Hospital-Associated Disability Associated With Delirium Among Older Adults

Hospital-associated disability (HAD), defined as a loss of activities of daily living (ADLs) occurring during hospitalization, is a common complication among older adults. Delirium is also a common complication during hospitalization and is associated with multiple long-term sequelae. We sought to determine the effect of delirium and known covariates on the risk of incident HAD in hospitalized older adults. We examined electronic health record (EHR) data for 35,201 older adults ≥ 65 years of age admitted to the general inpatient (non-ICU) units of UAB Hospital from January 1, 2015 to December 31, 2019. Delirium was defined as a score ≥ 2 on the Nursing Delirium Screening Scale (NuDESC) during hospital admission, and HAD defined as a decline on the Katz ADL scale from hospital admission to discharge. Generalized linear mixed models were used to examine the association between delirium and HAD, adjusting for covariates and repeated observations for individuals with multiple admissions. We found that 21.2% of older adults developed HAD during their hospitalization and experienced higher delirium rates as compared to those not developing HAD (25.2% vs. 16.3%). Presence of delirium, medical comorbidity score, baseline cognitive status, and baseline ADL function were associated (all p <0.001) with incident HAD. Mediation analyses also showed that 8% of the effect of comorbidity on incident HAD was due to delirium (p < 0.001). Reducing rates of delirium can be one component of a comprehensive approach to reduce rates of HAD in older adults.

Non-Pharmacological Interventions for Anemia Treatment: Systematic Review

The global prevalence of anemia in non-pregnant women, of childbearing age, is estimated at 29.0% and is more common in low- and middle-income countries, women belonging to low socioeconomic strata. iron deficiency can cause direct or risky disability. To determine the effectiveness of Non-Pharmacological Interventions for the treatment of anemia. The method used is with the help of electronic databases from journals that have been published through PubMed, Proquest, EBSCOhost, and Science Direct as many as 6 articles were reviewed from 1186 articles. The 6 articles reviewed in this study with varied respondents using patients, male rats, nurses, Sprague-Dawley (SD) Rattus norvegicus Domestica, bovine serum, premature neonates. Non-pharmacological interventions developed in the treatment of anemia in both human and animal samples as well as the development of treatment and laboratory examinations in the treatment of anemia are Nursing Delirium Screening scale, Hepcidin expression, pain identification, HM10760A, Divalent metal transporter DMT1/SLC11A2, conservative management.

Risk factors of post-anaesthesia care unit delirium in patients undergoing non-cardiac surgery in Singapore

Introduction: Post-anaesthesia care unit (PACU) delirium affects 5%–45% of patients after surgery and is associated with postoperative delirium and increased mortality. Up to 40% of PACU delirium is preventable but it remains under-recognised due to a lack of awareness for its diagnosis. Nursing Delirium Screening Scale (Nu-DESC) has been validated in diagnosing PACU delirium but is not routine locally. This study aim was to use the Nu-DESC to establish the incidence and risk factors of PACU delirium in patients undergoing non-cardiac surgery in the surgical population. Methods: With IRB approval and informed consent, we conducted an audit of eligible patients undergoing major surgery in three major public hospitals in Singapore over one week. Patients were assessed for delirium 30–60 minutes following their arrival in the PACU using the Nu-DESC with a score of ≥ 2 as indicative of delirium. Results: A total of 478 patients were assessed. The overall incidence rate of PACU delirium was 18/478 (3.8%) and 9/146 (6.2%) in patients over 65 years old. PACU delirium was more common in females, patients with malignancy and those who underwent longer operations. Logistic Regression analysis showed that the use of BIS (p < 0.001) and the presence of malignancy (p<0.001) were significantly associated with a higher incidence of PACU delirium. Conclusion: In this first local study, the incidence of PACU delirium was 3.8%, with the incidence increasing to 6.2% in those older than 65 years old. Understanding these risk factors will form the basis for which protocols can be established to optimise resource management and prevent long term morbidities and mortality of PACU delirium.

Delirium in Critically Ill Patients with and without COVID-19—A Retrospective Analysis

Background: Delirium complicating the course of Intensive care unit (ICU) therapy is a known driver of morbidity and mortality. It has been speculated that infection with the neurotrophic SARS-CoV-2 might promote delirium. Methods: Retrospective registry analysis including all patients treated at least 48 h on a medical intensive care unit. The primary endpoint was development of delirium as diagnosed by Nursing Delirium screening scale ≥2. Results were confirmed by propensity score matching. Results: 542 patients were included. The primary endpoint was reached in 352/542 (64.9%) patients, without significant differences between COVID-19 patients and non-COVID-19 patients (51.4% and 65.9%, respectively, p = 0.07) and correlated with prolonged ICU stay in both groups. In a subgroup of patients with ICU stay >10 days delirium was significantly lower in COVID-19 patients (p ≤ 0.01). After adjustment for confounders, COVID-19 correlated independently with less ICU delirium (p ≤ 0.01). In the propensity score matched cohort, patients with COVID-19 had significantly lower delirium incidence compared to the matched control patients (p ≤ 0.01). Conclusion: Delirium is frequent in critically ill patients with and without COVID-19 treated at an intensive care unit. Data suggests that COVID-19 itself is not a driver of delirium per se.

The Polish Version of the Nursing Delirium Screening Scale (NuDESC PL)-Experience of Using in Nursing Practice in Cardiac Surgery Intensive Care Unit

Introduction: Delirium is a common complication of patients hospitalized in Intensive care units (ICU). The risk of delirium is estimated at approximately 80% in intensive care units. In the case of cardiac surgery ICU, the risk of delirium increases due to the type of procedures performed with the use of extracorporeal circulation. The aim of this study was to provide an official translation and evaluation of Nursing Delirium Screening Scale (NuDESC) into Polish. The NuDESC scale is a scale used by nurses around the world to detect delirium at an early stage in treatment. Methods: The method used in the study was the NuDESC tool, which was translated into Polish. The study was conducted by Cardiac ICU nurses during day shift (at 8 a.m.), night shift (at 8 p.m.) and in other situations where the patients showed delirium-like symptoms. Results: Statistically significant differences were observed between the first and second day in the studied group of patients in the case of illusions/hallucinations. Delirium occurred more frequently during the night, but statistical significance was demonstrated for both daytime and nighttime shifts. It was not demonstrated in relation to the NuDESC scale in the case of insomnia disorders. The diagnosis of delirium and disorientation was the most common diagnosis observed in patients on the first day of their stay in the ICU, followed by problems with communication. Delirium occurred on the first day, mainly at night. On the second day, delirium was much less frequent during the night; the biggest problem was disorientation and problems with communication. Conclusion: This study contributed to the development of the Polish version of the scale (NuDESC PL) which is now used as the Polish screening tool for delirium detection. The availability of an easy-to-use nurse-based delirium instrument is a prerequisite for widespread implementation.

A Quantitative Study for Evaluating Risk Factors in Routine Perioperative Assessment During Elective Bariatric Surgery Regarding the Development of Postoperative Delirium

Background: Postoperative delirium (POD) is associated with long term physical and cognitive impairment. Identification of eligible biomarkers is desirable. In this subanalysis of data collected during the prospective observational CESARO study we investigate the relevance of preoperative organ dysfunctions on the onset of POD.Methods: N = 98 Patients undergoing laparoscopic bariatric surgery were screened for POD using the Nursing Delirium Screening Scale (Nu-DESC). All preoperative assessed routine data including laboratory results were investigated for association with the development of POD.Results: Twenty percent of patients had POD of short duration. Obstructive Sleep Apnea (OSAS) as well as elevated BUN and low HKT were identified as predictors.Conclusion: POD incidence was comparable to other studies nonetheless our patients had only marginal risk factors. Here identified parameters might be another piece to the answer of the question: which are correlating biomarkers to the pathophysiologic process of delirium onset?