Delirium in elderly patients: association with educational attainment

2016 ◽  
Vol 29 (2) ◽  
pp. 95-101 ◽  
Author(s):  
Sónia Martins ◽  
José Artur Paiva ◽  
Mário R. Simões ◽  
Lia Fernandes
Keyword(s):  
Elderly Patients ◽  
Educational Attainment ◽  
Cognitive Reserve ◽  
Statistical Significance ◽  
Strong Association ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Final Sample ◽  
Hospitalised Patients ◽  
Definition Of

ObjectiveAmong cognitive reserve markers, educational attainment is the most widely studied, with several studies establishing a strong association with risk of dementia. However, it has not yet been fully examined in delirium. This study aims to analyse the relationship between educational attainment and delirium.MethodsThe study included elderly hospitalised patients admitted (≥48 h) into an intermediate care unit (IMCU) of Intensive Care Medicine Service. Exclusion criteria were as follows: Glasgow Coma Scale (total≤11), blindness/deafness, inability to communicate or to speak Portuguese. The European Portuguese Version of the Confusion Assessment Method (CAM) was used for delirium assessment.ResultsThe final sample (n=157) had a mean age of 78.8 (SD=7.6) the majority being female (52.2%), married (51.5%) and with low educational level (49%). According to CAM, 21% of the patients had delirium. The delirium group presented the fewest years of education (median 1 vs. 4), with statistical significance (p=0.003). Delirium was more frequent among male patients [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.12–0.86; p=0.023], as well as those patients with lower education (OR 0.76; 95% CI 0.62–0.95; p=0.016), and with respiratory disease (OR 3.35; 95% CI 1.20–9.33; p=0.020), after controlling for age and medication.ConclusionSimilar to previous studies, these findings point to a negative correlation between education and delirium. This study appears as an attempt to contribute to the knowledge about the role of cognitive reserve in risk of delirium, particularly because is the first one that has been carried out in an IMCU, with lower educated elderly patients. Further studies are needed to clarify this relationship considering other markers (e.g. cognitive activities), which can contribute to the definition of preventive strategies.

scholarly journals Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital

2021 ◽  
Author(s):  
Andrea Kirfel ◽  
Jan Menzenbach ◽  
Vera Guttenthaler ◽  
Johanna Feggeler ◽  
Andreas Mayr ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Postoperative Delirium ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Hospital Length Of Stay ◽  
Confusion Assessment

Abstract Background Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital. Methods 254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day. Results POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel. Conclusion Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.

scholarly journals Twelve-Month Mortality Among Delirium Subtypes

2011 ◽  
Vol 20 (4) ◽  
pp. 404-421 ◽  
Author(s):  
Susan K. DeCrane ◽  
Kennith R. Culp ◽  
Bonnie Wakefield
Keyword(s):  
Statistical Significance ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Term Care ◽  
International Classification Of Disease ◽  
Subsyndromal Delirium ◽  
Icd 10 ◽  
Underlying Cause Of Death ◽  
State Examination

This study used data from the Delirium Among the Elderly in Rural Long-Term Care Facilities Study and data from the National Death Index (NDI) to examine mortality among 320 individuals. Individuals were grouped into noncases, subsyndromal cases, hypoactive delirium, hyperactive delirium, and mixed delirium on the basis of scoring using the Confusion Assessment Method (CAM), NEECHAM Scale, Mini-Mental State Examination (MMSE), Clinical Assessment of Confusion-A (CAC-A), and Vigilance A instruments. Risk ratios of mortality using “days of survival” did not reach statistical significance (α = .05) for any subgroup. Underlying cause of death (UCD) using International Classification of Disease, 10th version (ICD-10), showed typical UCD among older adults. There appeared to be clinical differences in UCD between delirium subgroups. Findings supported the conclusion that careful monitoring of patients with delirium and subsyndromal delirium is needed to avoid complications and injuries that could increase mortality.

scholarly journals Mannitol Is Associated with Less Postoperative Delirium after Aortic Valve Surgery in Patients Treated with Bretschneider Cardioplegia

2020 ◽  
Author(s):  
Marwan Hamiko ◽  
Efstratios I. Charitos ◽  
Markus Velten ◽  
Tobias Hilbert ◽  
Christian Putensen ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Hospital Stay ◽  
Postoperative Delirium ◽  
Heart Surgery ◽  
Statistical Significance ◽  
Patient Characteristics ◽  
Confusion Assessment Method ◽  
Simplified Acute Physiology Score ◽  
Assessment Method ◽  
Ventilation Time

Abstract Background Heart surgery with extracorporeal circulation (ECC) often leads to postoperative delirium (POD). This is associated with increased morbidity resulting in longer hospital stay and associated costs. The purpose of our study was to analyze the effect of intraoperative mannitol application on POD in patients undergoing elective aortic valve replacement (AVR). Materials and Methods In our retrospective single-center study, 259 patients underwent elective AVR, using Bretschneider cardioplegic solution for cardiac arrest, between 2014 and 2017. Patients were divided in mannitol (n = 188) and nonmannitol (n = 71) groups. POD was assessed using the confusion assessment method for the intensive care unit (ICU). Statistical significance was assumed at p < 0.05. Results Baseline patient characteristics did not differ between the groups. Incidence of POD was significantly higher in the nonmannitol group (33.8 vs. 13.8%; p = 0.001). These patients required longer ventilation time (24.1 vs. 17.1 hours; p = 0.021), higher reintubation rate (11.3 vs. 2.7%; p = 0.009), ICU readmission (12.7 vs. 4.8%; p = 0.026), prolonged ICU (112 vs. 70 hours; p = 0.040), and hospital stay (17.8 vs. 12.6 days; p < 0.001), leading to higher expenses (19,349 € vs. 16,606 €, p < 0.001). A 30-day mortality was not affected, but nonmannitol group showed higher Simplified Acute Physiology Score II score (32.2 vs. 28.7; p < 0.001). Mannitol substitution was independently associated with lower incidence of POD (odds ratio: 0.40; 95% confidence interval: 0.18–0.89; p = 0.02). Conclusion Treatment with mannitol during ECC was associated with decreased incidence of POD. This was accompanied by shorter ventilation time, ICU and hospital stay, and lower treatment expenses.

scholarly journals Long-term prognostic value of delirium in elderly patients with acute cardiac diseases admitted to two cardiac intensive care units: a prospective study (DELIRIUM CORDIS)

2017 ◽  
Vol 7 (7) ◽  
pp. 661-670 ◽  
Author(s):  
Giovanni Falsini ◽  
Simone Grotti ◽  
Italo Porto ◽  
Giulio Toccafondi ◽  
Aureliano Fraticelli ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Onset Time ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Cardiac Diseases ◽  
Confusion Assessment ◽  
Short And Long Term ◽  
Cardiac Intensive Care ◽  
Long Term Mortality

Background: Delirium is a frequent in-hospital complication in elderly patients, and is associated with poor clinical outcome. Its clinical impact, however, has not yet been fully addressed in the setting of the cardiac intensive care unit (CICU). The present study is a prospective, two-centre registry aimed at assessing the incidence, prevalence and significance of delirium in elderly patients with acute cardiac diseases. Methods: Between January 2014 and March 2015, all consecutive patients aged 65 years or older admitted to the CICU of our institutions were enrolled and followed for 6 months. Delirium was defined according to the confusion assessment method. Results: During the study period, 726 patients were screened for delirium. The mean age was 79.1±7.8 years. A total of 111 individuals (15.3%) were diagnosed with delirium; of them, 46 (41.4%) showed prevalent delirium (PD), while 65 (58.6%) developed incident delirium (ID). Patients 85 years or older showed a delirium rate of 52.3%. Hospital stay was longer in delirious versus non-delirious patients. Patients with delirium showed higher in-hospital, 30-day and 6-month mortality compared to non-delirious patients, irrespective of the onset time (overall, ID or PD). Six-month re-hospitalisation was significantly higher in overall delirium and the PD group, as compared to non-delirious patients. Kaplan–Meier analysis showed a significant reduction of 6-month survival in patients with delirium compared to those without, irrespective of delirium onset time (i.e. ID or PD). A positive confusion assessment method was an independent predictor of short and long-term mortality. Conclusions: Delirium is a common complication in elderly CICU patients, and is associated with a longer and more complicated hospital stay and increased short and long-term mortality. Our findings suggest the usefulness of a protocol for the early identification of delirium in the CICU. Clinicaltrials.gov: NCT02004665

Dementia in acutely-ill medical elderly patients

2016 ◽  
Vol 33 (S1) ◽  
pp. S190-S190 ◽  
Author(s):  
P. Sá Esteves ◽  
D. Loureiro ◽  
E. Albuquerque ◽  
F. Vieira ◽  
L. Lagarto ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Barthel Index ◽  
Medical Condition ◽  
Neuropsychiatric Symptoms ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Adverse Outcomes ◽  
Dementia Prevalence ◽  
Hospitalized Elderly ◽  
Hospitalized Elderly Patients

IntroductionDementia is one of the leading causes of disability and burden in Western countries. In Portugal, there is a lack of data regarding dementia prevalence in hospitalized elderly patients and factors associated with in-hospital adverse outcomes of these patients.ObjectivesDetermine dementia prevalence in acutely-ill medical hospitalized elderly patients and its impact in health outcomes.MethodsAll male patients (> 65 years) admitted to a medical ward (> 48 h) between 1.03.2015 to 31.08.2015 were included in the study. Patients were excluded if unable to be assessed due to sensorial deficits, communication problems or severity of the acute medical condition. Baseline evaluation included socio-demographic variables, RASS, NPI, Barthel Index and Confusion Assessment Method.ResultsThe final sample consisted of 270 male subjects with a mean age of 80.9 years, 116 (43%) having prior dementia. Dementia patients were significantly older (83.5 vs 78.9; P < 0.001) and had lower values of Barthel Index (dementia: 34.8 vs non-dementia: 85.8; P < 0.001). Mortality rate (9,3%) and length of hospitalization (11.2 days) were similar between groups (12.1 vs 7.1; P = 0.204 and 11.9 vs 10.6; P = 0.218, respectively). Patients with dementia had higher rates of all neuropsychiatric symptoms except depression, anxiety and mood elation. The level of consciousness (measured by RASS) was impaired in 50% of patients with dementia, which was significantly higher than in non-demented subjects (12.3%; P < 0.001). Delirium rates were 29.5% in dementia compared with 7.1% in controls (P < 0.001).ConclusionsThere is a high prevalence of dementia and an appreciable rate of delirium among these patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Validation study of the European Portuguese version of the Confusion Assessment Method (CAM)

2014 ◽  
Vol 27 (5) ◽  
pp. 777-784 ◽  
Author(s):  
Sónia Martins ◽  
Carla Lourenço ◽  
João Pinto-de-Sousa ◽  
Filipe Conceição ◽  
José Artur Paiva ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Predictive Value ◽  
Convergent Validity ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Intermediate Care ◽  
Reference Standard ◽  
Confusion Assessment ◽  
European Portuguese ◽  
Dsm Iv

ABSTRACTBackground:The Confusion Assessment Method (CAM) is the most widely used delirium screening instrument. The aim of this study was to evaluate the reliability and validity of the European Portuguese version of CAM.Methods:The sample included elderly patients (≥65 years), admitted for at least 48 h, into two intermediate care units (ICMU) of Intensive Medicine and Surgical Services in a university hospital. Exclusion criteria were: score ≤11 on the Glasgow Coma Scale (GCS), blindness/deafness, inability to communicate and to speak Portuguese. For concurrent validity, a blinded assessment was conducted by a psychiatrist (DSM-IV-TR, as a reference standard) and by a trained researcher (CAM). This instrument was also compared with other cognitive measures to evaluate convergent validity. Inter-rater reliability was also assessed.Results:In this sample (n = 208), 25% (n = 53) of the patients had delirium, according to DSM-IV-TR. Using this reference standard, the CAM had a moderate sensitivity of 79% and an excellent specificity of 99%. The positive predictive value was 95%, indicating a strong ability to confirm delirium with a positive test result, and the negative predictive value was lower (93%). Good convergent validity was also found, in particular with Mini-Mental State Examination (MMSE) (rs = −0.676; p ≤0.01) and Digit Span Test (DST) forward (rs = −0.605; p ≤0.01), as well as a high inter-rater reliability (diagnostic k = 1.00; single items’ k between 0.65 and 1.00).Conclusion:Robust results on concurrent and convergent validity and good reliability were achieved. This version was shown to be a valid and reliable instrument for delirium detection in elderly patients hospitalized in intermediate care units.

scholarly journals Elevated Procalcitonin and Depression As Risk Factors For Postoperative Delirium In The Elderly After Cardiac Surgery – A Prospective Observational Study.

2020 ◽  
Author(s):  
Anna Kupiec ◽  
Barbara Adamik ◽  
Natalia Kozera ◽  
Waldemar Gozdzik
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Elderly Patients ◽  
Postoperative Delirium ◽  
Inflammatory Marker ◽  
Functional Decline ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Multivariable Logistic Regression Model

Abstract Background One of the most common complications after cardiac surgery is delirium. Determining the origin of this complication from possible pathomechanisms is difficult. The activation of an inflammatory response during surgery has been suggested as one possible mechanism of delirium. The usefulness of the inflammatory marker procalcitonin (PCT) as a predictor of delirium after cardiac surgery with cardiopulmonary bypass (CBP) has not yet been investigated. Methods The purpose of this study was to prospectively investigate the risk of developing postoperative delirium in a group of elderly patients using a multivariate assessment of preoperative (PCT, comorbidities, functional decline, depression) and intraoperative risk factors. 149 elderly patients were included. Delirium was assessed using the Confusion Assessment Method for the ICU. Results Thirty patients (20%) developed post-operative delirium: hypoactive in 50%, hyperactive in 33%, mixed in 17%. Preoperative PCT above the reference range (> 0.05 ng/mL) was recorded more often in patients who postoperatively developed delirium than in the non-delirium group (50% vs. 27%, p=0.019). After surgery, PCT was significantly higher in the delirium than the non-delirium group: ICU admission after surgery: 0.08 ng/mL, IQR 0.03-0.15 vs. 0.05 ng/mL, IQR 0.02-0.09, p=0.011), and for consecutive days (day 1: 0.59 ng/mL, IQR 0.25-1.55 vs. 0.25 ng/mL, IQR 0.14-0.54, p=0.003; day 2: 1.21 ng/mL, IQR 0.24-3.29 vs. 0.36 ng/mL, IQR 0.16-0.76, p=0.006; day 3: 0.76 ng/mL, IQR 0.48-2.34 vs. 0.34 ng/mL, IQR 0.14-0.66, p=0.001). Patients with delirium were older (74 years, IQR 70 – 76 vs. 69 years, IQR 67 – 74; p=0.038) and more often had functional decline (47% vs. 28%, p=0.041). There was no difference in comorbidities with the exception of anaemia (43% vs. 19%, p=0.006). Depression was detected in 40% of patients with delirium and in 17% without delirium (p=0.005). In a multivariable logistic regression model of preoperative procalcitonin (OR= 3.05; IQR 1.02-9.19), depression (OR=5.02, IQR 1.67-15.10), age (OR=1.14; IQR 1.02-1.26), functional decline (OR=0.76; IQR 0.63-0.91) along with CPB time (OR=1.04; IQR 1.02-1.06) were significant predictors of postoperative delirium. Conclusion A preoperative PCT test and assessment of functional decline and depression may help identify patients at risk for developing delirium after cardiac surgery.

scholarly journals Delirium During COVID-19 Pandemic: Were We Over-Reporting an Overlooked Syndrome?

2021 ◽  
Author(s):  
Júlio César Garcia Alencar ◽  
Flávia Barreto Garcez Carvalho ◽  
Alicia Duddy Müller Veiga ◽  
Gabriela Souza Stanzani ◽  
Ian Ward Abdalla Maia ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Primary Outcome ◽  
Final Analysis ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Sao Paulo ◽  
São Paulo ◽  
High Incidence ◽  
Male Sex ◽  
De Medicina

Abstract Background Delirium is an overlooked syndrome in Emergency Departments (ED) around the world. Previous studies demonstrated high incidence of Delirium in elderly patients with COVID-19, however, these studies did not compare Delirium incidences in patients admitted for SARS-CoV-2 infection or sepsis for other etiologies. Methods This is an observational study that analyzed elderly patients (> 65 years) from two cohort studies that recruited patients in the ED at Hospital Clínicas da Faculdade de Medicina da Universidade de São Paulo, an urban, academic department in São Paulo, Brazil. The first cohort studied patients with sepsis and was conducted between September 30, 2019, and March 17, 2020. The second cohort studied COVID-19 patients between April 8, 2021, and May 28, 2021. Our primary outcome was incidence of delirium at admission in ED, which we defined using the Confusion Assessment Method (CAM). Additional study information was collected from medical records. Results We included 141 patients in our final analysis, with a median age of 72 (IQR 68-79) years and a predominance of the male sex (58%). We identified delirium at admission in 31 participants (22%), 20 in septic group and 11 in COVID-19 group (p = 0.70). Conclusion This present study does not support that elderly patients with COVID-19 have higher risk for Delirium at admission in Emergency Department when compared to patients hospitalized with sepsis for other etiologies. In spite of sepsis for COVID-19 have had more than 28% mortality, COVID-19 was not associated with higher mortality in elderly than sepsis for other etiologies.

The association between C-reactive protein and delirium in 710 acute elderly hospital admissions

2014 ◽  
Vol 26 (5) ◽  
pp. 717-724 ◽  
Author(s):  
C.W. Ritchie ◽  
T.H. Newman ◽  
B. Leurent ◽  
E.L. Sampson
Keyword(s):  
Cardiovascular Disease ◽  
Hospital Admissions ◽  
Inflammatory Marker ◽  
Strong Association ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Musculoskeletal Disease ◽  
C Reactive Protein ◽  
Musculoskeletal Infection ◽  
Reactive Protein

ABSTRACTBackground:Delirium is a common neuropsychiatric syndrome associated with poor outcomes. Evidence supports a neuroinflammatory etiology, but the role of the inflammatory marker C-reactive protein (C-RP) remains unclear. We investigated the relationship between C-RP and delirium and its severity as well as interaction with medical diagnosis.Methods:From an existing database (710 patients over 70 years old admitted to a Medical Acute Admissions Unit) we analyzed data which included C-RP levels, delirium (using the Confusion Assessment Method), and other clinical and demographic factors. Primary diagnoses were grouped (cardiovascular, musculoskeletal, infection, metabolic, and other).Results:There was a strong association between elevated C-RP and delirium (t = 5.09; p < 0.001), independent of other potential risk factors for delirium (odds ratio (OR) = 1.32 (95% CI: 1.10–1.58) p = 0.003). There was no significant association between C-RP and delirium severity, and between C-RP and delirium in the populations with cardiovascular disease, infection upon admission, or from the metabolic group despite an OR of 2.24 (95% CI: 0.92–5.45). There was an association in the musculoskeletal group (OR 2.19 (95% CI: 1.19–4.02)).Conclusions: There is an association between elevated C-RP and delirium. This is strongest in patients admitted with musculoskeletal disease but not in others, implying that C-RP is involved in the genesis of delirium in musculoskeletal disease, but that other factors or processes may be more important in those with cardiovascular disease or infection.

scholarly journals Hemoglobin Concentration and Post-Operative Delirium in Elderly Patients Undergoing Femoral Neck Fracture Surgery

2022 ◽  
Vol 8 ◽  
Author(s):  
Yu-Mei Liu ◽  
Hui Huang ◽  
Jie Gao ◽  
Jian Zhou ◽  
Hai-Chen Chu
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Confusion Assessment ◽  
Neck Fracture ◽  
Icu Transfer ◽  
Hb Concentration

This study aimed to determine the relationship between hemoglobin (Hb) concentration and post-operative delirium (POD) in elderly patients undergoing femoral neck fracture (FNF) surgery and to investigate whether the change in Hb concentration is associated with POD and the risk factors for POD. A total of 889 patients admitted with FNF between January 2016 and December 2020 were enrolled in this single-center, retrospective, case–control study. Hb concentrations were determined at admission and post-operative day 1 and the change in Hb concentration was defined as the absolute value of difference in pre-operative and post-operative Hb concentration. POD was assessed using the Confusion Assessment Method for the Intensive Care Unit (ICU) or the Confusion Assessment Method once a daily after surgery. The logistic regression analysis was performed for statistical analysis. In total, 172 (19.3%) patients developed POD and 151 (87.8%) patients developed POD within post-operative 3 days. Low pre-operative Hb concentration [p = 0.026, odds ratio (OR) = 0.978] and significant change in Hb concentration (p = 0.006, OR = 1.033) were significantly associated with POD. After excluding change in Hb concentration or pre-operative Hb concentration, neither of them was significantly associated with POD (p &gt; 0.05). The interaction analysis of change in Hb concentration and pre-operative Hb concentration in the logistic regression model was negative. There was no significant relationship between post-operative Hb concentration and POD. Age (p &lt; 0.001, OR = 1.072), stroke history (p = 0.003, OR = 2.489), post-operative ICU transfer (p = 0.007, OR = 1.981), and visual analog scale score within post-operative 2 days (p1 = 0.016 and p2 = 0.006) were independently associated with POD in the logistic regression analysis. Patients with low pre-operative Hb concentrations and high changes in Hb concentration seem to have an increased risk of POD and should receive more attention. Old age, stroke history, post-operative ICU transfer, and pain within post-operative 2 days were significantly associated with POD.

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