Article

Factors Determining Nurses' Clinical Judgments About Hospitalized Elderly Patients with Acute Confusion

School of Nursing, Chang-Gung Institute of Technology, 261 Wen-Hwa 1 Rd, RM 1110, Kwei-Shan, Tao-Yau 333, Taiwan.
Issues in Mental Health Nursing 07/2009; 30(6):399-405. DOI: 10.1080/01612840903037569
Source: PubMed

ABSTRACT

Acute confusion(AC)/delirium is a common clinical phenomenon in hospitalized elders that is often overlooked or misdiagnosed by nurses of various cultural backgrounds. The aim of this study was to better understand factors affecting nurses' clinical judgments regarding the detection of AC in elderly Taiwanese patients. Nurses from two hospitals in Taiwan (n = 654, response rate = 71.3%) participated in the study. A two-level hierarchical linear model analysis was used to examine the data. The characteristics of patients explained the most variance of the model (86.2%), with characteristics of nurse participants and their health organizations accounting for 13.8% of the variance. Patient characteristics of age, infection, hydration, and hypoactive subtypes of AC, as well as a nurse's strong belief in traditional Chinese values, such as respect for elders, hard work, modesty, noncompetitiveness, and respect for tradition, were positively associated with difficulty detecting acute confusion. Findings of this study indicated that the accuracy of nurses' clinical judgments in detecting AC were most related to characteristics of patients.

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Available from: Jeng Wang, Aug 15, 2014
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    • "This has implications for management of the critically ill patient; not only is the patient's life threatened by the primary illness, but also the effects of delirium may cause long term sequelae, principally cognitive deficits, and functional decline [8]. Hypoactive and mixed deliriums often go unrecognized despite being more common than hyperactive delirium [3, 8], resulting in undertreatment and poorer outcomes [8, 9]. Such factors present a challenge to clinicians to identify factors and possibly to prevent delirium in critically ill patients. "
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    ABSTRACT: Background. Delirium is characterized by disturbances of consciousness, attention, cognition, and perception. Delirium is a serious but reversible condition associated with poor clinical outcomes. This has implications for the critically ill patient; the effects of delirium cause long term sequelae, principally cognitive deficits, and functional decline. Objectives. The objective of the paper was to describe risk factors associated with delirium in critically ill adult patients. Methods. Published and unpublished literature from 1990 to 2012, limited to English, was searched using ten databases. Results. Twenty-two studies were included in this paper. A large number of risk factors were presented in the literature; some of these were common across all settings whilst others were exclusive to the type of setting. Benzodiazepines and opioids were shown to be risk factors for delirium independent of setting. Conclusion. With regard to patients admitted to medical and surgical intensive care units, risk factors of older age and comorbidity were common. In the cardiac ICU, older age and lower Mini-Mental Status Examination scores were cited most often as risk factors for delirium, but other risk factors exclusive to the setting were also significant. Benzodiazepines were identified as the most significant pharmacological risk factor for delirium.
    Full-text · Article · Mar 2013
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    • "The hypoactive form of delirium (representing the majority of cases, as reviewed above) and delirium in individuals with advanced age, sensorial deficits, prior cognitive impairment, or dementia and medical problems like infection or dehydration are the main reasons for the acute confusional sate not being recognised and diagnosed [69, 84, 85]. Hypoactive delirium and dementia comorbidity, appear to be the best predictors for overlooking delirium in the elderly with cognitive impairment [69]. "
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    ABSTRACT: Delirium is a neuropsychiatric syndrome characterized by altered consciousness and attention with cognitive, emotional and behavioural symptoms. It is particularly frequent in elderly people with medical or surgical conditions and is associated with adverse outcomes. Predisposing factors render the subject more vulnerable to a congregation of precipitating factors which potentially affect brain function and induce an imbalance in all the major neurotransmitter systems. Early diagnosis of delirium is crucial to improve the prognosis of patients requiring the identification of subtle and fluctuating signs. Increased awareness of clinical staff, particularly nurses, and routine screening of cognitive function with standardized instruments, can be decisive to increase detection rates of delirium. General measures to prevent delirium include the implementation of protocols to systematically identify and minimize all risk factors present in a particular clinical setting. As soon as delirium is recognized, prompt removal of precipitating factors is warranted together with environmental changes and early mobilization of patients. Low doses of haloperidol or olanzapine can be used for brief periods, for the behavioural control of delirium. All of these measures are a part of the multicomponent strategy for prevention and treatment of delirium, in which the nursing care plays a vital role.
    Full-text · Article · Jun 2011
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    ABSTRACT: Delirium in older patients is a common problem, whether patients are seen in a community setting, in a hospital for medical or surgical intervention or in an intensive care unit. Evaluation of elderly patients with confusion is challenging and in delirium several aspects of cognition, including perception, mental data processing and memory, must be considered. Delirium is thought to result from imbalances in cholinergic, dopaminergic and other neurotransmitter systems. It may manifest as a hyperactive, a hypoactive or a mixed state that fluctuates over time and requires a low threshold for investigation and a high index of suspicion for diagnosis. Once the presence of delirium has been established management strategies include treating any precipitating events, modifying potential risk factors and reassuring and reorienting the patient. Accurate identification and management of delirium in the elderly is important because delirium is associated with cognitive impairment and with increases in both morbidity and mortality. This review will discuss the variable presentations of delirium in the elderly, a diagnostic approach to acute confusion in the elderly, the acute management of delirium and the prognostic implications of delirium in this population.
    No preview · Article · Aug 2010 · Current Psychiatry Reviews
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