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Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study

  • Original Article
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Abstract

Background

Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation.

Aim

We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the “Delirium Day project”.

Methods

We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the “Delirium Day project” (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale.

Results

Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%).

In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17–1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08–2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62–2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10–1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02–1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68–3.36, p value < 0.0001).

Conclusion

This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors gratefully acknowledge the contributions of the Italian Study Group on Delirium (ISGoD) members who performed data collection and author’s family members. The full list of ISGoD can be found in Supplementary Material.

Tarasconi A, Sella M, Paternò G, Faggian G, Lucarelli C, De Grazia N, Alberto C, Porcella L, Nardiello I, Chimenti E, Zeni M, Romairone E, Minaglia C, Ceccotti C, Guerra G, Mantovani G, Monacelli F, Minaglia C, Candiani T, Santolini F, Minaglia C, Rosso M, Bono V, Sibilla S, Dal Santo P, Ceci M, Barone P, Schirinzi T, Formenti A, Nastasi G, Isaia G, Gonella D, Battuello A, Casson S, Calvani D, Boni F, Ciaccio A, Rosa R, Sanna G, Manfredini S, Cortese L, Rizzo M, Prestano R, Greco A, Lauriola M, Gelosa G, Piras V, Arena M, Cosenza D, Bellomo A, LaMontagna M, Gabbani L, Lambertucci L, Perego S, Parati G, Basile G, Gallina V, Pilone G, Giudice C, Pietrogrande L, Mosca M, Corazzin I, Rossi P, Nunziata V, D’Amico F, Grippa A, Giardini S, Barucci R, Cossu A, Fiorin L, Arena M, Distefano M, Lunardelli M, Brunori M, Ruffini I, Abraham E, Varutti A, Fabbro E, Catalano A, Martino G, Leotta D, Marchet A, Dell’Aquila G, Scrimieri A, Davoli M, Casella M, Cartei A, Polidori G, Basile G, Brischetto D, Motta S, Saponara R, Perrone P, Russo G, Del D, Car C, Pirina T, Franzoni S, Cotroneo A, Ghiggia F, Volpi G, Menichetti C, Bo M, Panico A, Calogero P, Corvalli G, Mauri M, Lupia E, Manfredini R, Fabbian F, March A, Pedrotti M, Veronesi M, Strocchi E, Borghi C, Bianchetti A, Crucitti A, DiFrancesco V, Fontana G, Geriatria A, Bonanni L, Barbone F, Serrati C, Ballardini G, Simoncelli M, Ceschia G, Scarpa C, Brugiolo R, Fusco S, Ciarambino T, Biagini C, Tonon E, Porta M, Venuti D, DelSette M, Poeta M, Barbagallo G, Trovato G, Delitala A, Arosio P, Reggiani F, Zuliani G, Ortolani B, Mussio E, Girardi A, Coin A, Ruotolo G, Castagna A, Masina M, Cimino R, Pinciaroli A, Tripodi G, Cassadonte F, Vatrano M, Scaglione L, Fogliacco P, Muzzuilini C, Romano F, Padovani A, Rozzini L, Cagnin A, Fragiacomo F, Desideri G, Liberatore E, Bruni A, Orsitto G, Franco M, Bonfrate L, Bonetto M, Pizio N, Magnani G, Cecchetti G, Longo A, Bubba V, Marinan L, Cotelli M, Turla M, Brunori M, Sessa M, Abruzzi L, Castoldi G, LoVetere D, Musacchio C, Novello M, Cavarape A, Bini A, Leonardi A, Seneci F, Grimaldi W, Seneci F, Fimognari F, Bambara V, Saitta A, Corica F, Braga M, Servi, Ettorre E, Camellini C, Bellelli G, Annoni G, Marengoni A, Bruni A, Crescenzo A, Noro G, Turco R, Ponzetto M, Giuseppe L, Mazzei B, Maiuri G, Costaggiu D, Damato R, Fabbro E, Formilan M, Patrizia G, Santuari L, Gallucci M, Minaglia C, Paragona M, Bini P, Modica D, Abati C, Clerici M, Barbera I, NigroImperiale F, Manni A, Votino C, Castiglioni C, Di M, Degl’Innocenti M, Moscatelli G, Guerini S, Casini C, Dini D, DeNotariis S, Bonometti F, Paolillo C, Riccardi A, Tiozzo A, Samy Salama Fahmy A, Riccardi A, Paolillo C, Di Bari M, Vanni S, Scarpa A, Zara D, Ranieri P, Alessandro M, Calogero P, Corvalli G, Di F, Pezzoni D, Platto C, D’Ambrosio V, Ivaldi C, Milia P, DeSalvo F, Solaro C, Strazzacappa M, Bo M, Panico A, Cazzadori M, Bonetto M, Grasso M, Troisi E, Magnani G, Cecchetti G, Guerini V, Bernardini B, Corsini C, Boffelli S, Filippi A, Delpin K, Faraci B, Bertoletti E, Vannucci M, Crippa P, Malighetti A, Caltagirone C, DiSanto S, Bettini D, Maltese F, Formilan M, Abruzzese G, Minaglia C, Cosimo D, Azzini M, Cazzadori M, Colombo M, Procino G, Fascendini S, Barocco F, Del P, D’Amico F, Grippa A, Mazzone A, Riva E, Dell’Acqua D, Cottino M, Vezzadini G, Avanzi S, Brambilla C, Orini S, Sgrilli F, Mello A, Lombardi L, Muti E, Dijk B, Fenu S, Pes C, Gareri P, Castagna A, Passamonte M, Rigo R, Locusta L, Caser L, Rosso G, Cesarini S, Cozzi R, Santini C, Carbone P, Cazzaniga I, Lovati R, Cantoni A, Ranzani P, Barra D, Pompilio G, Dimori S, Cernesi S, Riccò C, Piazzolla F, Capittini E, Rota C, Gottardi F, Merla L, Barelli A, Millul A, De G, Morrone G, Bigolari M, Minaglia C, Macchi M, Zambon F, D’Amico F, D’Amico F, Pizzorni C, DiCasaleto G, Menculini G, Marcacci M, Catanese G, Sprini D, DiCasalet T, Bocci M, Borga S, Caironi P, Cat C, Cingolani E, Avalli L, Greco G, Citerio G, Gandini L, Cornara G, Lerda R, Brazzi L, Simeone F, Caciorgna M, Alampi D, Francesconi S, Beck E, Antonini B, Vettoretto K, Meggiolaro M, Garofalo E, Bruni A, Notaro S, Varutti R, Bassi F, Mistraletti G, Marino A, Rona R, Rondelli E, Riva I, Cortegiani A, Pistidda L, D’Andrea R, Querci L, Gnesin P, Todeschini M, Lugano M, Castelli G, Ortolani M, Cotoia A, Maggiore S, DiTizio L, Graziani R, Testa I, Ferretti E, Castioni C, Lombardi F, Caserta R, Pasqua M, Simoncini S, Baccarini F, Rispoli M, Grossi F, Cancelliere L, Carnelli M, Puccini F, Biancofiore G, Siniscalchi A, Laici C, Mossello E, Torrini M, Pasetti G, Palmese S, Oggioni R, Mangani V, Pini S, Martelli M, Rigo E, Zuccalà F, Cherri A, Spina R, Calamai I, Petrucci N, Caicedo A, Ferri F, Gritti P, Brienza N, Fonnesu R, Dessena M, Fullin G, Saggioro D

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Author notes

  1. Alessandro Morandi and Giuseppe Bellelli equally contributed to the paper as senior authors.

Authors and Affiliations

  1. School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

    Chiara Sidoli & Giuseppe Bellelli

  2. Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano‐Bicocca, Milano, Italy

    Antonella Zambon

  3. Biostatistics Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy

    Antonella Zambon

  4. Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Center), School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

    Elena Tassistro & Emanuela Rossi

  5. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Enrico Mossello

  6. Division of Geriatric and Intensive Care Medicine, AOU Careggi, Florence, Italy

    Enrico Mossello

  7. Intermediate Care, Research and Teaching, Parc Sanitari Pere Virgili, Barcelona, Spain

    Marco Inzitari

  8. Geriatria, Accettazione Geriatrica e Centro di Ricerca per l’invecchiamento, IRCCS INRCA, Ancona, Italy

    Antonio Cherubini

  9. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

    Alessandra Marengoni

  10. Department of Rehabilitation, Azienda Speciale di Cremona Solidale, A.S.C.S., Cremona, Italy

    Alessandro Morandi

  11. Geriatric Research Group, Brescia, Italy

    Alessandro Morandi

  12. REFiT Bcn research group, Parc Sanitari Pere Virgili and Vall d’Hebrón Institut de Recerca (VHIR), Barcelona, Spain

    Alessandro Morandi

  13. Acute Geriatric Unit, San Gerardo hospital, Monza, Italy

    Giuseppe Bellelli

  14. Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, TN, USA

    Alessandro Morandi

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  1. Chiara Sidoli
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  2. Antonella Zambon
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  3. Elena Tassistro
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  4. Emanuela Rossi
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  5. Enrico Mossello
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  6. Marco Inzitari
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  8. Alessandra Marengoni
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  9. Alessandro Morandi
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  10. Giuseppe Bellelli
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Consortia

 on behalf of the Italian Study Group on Delirium

  • A Tarasconi
  • , M Sella
  • , G Paternò
  • , G Faggian
  • , C Lucarelli
  • , N De Grazia
  • , C Alberto
  • , L Porcella
  • , I Nardiello
  • , E Chimenti
  • , M Zeni
  • , E Romairone
  • , C Minaglia
  • , C Ceccotti
  • , G Guerra
  • , G Mantovani
  • , F Monacelli
  • , C Minaglia
  • , T Candiani
  • , F Santolini
  • , C Minaglia
  • , M Rosso
  • , V Bono
  • , S Sibilla
  • , P Dal Santo
  • , M Ceci
  • , P Barone
  • , T Schirinzi
  • , A Formenti
  • , G Nastasi
  • , G Isaia
  • , D Gonella
  • , A Battuello
  • , S Casson
  • , D Calvani
  • , F Boni
  • , A Ciaccio
  • , R Rosa
  • , G Sanna
  • , S Manfredini
  • , L Cortese
  • , M Rizzo
  • , R Prestano
  • , A Greco
  • , M Lauriola
  • , G Gelosa
  • , V Piras
  • , M Arena
  • , D Cosenza
  • , A Bellomo
  • , M LaMontagna
  • , L Gabbani
  • , L Lambertucci
  • , S Perego
  • , G Parati
  • , G Basile
  • , V Gallina
  • , G Pilone
  • , C Giudice
  • , L Pietrogrande
  • , M Mosca
  • , I Corazzin
  • , P Rossi
  • , V Nunziata
  • , F D’Amico
  • , A Grippa
  • , S Giardini
  • , R Barucci
  • , A Cossu
  • , L Fiorin
  • , M Arena
  • , M Distefano
  • , M Lunardelli
  • , M Brunori
  • , I Ruffini
  • , E Abraham
  • , A Varutti
  • , E Fabbro
  • , A Catalano
  • , G Martino
  • , D Leotta
  • , A Marchet
  • , G Dell’Aquila
  • , A Scrimieri
  • , M Davoli
  • , M Casella
  • , A Cartei
  • , G Polidori
  • , G Basile
  • , D Brischetto
  • , S Motta
  • , R Saponara
  • , P Perrone
  • , G Russo
  • , D Del
  • , C Car
  • , T Pirina
  • , S Franzoni
  • , A Cotroneo
  • , F Ghiggia
  • , G Volpi
  • , C Menichetti
  • , M Bo
  • , A Panico
  • , P Calogero
  • , G Corvalli
  • , M Mauri
  • , E Lupia
  • , R Manfredini
  • , F Fabbian
  • , A March
  • , M Pedrotti
  • , M Veronesi
  • , E Strocchi
  • , C Borghi
  • , A Bianchetti
  • , A Crucitti
  • , V DiFrancesco
  • , G Fontana
  • , A Geriatria
  • , L Bonanni
  • , F Barbone
  • , C Serrati
  • , G Ballardini
  • , M Simoncelli
  • , G Ceschia
  • , C Scarpa
  • , R Brugiolo
  • , S Fusco
  • , T Ciarambino
  • , C Biagini
  • , E Tonon
  • , M Porta
  • , D Venuti
  • , M DelSette
  • , M Poeta
  • , G Barbagallo
  • , G Trovato
  • , A Delitala
  • , P Arosio
  • , F Reggiani
  • , G Zuliani
  • , B Ortolani
  • , E Mussio
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  • , A Coin
  • , G Ruotolo
  • , A Castagna
  • , M Masina
  • , R Cimino
  • , A Pinciaroli
  • , G Tripodi
  • , F Cassadonte
  • , M Vatrano
  • , L Scaglione
  • , P Fogliacco
  • , C Muzzuilini
  • , F Romano
  • , A Padovani
  • , L Rozzini
  • , A Cagnin
  • , F Fragiacomo
  • , G Desideri
  • , E Liberatore
  • , A Bruni
  • , G Orsitto
  • , M Franco
  • , L Bonfrate
  • , M Bonetto
  • , N Pizio
  • , G Magnani
  • , G Cecchetti
  • , A Longo
  • , V Bubba
  • , L Marinan
  • , M Cotelli
  • , M Turla
  • , M Brunori
  • , M Sessa
  • , L Abruzzi
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  • , M Novello
  • , A Cavarape
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  • , A Leonardi
  • , F Seneci
  • , W Grimaldi
  • , F Seneci
  • , F Fimognari
  • , V Bambar
  • , A Saitta
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  • , M Ponzetto
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  • , C Votino
  • , C Castiglioni
  • , M Di
  • ,  M Degl’Innocenti
  • , G Moscatelli
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  • , M DiBari
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  • , P Ranieri
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  • , C Caltagirone
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  • , M Formilan
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  • , M Azzini
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  • , A Cantoni
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  • , S Dimori
  • , S Cernesi
  • , C Riccò
  • , F Piazzolla
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  • , C Rota
  • , F Gottardi
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  • , A Barelli
  • , A Millul
  • , G De
  • , G Morrone
  • , M Bigolari
  • , C Minaglia
  • , M Macchi
  • , F Zambon
  • , F D’Amico
  • , F D’Amico
  • , C Pizzorni
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  • , G Menculini
  • , M Marcacci
  • , G Catanese
  • , D Sprini
  • , T DiCasalet
  • , M Bocci
  • , S Borga
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  • , G Citerio
  • , L Gandini
  • , G Cornara
  • , R Lerda
  • , L Brazzi
  • , F Simeone
  • , M Caciorgna
  • , D Alampi
  • , S Francesconi
  • , E Beck
  • , B Antonini
  • , K Vettoretto
  • , M Meggiolaro
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  • , A Bruni
  • , S Notaro
  • , R Varutti
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  • , G Mistraletti
  • , A Marino
  • , R Rona
  • , E Rondelli
  • , I Riva
  • , A Cortegiani
  • , L Pistidda
  • , R D’Andrea
  • , L Querci
  • , P Gnesin
  • , M Todeschini
  • , M Lugano
  • , G Castelli
  • , M Ortolani
  • , A Cotoia
  • , S Maggiore
  • , L DiTizio
  • , R Graziani
  • , I Testa
  • , E Ferretti
  • , C Castioni
  • , F Lombardi
  • , R Caserta
  • , M Pasqua
  • , S Simoncini
  • , F Baccarini
  • , M Rispoli
  • , F Grossi
  • , L Cancelliere
  • , M Carnelli
  • , F Puccini
  • , G Biancofiore
  • , A Siniscalchi
  • , C Laici
  • , E Mossello
  • , M Torrini
  • , G Pasetti
  • , S Palmese
  • , R Oggioni
  • , V Mangani
  • , S Pini
  • , M Martelli
  • , E Rigo
  • , F Zuccalà
  • , A Cherri
  • , R Spina
  • , I Calamai
  • , N Petrucci
  • , A Caicedo
  • , F Ferri
  • , P Gritti
  • , N Brienza
  • , R Fonnesu
  • , M Dessena
  • , G Fullin
  •  & D Saggioro

Contributions

All authors contributed to the conception and design of the study. CS, EM, MI, AC, AMa, AMo, GB: contributed to the acquisition of the data. AZ, ET and ER: were responsible for the statistical analysis and interpretation of the data. CS, AZ, AMo and GB: contributed to the draft of this paper. All authors have read, revised and approved the final manuscript.

Corresponding author

Correspondence to Alessandro Morandi.

Ethics declarations

Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Ethics approval

The study protocol for Delirium day events were approved from the Ethical Committees of the IRCCS Fondazione Santa Lucia, Rome (year 2015) and of the University of Milano-Bicocca, Monza, Italy (years 2016–2017).

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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All participants gave their written informed consent prior to participation.

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The list of authors in Italian Study Group on Delirium (ISGoD) is mentioned in Supplementary Material.

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Sidoli, C., Zambon, A., Tassistro, E. et al. Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study. Aging Clin Exp Res 34, 1827–1835 (2022). https://doi.org/10.1007/s40520-022-02099-8

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