Delirium in older persons. N Engl J Med

Department of Medicine, Harvard Medical School, Boston, USA.
New England Journal of Medicine (Impact Factor: 55.87). 04/2006; 354(11):1157-65. DOI: 10.1056/NEJMra052321
Source: PubMed


The prevalence of delirium increases sharply with age, and about 20 percent of older patients have delirium at the time of hospital admission for any reason. This review summarizes the clinical manifestations of and risk factors for delirium and the evaluation of patients with this condition. It includes an update on the current understanding of the pathogenesis of delirium and provides guidance regarding practical measures to prevent this common complication.

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    • "Delirium is most common among older hospital patients [5], with the highest incidence rates in surgical and ICU patients [3]. Given the high costs, prolonged hospital stays and increased rates of morbidity and mortality associated with delirium [1], as well as the poor cognitive and functional prognosis for those affected [6], the investigation of means to reduce its incidence in older hospital patients is of vital importance. "
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    ABSTRACT: To investigate the association between smoking in the older population and the risk of inpatient delirium, which is common and has adverse consequences. Participants (N=3754) were insurants aged ≥55years of the largest German statutory health insurance company, who enrolled in a 6-year prospective population-based study. Baseline smoking, adjusted for age, sex, depressive symptoms, cognitive impairment and alcohol consumption, was analyzed as risk factor of inpatient delirium. Results are presented as hazard ratios (HRs) and 95% confidence intervals (95% CIs). Three-hundred seventy-three (10.0%) participants were smokers at baseline, 865 (23.0%) were quitters and 2516 (67.0%) were lifelong abstainers. Mean pack-years of smokers and quitters were 23.8 (S.D.=22.4). Sixty-one (1.6%) received a diagnosis of inpatient delirium. Smokers had an increased risk of delirium compared to abstainers in the fully adjusted model (HR=2.87, 95% CI 1.24-6.66). Quitters and abstainers did not differ (HR=0.79, 95% CI 0.37-1.72). Comparing smokers and quitters, current smoking status (HR=3.22, 95% CI 1.20-8.62) but not pack-years [residual χ(2)(1)=0.25, P=.874] were associated with inpatient delirium. Only current smoking but not being a quitter and the lifetime amount smoked were associated with inpatient delirium, indicating that acute nicotine withdrawal may represent a relevant pathogenic mechanism. Copyright © 2015. Published by Elsevier Inc.
    General hospital psychiatry 03/2015; 37(4). DOI:10.1016/j.genhosppsych.2015.03.009 · 2.61 Impact Factor
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    • "Its substantial advantage is further a favourable profile of acute extrapyramidal side effects that occur in very rare cases [15]. Offlabel use, that is, unlabeled or unapproved use, is common in conditions such as agitation, anxiety, dementia, obsessivecompulsive disorders, psychosis [16], and delirium [17] [18]. Because of many inconclusive study results, evidence is limited. "
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    ABSTRACT: . Prescription of fragmented tablets is useful for individualisation of dose but includes several drawbacks. Although without score lines, the antipsychotic drug quetiapine was in 2011 the most often prescribed 1/2 tablet in discharge prescriptions at the University Hospital in Basel (USB, 671 beds). We aimed at analysing the prescription patterns of split tablets in general and of quetiapine in particular in Switzerland. Methods . All orders of community pharmacies for unit-of-use soft pouch blisters placed at Medifilm AG, the leader company in Switzerland for repackaging into pouch blisters, were analysed. Results . Out of 4,784,999 tablets that were repacked in 2012 in unit-of-use pouch blisters, 8.5% were fragmented, mostly in half (87.6%), and were predominantly psycholeptics (pipamperone 15.8%). Prescription of half quetiapine appears to be a Basel specificity (highest rates of fragments and half quetiapine). Conclusions . Prescription of fragmented tablet is frequent. It represents a safety issue for the patient, and a pharmaceutical care issue for the pharmacist. In ambulatory care, the patient’s cognitive and physical capacities must be clarified, suitability of the splitting of the tablet must be checked, appropriate aids must be offered, like a pill-splitting device in order to improve accuracy, and safe use of the drug must be ensured.
    BioMed Research International 01/2015; 2015(5-6). DOI:10.1155/2015/602021 · 2.71 Impact Factor
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    • "gency departments and hospital wards, exposure to the risks of delirium, functional decline and other hospitalacquired complications, and potentially long delays in transfer back to their home or LTC home [6] [7]. Many of these admissions and their associated complications might be prevented through more optimal management of HF in LTC [8] [9] [10] [11] [12]. "
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    ABSTRACT: Background: Implementation of heart failure guidelines in long-term care (LTC) settings is challenging. Understanding the conditions of nursing practice can improve management, reduce suffering, and prevent hospital admission of LTC residents living with heart failure. Objective: The aim of the study was to understand the experiences of LTC nurses managing care for residents with heart failure. Methods: This was a descriptive qualitative study nested in Phase 2 of a three-phase mixed methods project designed to investigate barriers and solutions to implementing the Canadian Cardiovascular Society heart failure guidelines into LTC homes. Five focus groups totaling 33 nurses working in LTC settings in Ontario, Canada, were audiorecorded, then transcribed verbatim, and entered into NVivo9. A complex adaptive systems framework informed this analysis. Thematic content analysis was conducted by the research team. Triangulation, rigorous discussion, and a search for negative cases were conducted. Data were collected between May and July 2010. Results: Nurses characterized their experiences managing heart failure in relation to many influences on their capacity for decision-making in LTC settings: (a) a reactive versus proactive approach to chronic illness; (b) ability to interpret heart failure signs, symptoms, and acuity; (c) compromised information flow; (d) access to resources; and (e) moral distress. Discussion: Heart failure guideline implementation reflects multiple dynamic influences. Leadership that addresses these factors is required to optimize the conditions of heart failure care and related nursing practice.
    Nursing Research 09/2014; 63(5):357-365. DOI:10.1097/NNR.0000000000000049 · 1.36 Impact Factor
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