Skip to main content
SpringerLink
Log in

Opvattingen van artsen en verpleegkundigen over de preventie, diagnose en behandeling van delirium

  • Artikel
  • Published:
Tijdschrift voor Gerontologie en Geriatrie

Opinions of physicians and nurses regarding the prevention, diagnosis and management of delirium

To assess the current opinions of physicians and nurses regarding the prevention, diagnosis and management of delirium, survey administration was conducted to 2256 nurses and 982 physicians within the University Hospitals of Leuven (Belgium). Response rate was 26% with 819 respondents (600 nurses; 219 physicians) completing the questionnaire. 72% of the respondents considered delirium as a minor problem or no problem at all. Yet over half of respondents working on a palliative care unit (87%, n=15), traumatological ward (67%, n=18), cardio-thoracic surgery ward (58%, n=20), intensive care unit (55%, n=120) and geriatric ward (55%, n=42) reported it as a serious problem. Delirium was considered as an underdiagnosed (85%) but preventable (75%) syndrome. Yet patients at risk are rarely (34%) or never (52%) screened for delirium. In case of screening (48%), only 4% used a specific validated assessment tool. 97% of all respondents were convinced that delirium requires an active and immediate intervention of nurse and physician. 82% of the physicians preferred haldol® to treat delirium, in case of alcohol withdrawal 69% chose tranxëne®. Physical restraints were considered important in the management of delirium by a greater proportion of nurses (49%) than physicians (28%). Conclusion: the severity of the problem is underestimated. While opinions regarding the treatment were quite correct, prevention and early detection of delirium deserve more attention.

Samenvatting

Deze survey wil zicht krijgen op de opvattingen van ziekenhuisartsen en verpleegkundigen over de preventie, diagnose en behandeling van delirium. Vragenlijsten werden verspreid aan 2256 verpleegkundigen en 982 artsen werkzaam binnen de Universitaire Ziekenhuizen van Leuven (UZ Leuven). De respons bedroeg 26% met een totaal van 819 bruikbare vragenlijsten (600 verpleegkundigen; 219 artsen). 72% van alle respondenten oordeelde dat delirium geen tot een minimaal probleem was op hun afdeling. Toch vond meer dan de helft van de medewerkers op de afdeling palliatieve zorg (87%, n=15), traumatologie (67%, n=18), cardio-thoracale chirurgie (58%, n=20), intensieve zorg (55%, n=120) en geriatrie (55%, n=42) het een ernstig probleem. Delirium werd beschouwd als een ondergediagnosticeerd (85%), te voorkomen syndroom (75%). Risicopatiënten werden echter zelden (34%) tot nooit (52%) gescreend op delirium. Gebeurde dit toch (48%), dan gebruikte slechts 4% een specifiek gevalideerd meetinstrument.

97% van alle respondenten vond dat delirium een actieve en onmiddellijke interventie van de verpleegkundige en de zaalarts vereiste. Bij een delirium gebruikte 82% van de artsen haldol®, in het geval van een delirium tengevolge van alcohol of benzodiazepine onttrekking prefereerde 69% tranxène®. Het gebruik van fysieke fixatie bij onrustige, geagiteerde patiënten was belangrijk voor een groter aandeel verpleegkundigen (49%) dan artsen (28%).

Conclusie: de ernst van het probleem wordt vaak onderschat. Hoewel de behandeling meestal correct wordt ingesteld, moet verder geïnvesteerd worden in de preventie en de vroegtijdige detectie van delirium.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Literatuur

  1. American Psychiatric Association (APA). Practice guideline for the treatment of patients with delirium. Am J Psychiatry 1999; 156(Mei suppl):1-20.

    Google Scholar 

  2. Kiely DK, Bergmann MA, Jones RN, Murphy KM, Orav EJ, Marcantonio ER. Characteristics associated with delirium persistence among newly admitted post-acute facility patients. J Gerontol A Biol Sci Med Sci 2004; 59(4): 344-349.

    Google Scholar 

  3. Rockwood K. Delirium and frailty. Primary Psychiatry 2004; 11(11): 36-39.

    Google Scholar 

  4. Cole MG. Delirium in elderly patients: clinical review. Am J Geriatr Psychiatry 2004; 12: 7-21.

    Google Scholar 

  5. Marcantonio ER, Simon SE, Bergmann MA, Jones RN, Murphy KM, Morris JN. Delirium symptoms in post-acute care: prevalent, persistent, and associated with poor functional recovery. JAGS 2003; 51: 4-9.

    Google Scholar 

  6. Litton KA. Delirium in the critical care patient. What the professional staff needs to know. Crit Care Nurs Q 2003; 26(3): 208-213.

    Google Scholar 

  7. Milisen K, Foreman MD, Godderis J, Abraham IL, Broos PLO. Delirium in the hospitalised elderly: nursing assessment and management. Nurs Clin North Am 1998; 33(3): 417-439.

    Google Scholar 

  8. Schuurmans MJ, Duursma SA, Shortridge-Baggett LM. Early recognition of delirium: review of the literature. J Clin Nurs 2001; 10: 721-729.

    Google Scholar 

  9. Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291(14): 1753-1762.

    Google Scholar 

  10. McCusker J, Cole MG, Abrahamowicz M, Primeau F, Belzile E. Delirium predicts 12-month mortality. Arch Intern Med 2002; 162: 457-463.

    Google Scholar 

  11. Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS. Impact on different diagnostic criteria on prognosis of delirium: a prospective study. Dement Geriatr Cogn Disord 2004; 18: 240-244.

    Google Scholar 

  12. Ely EW, Gautam S, Margolin R, et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 2001; 27(12): 1892-1900.

    Google Scholar 

  13. McCusker J, Cole MG, Dendukuri N, Belzile E. Does delirium increase hospital stay? JAGS 2003; 51: 1539-1546.

  14. Saravay SM, Kaplowitz M, Kurek J, et al. How do delirium and dementia increase length of stay of elderly general medical inpatients? Psychosomatics 2004; 45(3): 235-242.

    Google Scholar 

  15. Leslie DL, Zhang Y, Bogardus ST, Holford TR, Leo-Summers LS, Inouye SK. Consequences of preventing delirium in hospitalized older adults on nursing home costs. JAGS 2005; 53: 405-409.

    Google Scholar 

  16. Inouye, SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalised elderly medical patients. Am J Med 1994; 97: 278-288.

    Google Scholar 

  17. Pun BT, Ely EW. The delirium dilemma in the intensive care unit: current concepts in monitoring and management. Primary Psychiatry 2004; 11(11): 59-64.

    Google Scholar 

  18. Weber JB, Coverdale JH, Kunik ME. Delirium: current trends in prevention and treatment: review. Intern Med J 2004; 34: 115-121.

    Google Scholar 

  19. Kalisvaart CJ, Vreeswijk R, de Jonghe JFM, Milisen K. Een systematisch overzicht van multifactoriële interventies ter primaire preventie van delier bij ouderen. Tijdschr Gerontol Geriatr 2005; 36: 224-231.

    Google Scholar 

  20. Milisen K, Lemiengre J, Braes T, Foreman M. Multicomponent intervention strategies for managing delirium in hospitalised older people: a systematic review. J Adv Nurs 2005; 52(1):79-90.

    Google Scholar 

  21. Siddiqi N, Stockdale R, Britton AM, Holmes J. Interventions for preventing delirium in hospitalised patients (review). The Cochrane Database of Systematic Reviews 2007; Issue 2.

  22. Inouye SK, Schlesinger MJ, Lydon TJ. Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care. Am J Med 1999; 106: 565-573.

    Google Scholar 

  23. Francis J. Historical overview of investigations into delirium. Primary Psychiatry 2004; 11: 31-35.

    Google Scholar 

  24. Rockwood K, Bhat R. Should we think before we treat delirium? Intern Med J 2004; 34: 76-78.

    Google Scholar 

  25. Ely EW, Stephens RK, Jackson JC, et al. Current opinions regarding the importance, diagnosis and management of delirium in the intensive care unit: a survey of 912 healthcare professionals. Crit Care Med 2004; 32(1):106-112.

    Google Scholar 

  26. American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders. 4th ed.-revised. American Psychiatric Association. Washington DC, 2000: 943.

  27. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113(12): 941-948.

    Google Scholar 

  28. Schuurmans MJ, Shortridge-Baggett LM, Duursma SA. The Delirium observation Screening Scale: a screening instrument for delirium. Res Theory Nurs Pract 2003; 17(1): 31-50.

    Google Scholar 

  29. Neelon VJ, Champagne MT, Carlson JR, Funk SG. The NEECHAM Confusion Scale: construction, validation and clinical testing. Nurs Res 1996; 45(6): 324-330.

    Google Scholar 

  30. Lindesay J, Rockwood K, Rolfson D. The epidemiology of delirium. In: Lindesay J, Rockwood K, MacDonald A, eds. Delirium in old age. Oxford, UK: Oxford University Press, 2002.

  31. McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit: occurrence and clinical course in older patients. JAGS 2003; 51: 591-598.

    Google Scholar 

  32. Lawlor PG, Gagnon B, Mancini IL, et al. Occurrence, causes and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med 2000; 160: 786-794.

    Google Scholar 

  33. Cobb JL, Glantz MJ, Nicholas PK, et al. Delirium in patients with cancer at the end of life. Cancer Practice 2000; 8(4): 172-177.

    Google Scholar 

  34. Inouye SK, Foreman MD, Mion LC, Katz KH, Cooney LM. Nurses’ recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Arch Intern Med 2001; 161: 2467-2473.

    Google Scholar 

  35. Foreman MD, Milisen K. Improving recognition of delirium in the elderly. Primary Psychiatry 2004; 11(11): 46-50.

    Google Scholar 

  36. Meagher DJ. Clinical review. Delirium: optimising management. BMJ 2001; 322: 144-149.

    Google Scholar 

  37. Evans D, Wood J, Lambert L A review of physical restraint minimization in the acute and residential care settings. J Adv Nurs 2002; vol. 40(6): 616-625.

    Google Scholar 

  38. Mott S, Poole J, Kenrick M. Physical and chemical restraints in acute care: their potential impact on the rehabilitation of older people. Int J Nurs Pract 2005; 11(3): 95-101.

    Google Scholar 

  39. Kalisvaart KJ, de Jonghe JF, Bogaards MJ, et al. Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. JAGS 2005; 53(10): 1658-1666.

    Google Scholar 

  40. Lonergan E, Britton AM, Luxenberg J, Wyller T. Haloperidol for delirium: protocol. The Cochrane Database of Systematic Reviews 2004; Issue 4.

  41. Mayo-Smith MF, Beecher LH, Fischer TL, et al. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med 2004; 164(13): 1405-1412.

    Google Scholar 

  42. Puffer S, Rashidian A. Practice nurses’ intentions to use clinical guidelines. J Adv Nurs 2004; 47(5): 500-509.

    Google Scholar 

  43. Cabana MD, Rand CS, Powe NR, et al. Why don’t physicians follow clinical practice guidelines: a framework for improvement. JAMA 1999; 282(15): 1458-1465.

    Google Scholar 

  44. Kingma JH. De oudere patiënt met een delirium in het ziekenhuis: verwardheid nog onvoldoende onderkend. Inspectierapport gezondheidszorg. Den Haag, 2005.

Download references

Author information

Authors and Affiliations

  1. www.bsl.nl/shop/tijdschrift-voor-gerontologie-en-geriatrie-0167-9228.html

    L. Verstraete

Authors
  1. L. Verstraete
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Joosten
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Milisen
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Verpleegkundige, afdeling pneumologie, Universitaire Ziekenhuizen Leuven

Internist-geriater, afdeling geriatrie, Universitaire Ziekenhuizen Leuven

Hoofddocent verplegingswetenschap, Centrum voor Ziekenhuis- en Verplegingswetenschap, Katholieke Universiteit Leuven en verpleegkundig specialist, afdeling geriatrie, Universitaire Ziekenhuizen Leuven.

Prof. dr. Koen Milisen, Katholieke Universiteit Leuven, Centrum voor Ziekenhuis- en Verplegingswetenschap, Kapucijnenvoer 35/4, 3000 Leuven, België. Tel.: +32-16-336975

About this article

Cite this article

Verstraete, L., Joosten, E. & Milisen, K. Opvattingen van artsen en verpleegkundigen over de preventie, diagnose en behandeling van delirium. GEEG 39, 26–34 (2008). https://doi.org/10.1007/BF03078120

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03078120

Search

Navigation