Association Between Psychomotor Activity Delirium Subtypes and Mortality Among Newly Admitted Postacute Facility Patients

Harvard University, Cambridge, Massachusetts, United States
The Journals of Gerontology Series A Biological Sciences and Medical Sciences (Impact Factor: 5.42). 03/2007; 62(2):174-9. DOI: 10.1093/gerona/62.2.174
Source: PubMed


Delirium is common among hospitalized elders and may persist for months. Therefore, the adverse impact of delirium on independence often occurs in the post acute care (PAC) setting. The effect of psychomotor subtypes on delirium remains uncertain. The purpose of this study is to examine the association between psychomotor activity delirium subtypes and 1-year mortality among 457 newly admitted delirious PAC patients.
Patients were screened for delirium on admission to PAC facilities after an acute hospitalization, and patients with "Confusion Assessment Method"-defined delirium were enrolled. Psychomotor activity was assessed using the Memorial Delirium Assessment Scale, and patients were classified as to their delirium subtype (hyperactive, hypoactive, mixed, or normal). One-year mortality data were obtained from the National Death Index. A Kaplan-Meier survival analysis and a proportional hazards analysis using indicator (dummy) variables with normal psychomotor activity as the referent were performed.
The normal psychomotor activity group had the lowest 1-year mortality rate, followed by the hyperactive, mixed, then hypoactive groups in increasing order. Independent of age, gender, comorbidity, dementia, and delirium severity, hypoactive patients were 1.60 (95% confidence interval [CI], 1.09-2.35) times more likely to die during the 1-year follow-up period than were patients with normal psychomotor activity. The hyperactive (hazard ratio = 1.30; 95% CI, 0.73-2.31) and mixed (hazard ratio = 1.25; 95% CI, 0.72-2.17) psychomotor groups had nonsignificant elevated risks relative to the normal psychomotor behavior group.
All three psychomotor disturbance subtypes had an elevated risk of dying during the 1-year follow-up relative to the normal psychomotor group, though the hypoactive group had the highest mortality risk and was the only group with a statistically significantly elevated risk relative to the normal group.

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    • "Long period of stay in critical care has also been found to contributing to the prevalence of delirium as, 70–80% of these category patients experience delirium [7,2829. Also contributing to the high prevalence are those patient place on mechanical ventilators, studies has shown that 87% of these patients experience delirium [7,242526. It is also pertinent to know that among all these cases of prevalence 50% of them result from poor detection or missed diagnosis in clinical practice [18, 30]. "

    Full-text · Article · Dec 2015
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    • "However, despite these methodological limitations, hypoactive subtypes have been found to have a significantly poorer prognosis (Yang et al., 2009). In particular, hypoactive motor profiles have been found to have highest associated mortality independent of factors such as comorbidity , age, delirium, and dementia severity (Kiely et al., 2007). However, the association between hypoactive delirium and elevated mortality may be reflective of delayed detection of delirium, and hence more prolonged episodes (Gonzalez et al., 2009). "
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    ABSTRACT: Background: Delirium is a common neuropsychiatric syndrome that includes clinical subtypes identified by the Delirium Motor Subtyping Scale (DMSS). We explored the concordance between the DMSS and an abbreviated 4-item version in elderly medical inpatients. Methods: Elderly general medical admissions (n = 145) were assessed for delirium using the Revised Delirium Rating scale (DRS-R98). Clinical subtype was assessed with the DMSS (which includes the four items included in the DMSS-4). Motor subtypes were generated for all patient assessments using both versions of the scale. The concordance of the original and abbreviated DMSS was examined. Results: The agreement between the DMSS and DMSS-4 was high, both at initial and subsequent assessments (κ range 0.75-0.91). Intraclass Correlation Coefficient (ICC) for all three raters for the DMSS was high (0.70) and for DMSS-4 was moderate (0.59). Analysis of the agreement between raters for individual DMSS items found higher concordance in respect of hypoactive features compared to hyperactive. Conclusions: The DMSS-4 allows for rapid assessment of clinical subtype in delirium and has high concordance with the longer and well-validated DMSS, including over longitudinal assessment. There is good inter-rater reliability between medical and nursing staff. More consistent clinical subtyping can facilitate better delirium management and more focused research effort.
    Full-text · Article · Nov 2015 · International Psychogeriatrics
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    • "It has been reported that hypoactive patients are more likely to develop pressure sores or hospital-acquired infections, while falls are most likely in patients with hyperactive delirium [14]. Regarding prognostic significance of delirium subtypes studies have yielded contradictory results [13], but there is some evidence that hypoactive patients may have higher mortality risk compared to other psychomotor activity patient groups [15]. There is an ongoing research on delirium subtypes and here we intend to provide an up-to-date review of the recent literature focused on hypoactive delirium (HD). "
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    ABSTRACT: Delirium is a complex neuropsychiatric syndrome which is common in all medical settings. It often goes unrecognized due to difficulties in the detection of its hypoactive variant. This review aims to provide an up-to-date account on recent research on hypoactive delirium (HD). Thirty-eight studies, which were conducted in various clinical settings, including the Intensive Care Unit (ICU), were included in this review. Those studies involved recent research that has been published during the last 6 years. Prevalence of HD was found to vary considerably among different settings. HD seems to be more common in critically ill patients and less common in patients examined by consultation-liaison psychiatric services and in mixed patient populations. The presence of HD in ICU patients was associated with higher short- and long-term mortality and other adverse outcomes, but no such association was reported in other settings. Research on other possible associations of HD with clinical variables and on symptom presentation yielded inconclusive results, although there is some evidence for a possible association of HD with benzodiazepine use. There are several methodological issues that need to be addressed by future research. Future studies should examine HD in the primary care setting; treatment interventions should also be the objective of future research.
    Full-text · Article · Sep 2015 · Behavioural neurology
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