Paola Casson, Meri Marin, Marisa Padovan, Michele Picogna, Patrizia Taddia, Daniele Salmaso, Paolo Chiari, Tiziana Frison, Oliva Marognolli, Federica Canzan, Elisa Ambrosi, Luisa Saiani.

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Authors and Affiliations

  1. Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy

    Irene Mansutti

  2. Department of Medical Science, Udine University, Viale Ungheria 20, 33100, Udine, Italy

    Margherita Venturini & Alvisa Palese

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  1. Irene Mansutti
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  2. Margherita Venturini
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  3. Alvisa Palese
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Consortia

the ESAMED team

  • Annamaria Guarnier
  • , Paolo Barelli
  • , Paola Zambiasi
  • , Elisabetta Allegrini
  • , Letizia Bazoli
  • , Paola Casson
  • , Meri Marin
  • , Marisa Padovan
  • , Michele Picogna
  • , Patrizia Taddia
  • , Daniele Salmaso
  • , Paolo Chiari
  • , Tiziana Frison
  • , Oliva Marognolli
  • , Federica Canzan
  • , Elisa Ambrosi
  •  & Luisa Saiani

Corresponding author

Correspondence to Alvisa Palese.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Mansutti, I., Venturini, M., Palese, A. et al. Episodes of psychomotor agitation among medical patients: findings from a longitudinal multicentre study. Aging Clin Exp Res 32, 1101–1110 (2020). https://doi.org/10.1007/s40520-019-01293-5

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  • DOI: https://doi.org/10.1007/s40520-019-01293-5

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