scholarly journals Associations between Frailty and Delirium among Older Patients Admitted to an Emergency Department

2019 ◽  
Vol 9 (2) ◽  
pp. 236-249 ◽  
Author(s):  
Sandra Choutko-Joaquim ◽  
Nadine Tacchini-Jacquier ◽  
Géraldine Pralong D’Alessio ◽  
Henk Verloo
Keyword(s):  
Emergency Department ◽  
Emergency Services ◽  
Signs And Symptoms ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Multiple Chronic Conditions ◽  
Cross Sectional ◽  
Subsyndromal Delirium ◽  
Clinical Difference

Background: Switzerland’s demographic trends show, as elsewhere on the planet, increasing numbers of older and very old adults. This suggests that its healthcare system will suffer serious repercussions, including in the use of care and especially the use of emergency services. Significant numbers of older adults will be at risk of developing multiple chronic conditions including one or more geriatric syndromes, such as frailty and delirium. Few studies to date have documented associations between frailty and delirium. Aim: To explore the relationships between frailty and delirium in older adult patients consulting (n = 114) at an emergency department (ED) in Switzerland. Method: A cross-sectional study was conducted in a peripheral hospital ED in the French-speaking part of Switzerland. Frailty was assessed using the Tilburg Frailty Indicator (TFI). Delirium was assessed using the Confusion Assessment Method (CAM). Participants’ cognitive states were assessed using the 6-item Cognitive Impairment Test (6CIT) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQ-CODE), completed by the participant’s most significant informal caregiver. Results: The mean participant age was 77.6 years (SD = 7.7); the majority of the subjects were women (54%). The participants took an average of 4.7 different medications a day (SD = 3.2, median = 4). More than half (62%) of the participants were frail; 2 and 14% presented signs and symptoms of delirium and subsyndromal delirium, respectively. A weak but significant association between scores for frailty and delirium (p < 0.05) was demonstrated, and clinical observation confirmed this. A 4-h follow-up measurement of delirium in the ED revealed no significant or clinical difference. Conclusion: Although the literature describes strong associations between frailty and delirium in surgical units and community care settings, the present study only demonstrated a weak-to-moderate association between frailty and delirium in our ED.

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 Performance of the French version of the 4AT for screening the elderly for delirium in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 903-910 ◽  
Author(s):  
Anne-Julie Gagné ◽  
Philippe Voyer ◽  
Valérie Boucher ◽  
Alexandra Nadeau ◽  
Pierre-Hugues Carmichael ◽  
...  
Keyword(s):  
Emergency Department ◽  
Screening Tool ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Systematic Screening ◽  
French Version ◽  
Administration Time ◽  
Older Inpatients ◽  
Patients At Risk

CLINICIAN’S CAPSULEWhat is known about the topic?Delirium is frequent in older inpatients but often goes undetected. A short tool, the 4 A’s Test (4AT), was created and validated for the detection of delirium.What did this study ask?This study compared the performance of the French version of the 4AT (4AT-F) with the Confusion Assessment Method (CAM) for the screening of delirium.What did this study find?The 4AT-F was a fast and reliable screening tool for delirium in the emergency department (ED).Why does this study matter to clinicians?Because of its quick administration time, it allows for systematic screening of patients at risk of delirium and cognitive impairment.

Delirium etiology subtypes and their effect on six-month function and cognition in older emergency department patients

2018 ◽  
Vol 31 (2) ◽  
pp. 267-276 ◽  
Author(s):  
Jamie Cirbus ◽  
Alasdair M. J. MacLullich ◽  
Christopher Noel ◽  
E. Wesley Ely ◽  
Rameela Chandrasekhar ◽  
...  
Keyword(s):  
Emergency Department ◽  
Short Form ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Emergency Department Patients ◽  
Factor Interactions

ABSTRACTBackground:Delirium is heterogeneous and can vary by etiology.Objectives:We sought to determine how delirium subtyped by etiology affected six-month function and cognition.Design:Prospective cohort study.Setting:Tertiary care, academic medical center.Participants:A total of 228 hospitalized patients > 65 years old were admitted from the emergency department (ED).Measurements:The modified Brief Confusion Assessment Method was used to determine delirium in the ED. Delirium etiology was determined by three trained physician reviewers using a Delirium Etiology checklist. Pre-illness and six-month function and cognition were determined using the Older American Resources and Services Activities of Daily Living (OARS ADL) questionnaire and the short-form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Multiple linear regression was performed to determine if delirium etiology subtypes were associated with six-month function and cognition adjusted for baseline OARS ADL and IQCODE. Two-factor interactions were incorporated to determine pre-illness function or cognition-modified relationships between delirium subtypes and six-month function and cognition.Results:In patients with poorer pre-illness function only, delirium secondary to metabolic disturbance (β coefficient = −2.9 points, 95%CI: −0.3 to −5.6) and organ dysfunction (β coefficient = −4.3 points, 95%CI: −7.2 to −1.4) was significantly associated with poorer six-month function. In patients with intact cognition only, delirium secondary to central nervous system insults was significantly associated with poorer cognition (β coefficient = 0.69, 95%CI: 0.19 to 1.20).Conclusions:Delirium is heterogeneous and different etiologies may have different prognostic implications. Furthermore, the effect of these delirium etiologies on outcome may be dependent on the patient's pre-illness functional status and cognition.

scholarly journals AVALIAÇÃO DA PREVALÊNCIA DE DELIRIUM EM UMA UNIDADE DE TERAPIA INTENSIVA PÚBLICA

2019 ◽  
Vol 10 (3) ◽  
Author(s):  
Juliana Bessa Martins ◽  
Adriana Alves Dos Santos ◽  
Luís Joeci Jaques De Macedo Júnior ◽  
Carolina Chitolina Eberle
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Signs And Symptoms ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Porto Alegre ◽  
Cross Sectional ◽  
Care Clinic ◽  
Confusion Assessment ◽  
Terapia Intensiva

Objetivo: Conhecer a prevalência do delirium em uma Unidade de Terapia Intensiva Clínica e Cirúrgica pública. Métodos: Abordagem quantitativa descritiva de corte transversal, com pacientes de 18 anos ou mais internados em um hospital público de Porto Alegre-RS, com utilização da escala Confusion Assessment Method in a Intensive Care Unit (CAM-ICU). Resultados: A prevalência do delirium foi 36%. Apresentaram relação com o delirium, com significância estatística: média de idade dos pacientes, a mediana de dias de internação hospitalar e em UTI, tipo de UTI, motivo de internação, doença neurológica anterior, uso de sedação, ventilação mecânica e utilização de haloperidol. Conclusões: Este estudo conclui que o delirium apresentou prevalência de 36%, demonstrando que esta síndrome apresenta prevalência significante em Unidade de Terapia Intensiva, portanto, o reconhecimento de seus sinais e sintomas é fundamental para a sua prevenção, aliada a aplicação de escalas de rastreio.Descritores: Delirium, Unidades de Terapia Intensiva, Enfermagem. EVALUATION OF THE PREVALENCE OF DELIRIUM IN AN PUBLIC INTENSIVE CARE UNITObjective: To know the prevalence of delirium in a Public Intensive Care Clinic and Surgical Unit. Methodology: Descriptive quantitative cross-sectional approach with patients aged 18 years or more admitted to a public hospital in Porto Alegre, Brazil, using the Confusion Assessment Method in the Intensive Care Unit (CAM-ICU). Results: The prevalence of delirium was 36%, in a sample of 335 patients interviewed. The mean age of the patients, median days of hospital stay and ICU, type of ICU, reason for hospitalization, previous neurological disease, use of sedation, mechanical ventilation and use of haloperidol were statistically significant. Conclusions: This study concludes that delirium presented a prevalence of 36%, demonstrating that this syndrome presents a significant prevalence in the Intensive Care Unit, therefore, the recognition of its signs and symptoms is fundamental for its prevention, allied to the application of screening scales.Descriptors: Delirium; Intensive Care Units; Nursing. EVALUACIÓN DE LA PREVALENCIA DE DELIRIUM EN UNA UNIDAD DE TERAPIA INTENSIVA PÚBLICAObjetivo: Conocer la prevalencia del delirium en una Unidad de Terapia Intensiva Clínica y Quirúrgica pública. Metodologia: En el presente trabajo se analizaron los resultados obtenidos en el análisis de los resultados obtenidos en el estudio. Resultados: La prevalencia del delirium fue del 36%, en una muestra de 335 pacientes entrevistados. En la mayoría de los casos, se observó un aumento en la incidencia de la enfermedad de Chagas en el momento de la intervención, Conclusiones: Este estudio concluye que el delirium presentó prevalencia del 36%, demostrando que este síndrome presenta prevalencia significante en Unidad de Terapia Intensiva, por lo tanto, el reconocimiento de sus signos y síntomas es fundamental para su prevención, aliada a la aplicación de escalas de rastreo.Descriptores: Delirium; Unidades de Terapia Intensiva; Enfermería.

scholarly journals Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly

2001 ◽  
Vol 59 (2A) ◽  
pp. 175-179 ◽  
Author(s):  
Renato Moraes Alves Fabbri ◽  
Marcos Aurélio Moreira ◽  
Regiane Garrido ◽  
Oswaldo Pereira Almeida
Keyword(s):  
Emergency Service ◽  
Emergency Services ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Assessment Instrument ◽  
Diagnostic Assessment ◽  
Validity And Reliability ◽  
Portuguese Version ◽  
Confusion Assessment

This study has tested the validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM), a diagnostic assessment instrument for delirium developed by Inouye et al. (1990). The sample was formed by 100 patients with 60 and more years of age, admitted at the emergency service of Santa Casa de São Paulo, in the time periods between July and August, 1996, November and December, 1996 and February and March, 1997. The sensibility was 94.1% and specificity 96.4%. The assessors reliability in a sample of the 24 patients resulted in a kappa = 0.70. We have concluded that CAM is an adequate instrument to assess the presence of delirium, reliable to assess elderly patients at the emergency services.

scholarly journals Evaluation of delirium in aged patients assisted at emergency hospital service

2019 ◽  
Vol 72 (suppl 2) ◽  
pp. 153-160
Author(s):  
Isabella Cristina Barduchi Ohl ◽  
Suzel Regina Ribeiro Chavaglia ◽  
Rosali Isabel Barduchi Ohl ◽  
Maria Carolina Barbosa Teixeira Lopes ◽  
Cássia Regina Vancini Campanharo ◽  
...  
Keyword(s):  
Physical Activity ◽  
Emergency Services ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Cerebrovascular Diseases ◽  
Chi Square ◽  
Aged Patients ◽  
Cross Sectional ◽  
Significance Level ◽  
Emergency Hospital Service

ABSTRACT Objective: identify the occurrence of delirium in aged patients assisted in emergency services and verify its relationship with sociodemographic and clinical variables. Method: cross-sectional, prospective study with a quantitative approach. Two hundred aged hospitalized patients participated. The Confusion Assessment Method was used for data collection. For statistical analysis, chi-square tests, likelihood ratio and Fisher’s test were used, with a significance level of 5%. Results: male gender and mean age of 71.8 years were predominant. In the first 24 hours of hospitalization, 56 (28%) aged individuals presented delirium. An association of the disease with lack of physical activity, presence of a caregiver, hypertension, dyslipidemia and cerebrovascular diseases was identified. Conclusion: Delirium was associated with no physical activity, the need of a caregiver, and the presence of comorbidities. The importance of conducting other studies that may lead to early identification of the condition to prevent its complications is emphasized.

scholarly journals Factors Affecting Nursing Ability To Know Acute Coroner Syndrome In Emergency Installation

2018 ◽  
Vol 2 (1) ◽  
pp. 64-72
Author(s):  
Agus Riyadi ◽  
Karmiati Karmiati
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Emergency Services ◽  
P Value ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Research Education ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
Almost All

Background: Coronary heart disease is the most cardiovascular disease that causes death in the world. The ability of nurses to recognize acute coronary syndromes is very necessary as part of the emergency services team. Purpose : The purpose of this study was to determine the description of the factors that influence the ability of nurses to know acute coronary syndrome in the emergency department of dr. Iskak Tulungagung. Methods : The design of this research is descriptive analytic with a cross sectional approach with the population of all nurses who work in the Emergency Department of dr. Iskak Tulungagung. The population is 55 nurses. The sample is all of the population, namely 55 respondents with total sampling sampling techniques. The data that has been collected is processed by a statistical test of Multivariate Analysis, Ordinal Regression with significance α = 0.05. Result : The results showed that most of the respondents with D3 education were 33 respondents (60.0%), almost all respondents had never attended ECG training in the amount of 50 respondents (90.9%) and almost half of the respondents had a working period of 2-5 year is 25 respondents (45.5%). The results of the regression regression analysis showed that the p-value = 0.855 on the education factor which means that H0 was accepted, the p-value = 0.041 in the training factor which means H1 is received, the p-value = 0.003 on the working period, which means that H1 is accepted Conclusion : Based on research, education does not affect the ability to recognize acute coronary syndrome. The education obtained will develop according to the increase in the work period and the frequent training that is obtained and practiced directly in real situations

scholarly journals Validation of the Confusion Assessment Method for the Intensive Care Unit in Older Emergency Department Patients

2014 ◽  
Vol 21 (2) ◽  
pp. 180-187 ◽  
Author(s):  
Jin H. Han ◽  
Amanda Wilson ◽  
Amy J. Graves ◽  
Ayumi Shintani ◽  
John F. Schnelle ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Confusion Assessment ◽  
Emergency Department Patients

scholarly journals Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) completion on an acute care ward for the elderly: a brief study of informant characteristics

2012 ◽  
Vol 24 (10) ◽  
pp. 1700-1701 ◽  
Author(s):  
K. Bloomfield ◽  
N. John
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Decline ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Cognitive Screening ◽  
Screening Algorithm ◽  
Drawing Task ◽  
The Uk ◽  
State Examination

Over recent years in the UK, emphasis has been placed on appropriate diagnosis and referral of patients with dementia. In guidelines published by the British Geriatrics Society (BGS) and Faculty of Old Age Psychiatrists consensus group (Forsyth et al., 2006), a cognitive screening algorithm was developed, which consists of initial screening for cognitive impairment with the Mini-Mental State Examination (MMSE) and CLOX1 (an executive clock drawing task). If the scores meet cut-off points indicated in the algorithm (MMSE <24 or CLOX1 <11), further assessments with the Confusion Assessment Method (CAM) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) are applied with the aim to differentiate between delirium (CAM positive, IQCODE negative), delirium and chronic impairment (CAM positive, IQCODE positive), or chronic cognitive impairment (CAM negative, IQCODE positive).

Decisional capacity in patients with acute delirium. A Rawlsian approach

2017 ◽  
Vol 41 (S1) ◽  
pp. S581-S581
Author(s):  
S. Hostiuc ◽  
I. Negoi ◽  
E. Drima
Keyword(s):  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Ethical Principle ◽  
Point Of View ◽  
Practical Implementation ◽  
Decisional Capacity ◽  
Confusion Assessment ◽  
Competing Interest ◽  
Proper Analysis

Delirium is characterized by a temporary, usually reversible, cause of mental alteration; it can occur at any age, but affect most often the elderly. Delirium patients may also present acute psychotic episodes, which might make them decisionally incompetent. In order to assess decisional capacity, Fan et al developed a two-stage approach, which tries to analyse:– the presence of delirium, using the Confusion Assessment Method;– a proper analysis of the decisional capacity.Often, in patients with decreased decisional capacity, physicians must assess which ethical principle should respect first – the principle of autonomy, whose practical implementation is informed consent, or beneficence – the good of the patient, irrespective of the its declared wishes. In this poster, we will look at the issue of decisional capacity in patients with acute delirium from a Rawlsian point of view, and will try to give an answer based on what is just – to respect the autonomy of the patient, or the moral duty to do good to the patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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