Development of Delirium: A Prospective Cohort Study in a Community Hospital

University of Waterloo, Ватерлоо, Ontario, Canada
International Psychogeriatrics (Impact Factor: 1.93). 04/2000; 12(1):117-27. DOI: 10.1017/S1041610200006244
Source: PubMed


Previous research on risk of delirium in acute hospital settings identified mainly patient variables (e.g., age) that are not amenable to intervention. The purpose of this study was to develop a model for new delirium in hospitalized older patients that included process of care and social variables.
A prospective cohort study was undertaken in a community hospital in Ontario, Canada. Research participants included 156 hospitalized patients age 65+ years and without delirium on admission who were admitted to a medical or surgical unit. The measures included daily appraisal of delirium using a standardized and validated tool, and assessment of patient, process of care, and social variables.
Delirium developed in 28 of the 156 patients (17.9%). Older age and cognitive impairment were significant patient variables. Significant process of care variables included a high number of medications administered during hospitalization, surgery, a high number of procedures during early hospitalization (e.g., x-rays, blood tests), and intensive care treatment.
Approximately one older patient in five developed delirium after admission to a medical or surgical unit. Risks not easily amenable to intervention included age, cognitive dysfunction, surgery, and intensive care requirements. Risk factors that are potentially modifiable included number of medications and number of procedures. Future research might focus on the efficacy of such intervention to reduce new-onset delirium in acute hospital settings.

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Available from: Michael Stones, Jul 22, 2014
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    • "Assessment was used broadly to include screening, e.g. triage in the ED (Rutschmann et al., 2005; Warburton, 2005; Di Bari et al., 2010), functional or risk identification including pressure ulcers (Zulkowski & Kindsfater, 2000) and alternate level of care (Rock & Auerbach, 1994) or assessment of specific clinical needs including nutrition (Incalzi et al., 1996; Xia & McCutcheon, 2006; Patel & Martin, 2008), communication (VanCott, 2002), family concerns (Higgins et al., 2007) and assessment of common geriatric syndromes including delirium, overlapping depression and delirium, falls and toileting, interest in mobility and frailty (Inouye & Charpentier, 1996; Bakarich et al., 1997; Crawley & Miller, 1998; Inouye et al., 1998; Fick & Foreman, 2000; Martin et al., 2000; Arora et al., 2007; Brown et al., 2009; Givens et al., 2009; Andela et al., 2010). Of all the clinical concerns studied, delirium was prominent. "
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    • "rium ( Berggren et al . , 1987 ; Gustafson et al . , 1988 ; Levkoff et al . , 1991 ; Smita et al . , 1995 ; Tune et al . , 1993 ) . Rudberg et al . ( 1997 ) reported that medication is the leading cause for delirium for medical - surgical elderly patients . Other researchers reported that use of multiple medications ( Inouye & Charpentier , 1996 ; Martin et al . , 2000 ) , narcotics or sedatives ( Francis et al . , 1990 ) , neuroleptic or narcotics ( Schor et al . , 1992 ) , alcohol ( Marcantonio et al . , 1994 ; Pompei et al . , 1994 ; Williams - Russo et al . , 1992 ) , and psychoactive drugs ( Dai et al . , 2000 ) precipitated delirium development . From the literature review , a theoretical model "
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