scholarly journals Predisposing and Precipitating Factors for Delirium in the Very Old (≥80 Years): A Prospective Cohort Study of 3,076 Patients

Gerontology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Justus Marquetand ◽  
Leonie Bode ◽  
Simon Fuchs ◽  
Jutta Ernst ◽  
Roland von Känel ◽  
...  
Keyword(s):  
Assisted Living ◽  
The Elderly ◽  
Predisposing Factors ◽  
Pressure Sores ◽  
Precipitating Factors ◽  
Statistical Manual ◽  
Younger Patients ◽  
Very Old ◽  
Diagnostic And Statistical Manual ◽  
Dos Scale

<b><i>Background:</i></b> Predisposing and precipitating factors for delirium for the elderly, over the age of 65 years, are known, but not for the very old, over 80 years. As the society is getting older and evermore patients will reach &#x3e;80 years, more evidence of the factors and their contribution to delirium is required in this patient group. <b><i>Methods:</i></b> In the course of 1 year, 3,076 patients above 80 years were screened prospectively for delirium based on a Delirium Observation Screening (DOS) scale, Intensive Care Delirium Screening Checklist (ICDSC), and a DSM (Diagnostic and Statistical Manual)-5 nursing instrument (ePA-AC) construct. Relevant predisposing and precipitating factors for delirium were assessed with a multiple regression analysis. <b><i>Results:</i></b> Of 3,076 patients above 80 years, 1,285 (41.8%) developed a delirium, which led to twice prolonged hospitalization (<i>p</i> &#x3c; 0.001), requirement for subsequent assisted living (OR 2.2, CI: 1.73–2.8, <i>p</i> &#x3c; 0.001), and increased mortality (OR 24.88, CI: 13.75–45.03, <i>p</i> &#x3c; 0.001). Relevant predisposing factors were dementia (OR 15.6, CI: 10.17–23.91, <i>p</i> &#x3c; 0.001), pressure sores (OR 4.61, CI: 2.74–7.76, <i>p</i> &#x3c; 0.001), and epilepsy (OR 3.65, CI: 2.12–6.28, <i>p</i> &#x3c; 0.0001). Relevant precipitating factors were acute renal failure (4.96, CI: 2.38–10.3, <i>p</i> &#x3c; 0.001), intracranial hemorrhage (OR 8.7, CI: 4.27–17.7, <i>p</i> &#x3c; 0.001), and pleural effusions (OR 3.25, CI: 1.77–17.8, <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> Compared to the general delirium rate of approximately 20%, the prevalence of delirium doubled above the age of 80 years (41.8%) due to predisposing factors uncommon in younger patients.

Trauma in Late Life

2018 ◽  
Author(s):  
Kenneth Sakauye ◽  
James E. Nininger
Keyword(s):  
Stress Disorder ◽  
Acute Stress ◽  
Traumatic Event ◽  
Adjustment Disorder ◽  
The Elderly ◽  
Statistical Manual ◽  
Traumatic Grief ◽  
Diagnostic And Statistical Manual ◽  
Serious Injury ◽  
Biological Differences

This chapter focuses on the prevalence of trauma exposure and posttraumatic problems in the elderly and reviews information on resilience and suggested treatment approaches. While posttraumatic stress disorder in the elderly has been studied, less is known about other common trauma- and stressor-related disorders including adjustment disorder, acute stress disorder, and traumatic grief. The Diagnostic and Statistical Manual of Mental Disorders (fifth edition) defines trauma as “exposure or actual or threatened death, serious injury, or sexual violence.” It must be directly experienced, witnessed, or occur to a family member or friend, or it could be a repeated or extreme exposure to aversive details of a traumatic event. No event is always traumatic, and, conversely, even a seemingly mild negative event can be traumatic to some individuals. Two presumed variables are (a) appraisal of the situation (whether a person feels in control) and (b) individual biological differences in responsiveness.

scholarly journals Risk Factors for Delirium Are Different in the Very Old: A Comparative One-Year Prospective Cohort Study of 5,831 Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Justus Marquetand ◽  
Leonie Bode ◽  
Simon Fuchs ◽  
Florian Hildenbrand ◽  
Jutta Ernst ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Health Care Systems ◽  
Predisposing Factors ◽  
Precipitating Factors ◽  
Very Old ◽  
Number Of Patients ◽  
Care Systems

Background: In an ever-aging society, health care systems will be confronted with an increasing number of patients over 80 years (“the very old”). Currently, knowledge about and recommendations for delirium management are often based on studies in patients aged 60 to 65 years. It is not clear whether these findings apply to patients ≥80 years.Aim: Comparison of younger and older patients with delirium, especially regarding risk factors.Methods: In this prospective cohort study, within 1-year, 5,831 patients (18–80 years: n = 4,730; ≥80: n = 1,101) with delirium were enrolled. The diagnosis of delirium was based on the Delirium Observation screening scale (DOS), Intensive Care Delirium Screening Checklist (ICDSC) and a DSM (Diagnostic and Statistical Manual)-5 construct of nursing instrument. Sociodemographic trajectories, as well as the relevant predisposing and precipitating factors for delirium, were assessed via a multiple regression analysis.Results: The very old were more commonly admitted as emergencies (OR 1.42), had a greater mortality risk (OR 1.56) and displayed fewer precipitating risk factors for the development of a delirium, although the number of diagnoses were not different (p = 0.325). Predisposing factors were sufficient almost alone for the development of delirium in patients ≥ 80 years of age; in 18–80 years of age, additional precipitating factors had to occur to make a delirium possible.Conclusion: When relevant predisposing factors for delirium are apparent, patients over 80 years of age require comparatively few or no precipitating factors to develop delirium. This finding should be taken into account at hospitalization and may allow better treatment of delirium in the future.

scholarly journals Εξελίξεις και συγκρούσεις αναφορικά με την ταξινόμηση των ψυχικών διαταραχών στο DSM-5: Μία ανασκόπηση του επιστημονικού διαλόγου και κριτικής

2020 ◽  
Vol 21 (2) ◽  
pp. 130
Author(s):  
Ειρήνη Μούτσου ◽  
Ευγενία Γεωργάκα
Keyword(s):  
Mental Disorders ◽  
American Psychiatric Association ◽  
Age Groups ◽  
The Elderly ◽  
Current Paper ◽  
Statistical Manual ◽  
Scientific Discussion ◽  
Diagnostic Categories ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM- 5) was released by the American Psychiatric Association in May 2013 and has provoked a broad scientific discussion, since it entails significant changes in relation to its previous editions. The current paper offers a review of this discussion, with emphasis on the main changes that are under dispute. Initially, we discuss the developmental course of the various editions of the DSM, the main principles and practices of the current edition as well as the main points of critique against it. We then examine in more detail some significant changes in particular diagnostic categories and their expected implications for the diagnosis and treatment of these mental disorders. In conclusion, the main critique against DSM-5 is that it seems to intensify the medicalisation of mental disorders, which characterises its latest editions, to pathologise a range of everyday experiences and behaviours, and to broaden the diagnosed population, especially to children and the elderly, expanding possibly the use of medication to new age groups.

The Delirium Observation Screening Scale: A Screening Instrument for Delirium

2003 ◽  
Vol 17 (1) ◽  
pp. 31-50 ◽  
Author(s):  
Marieke J. Schuurmans ◽  
Lillie M. Shortridge-Baggett ◽  
Sijmen A. Duursma
Keyword(s):  
Hip Fracture ◽  
Construct Validity ◽  
Predictive Validity ◽  
Internal Consistency ◽  
Barthel Index ◽  
Early Recognition ◽  
Geriatric Medicine ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dos Scale

The Delirium Observation Screening (DOS) scale, a 25-item scale, was developed to facilitate early recognition of delirium, according to the Diagnostic and Statistical Manual-IV criteria, based on nurses’ observations during regular care. The scale was tested for content validity by a group of seven experts in the field of delirium. Internal consistency, predictive validity, and concurrent and construct validity were tested in two prospective studies with high risk groups of patients: geriatric medicine patients and elderly hip fracture patients. Among the patients admitted to a geriatric department (N = 82), 4 became delirious; among the elderly hip fracture patients (N = 92), 18 became delirious. The DOS scale was determined to be content valid and showed high internal consistency, α = 0.93 and α = 0.96. Predictive validity against the Diagnostic and Statistical Manual-IV diagnosis of delirium made by a geriatrician was good in both studies. Correlations of the DOS scale with the Mini Mental State Examination (MMSE) were Rs -0.79 (p ≤ 0.001) in the hip fracture patients and Rs -0.66 (p ≤ 0.001) in the geriatric medicine patients. Concurrent validity, as tested by comparison of the research nurse’s ratings of the DOS scale and the Confusion Assessment Method (CAM), for the group of hip fracture patients was 0.63 (p ≤ 0.001). Construct validity of the DOS was tested against the Informant Questionnaire of Cognitive Decline in Elderly (IQCODE), a preexisting psychiatric diagnosis and the Barthel Index. Correlation with the IQCODE was 0.74 (p ≤ 0.001) in the study with the hip fracture patients and 0.33 (p ≤ 0.05) in the study with the geriatric medicine patients. Correlation with the Barthel Index was -0.26 (p ≤ 0.05) in the geriatric medicine patients and -0.55 (p ≤ 0.001) in the hip fracture patients. The overall conclusion of these studies is that the DOS scale shows satisfactory validity and reliability, to guide early recognition of delirium by nurses’ observation.

The prevalence rates and adversities of delirium: Too common and disadvantageous

2020 ◽  
pp. 1-9
Author(s):  
Soenke Boettger ◽  
Carl Moritz Zipser ◽  
Leonie Bode ◽  
Tobias Spiller ◽  
Jeremy Deuel ◽  
...  
Keyword(s):  
Intensive Care ◽  
Adverse Outcomes ◽  
Prevalence Rates ◽  
Odds Ratios ◽  
Related Services ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Simple Logistic ◽  
The Impact ◽  
Dos Scale

Abstract Objective The prevalence rates and adversities of delirium have not yet been systematically evaluated and are based on selected populations, limited sample sizes, and pooled studies. Therefore, this study assesses the prevalence rates and outcome of and odds ratios for managing services for delirium. Methods In this prospective cohort study, based on the Diagnostic and Statistical Manual (DSM) 5, the Delirium Observation Screening (DOS) scale, and the Intensive Care Delirium Screening Checklist (ICDSC) construct, 28,118 patients from 35 managing services were included, and the prevalence rates and adverse outcomes were determined by simple logistic regressions and their corresponding odds ratios (ORs). Results Delirious patients were older, admitted from institutions (OR 3.44–5.2), admitted as emergencies (OR 1.87), hospitalized twice longer, and discharged, transferred to institutions (OR 5.47–6.6) rather than home (OR 0.1), or deceased (OR 43.88). The rate of undiagnosed delirium was 84.2%. The highest prevalence rates were recorded in the intensive care units (47.1–84.2%, pooled 67.9%); in the majority of medical services, rates ranged from 20% to 40% (pooled 26.2%), except, at both ends, palliative care (55.9%), endocrinology (8%), and rheumatology (4.4%). Conversely, in surgery and its related services, prevalence rates were lower (pooled 13.1%), except for cardio- and neurosurgical services (53.3% and 46.4%); the lowest prevalence rate was recorded in obstetrics (2%). Significance of results Delirium remains underdiagnosed, and novel screening approaches are required. Furthermore, this study identified the impact of delirium on patients, determined the prevalence rates for 32 services, and elucidated the association between individual services and delirium.

106 Precipitating factors in the elderly patients admitted with the diagnosis of heart failure. Are easy to find?

2006 ◽  
Vol 5 (1) ◽  
pp. 25-26
Author(s):  
R VIDALPEREZ ◽  
E ABUASSI ◽  
M PARAMODEVEGA ◽  
P VELOSO ◽  
A VARELAROMAN ◽  
...  
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
The Elderly ◽  
Precipitating Factors

Comparison of Alcohol Use Disorders in DSM and ICD

2020 ◽  
Vol 66 (3) ◽  
pp. 143-153
Author(s):  
Jessica W. M. Wong ◽  
Friedrich M. Wurst ◽  
Ulrich W. Preuss
Keyword(s):  
Alcohol Use Disorders ◽  
International Classification Of Diseases ◽  
Clinical Use ◽  
Diagnostic Systems ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Classification Of Diseases ◽  
Historical Developments

Abstract. Introduction: With advances in medicine, our understanding of diseases has deepened and diagnostic criteria have evolved. Currently, the most frequently used diagnostic systems are the ICD (International Classification of Diseases) and the DSM (Diagnostic and Statistical Manual of Mental Disorders) to diagnose alcohol-related disorders. Results: In this narrative review, we follow the historical developments in ICD and DSM with their corresponding milestones reflecting the scientific research and medical considerations of their time. The current diagnostic concepts of DSM-5 and ICD-11 and their development are presented. Lastly, we compare these two diagnostic systems and evaluate their practicability in clinical use.

Angststörungen – von der ICD-10 zur ICD-11

2020 ◽  
pp. 1-5
Author(s):  
Timo D. Vloet ◽  
Marcel Romanos
Keyword(s):  
Mental Disorders ◽  
International Classification Of Diseases ◽  
International Classification ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Classification Of Diseases ◽  
Icd 10

Zusammenfassung. Hintergrund: Nach 12 Jahren Entwicklung wird die 11. Version der International Classification of Diseases (ICD-11) von der Weltgesundheitsorganisation (WHO) im Januar 2022 in Kraft treten. Methodik: Im Rahmen eines selektiven Übersichtsartikels werden die Veränderungen im Hinblick auf die Klassifikation von Angststörungen von der ICD-10 zur ICD-11 zusammenfassend dargestellt. Ergebnis: Die diagnostischen Kriterien der generalisierten Angststörung, Agoraphobie und spezifischen Phobien werden angepasst. Die ICD-11 wird auf Basis einer Lebenszeitachse neu organisiert, sodass die kindesaltersspezifischen Kategorien der ICD-10 aufgelöst werden. Die Trennungsangststörung und der selektive Mutismus werden damit den „regulären“ Angststörungen zugeordnet und können zukünftig auch im Erwachsenenalter diagnostiziert werden. Neu ist ebenso, dass verschiedene Symptomdimensionen der Angst ohne kategoriale Diagnose verschlüsselt werden können. Diskussion: Die Veränderungen im Bereich der Angsterkrankungen umfassen verschiedene Aspekte und sind in der Gesamtschau nicht unerheblich. Positiv zu bewerten ist die Einführung einer Lebenszeitachse und Parallelisierung mit dem Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Schlussfolgerungen: Die entwicklungsbezogene Neuorganisation in der ICD-11 wird auch eine verstärkte längsschnittliche Betrachtung von Angststörungen in der Klinik sowie Forschung zur Folge haben. Damit rückt insbesondere die Präventionsforschung weiter in den Fokus.

Comparison of Three Questionnaires to Screen for Borderline Personality Disorder in Adolescents and Young Adults

2017 ◽  
Vol 33 (2) ◽  
pp. 123-128 ◽  
Author(s):  
Anne van Alebeek ◽  
Paul T. van der Heijden ◽  
Christel Hessels ◽  
Melissa S.Y. Thong ◽  
Marcel van Aken
Keyword(s):  
Young Adults ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Adolescents And Young Adults ◽  
Patient Questionnaire ◽  
Statistical Manual ◽  
Axis Ii ◽  
Diagnostic And Statistical Manual ◽  
Dsm Iv

Abstract. One of the most common personality disorders among adolescents and young adults is the Borderline Personality Disorder (BPD). The objective of current study was to assess three questionnaires that can reliably screen for BPD in adolescents and young adults (N = 53): the McLean Screening Instrument for BPD (MSI-BPD; Zanarini et al., 2003 ), the Personality Diagnostic Questionnaire 4th edition – BPD scale (PDQ-4 BPD; Hyler, 1994 ), and the SCID-II Patient Questionnaire – BPD scale (SCID-II-PQ BPD). The nine criteria of BPD according to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV; APA, 1994 ) were measured with the Structural Clinical Interview for DSM-IV Axis II disorders – BPD scale (SCID-II; First, Spitzer, Gibbon, Williams, & Benjamin, 1995 ). Correlations between the questionnaires and the SCID-II were calculated. In addition, the sensitivity and specificity of the questionnaires were tested. All instruments predicted the BPD diagnosis equally well.

Sign in / Sign up

Export Citation Format

Share Document