Emergency Department Stay Associated Delirium in Older Patients*

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Caring for older patients can be challenging in the Emergency Department (ED). A > 12 hr ED stay could lead to incident episodes of delirium in those patients. The aim of this study was to assess the incidence and impacts of ED-stay associated delirium.

Methods

A historical cohort of patients who presented to a Canadian ED in 2009 and 2011 was randomly constituted. Included patients were aged ≥ 65 years old, admitted to any hospital ward, non-delirious upon arrival and had at least a 12-hour ED stay. Delirium was detected using a modified chart-based Confusion Assessment Method (CAM) tool. Hospital length of stay (LOS) was log-transformed and linear regression assessed differences between groups. Adjustments were made for age and comorbidity profile.

Results

200 records were reviewed, 55.5% were female, median age was 78.9 yrs (SD:7.3). 36(18%) patients experienced ED-stay associated delirium. Nearly 50% of episodes started in the ED and within 36 hours of arrival. Comorbidity profile was similar between the positive CAM group and the negative CAM group. Mean adjusted hospital LOS were 20.5 days and 11.9 days respectively ( p<.03).

Conclusions

1 older adult out of 5 became delirious after a 12 hr ED stay. Since delirium increases hospital LOS by more than a week, better screening and implementation of preventing measures for delirium could reduce LOS and overcrowding in the ED.

Related collections

Most cited references 23

Record: found
Abstract: found
Article: not found

Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.

Donna M Fick, James W. Cooper, William Wade … (2003)

Medication toxic effects and drug-related problems can have profound medical and safety consequences for older adults and economically affect the health care system. The purpose of this initiative was to revise and update the Beers criteria for potentially inappropriate medication use in adults 65 years and older in the United States. This study used a modified Delphi method, a set of procedures and methods for formulating a group judgment for a subject matter in which precise information is lacking. The criteria reviewed covered 2 types of statements: (1) medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available and (2) medications that should not be used in older persons known to have specific medical conditions. This study identified 48 individual medications or classes of medications to avoid in older adults and their potential concerns and 20 diseases/conditions and medications to be avoided in older adults with these conditions. Of these potentially inappropriate drugs, 66 were considered by the panel to have adverse outcomes of high severity. This study is an important update of previously established criteria that have been widely used and cited. The application of the Beers criteria and other tools for identifying potentially inappropriate medication use will continue to enable providers to plan interventions for decreasing both drug-related costs and overall costs and thus minimize drug-related problems.

0 comments Cited 389 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability.

Sharon Inouye, Kevin P Charpentier (1996)

To prospectively develop and validate a predictive model for delirium based on precipitating factors during hospitalization, and to examine the interrelationship of precipitating factors and baseline vulnerability. Two prospective cohort studies, in tandem. General medical wards, university teaching hospital. For the development cohort, 196 patients aged 70 years and older with no delirium at baseline, and for the validation cohort, 312 comparable patients. New-onset delirium by hospital day 9, defined by the Confusion Assessment Method diagnostic criteria. Delirium developed in 35 patients (18%) in the development cohort. Five independent precipitating factors for delirium were identified; use of physical restraints (adjusted relative risk [RR], 4.4; 95% confidence interval [CI], 2.5 to 7.9), malnutrition (RR, 4.0; 95% CI, 2.2 to 7.4), more than three medications added (RR, 2.9; 95% CI, 1.6 to 5.4), use of bladder catheter (RR, 2.4; 95% CI, 1.2 to 4.7), and any iatrogenic event (RR, 1.9; 95% CI, 1.1 to 3.2). Each precipitating factor preceded the onset of delirium by more than 24 hours. A risk stratification system was developed by adding 1 point for each factor present. Rates of delirium for low-risk (0 points), intermediate-risk (1 to 2 points), and high-risk groups (> or equal to 3 points) were 3%, 20%, and 59%, respectively (P < .001). The corresponding rates in the validation cohort, in which 47 patients (15%) developed delirium, were 4%, 20%, and 35%, respectively (P < .001). When precipitating and baseline factors were analyzed in cross-stratified format, delirium rates increased progressively from low-risk to high-risk groups in all directions (double-gradient phenomenon). The contributions of baseline and precipitating factors were documented to be independent and statistically significant. A simple predictive model based on the presence of five precipitating factors can be used to identify elderly medical patients at high risk for delirium. Precipitating and baseline vulnerability factors are highly interrelated and contribute to delirium in independent substantive, and cumulative ways.

0 comments Cited 171 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method.

Sharon Inouye, Sidney T Bogardus, Jin-ying Zhang … (2005)

To validate a chart-based method for identification of delirium and compare it with direct interviewer assessment using the Confusion Assessment Method (CAM). Prospective validation study. Teaching hospital. Nine hundred nineteen older hospitalized patients. A chart-based instrument for identification of delirium was created and compared with the reference standard interviewer ratings, which used direct cognitive assessment to complete the CAM for delirium. Trained nurse chart abstractors were blinded to all interview data, including cognitive and CAM ratings. Factors influencing the correct identification of delirium in the chart were examined. Delirium was present in 115 (12.5%) patients according to the CAM. Sensitivity of the chart-based instrument was 74%, specificity was 83%, and likelihood ratio for a positive result was 4.4. Overall agreement between chart and interviewer ratings was 82%, kappa=0.41. By contrast, using International Classification of Diseases, Ninth Revision, Clinical Modification, administrative codes, the sensitivity for delirium was 3%, and specificity was 99%. Independent factors associated with incorrect chart identification of delirium were dementia, severe illness, and high baseline delirium risk. With all three factors present, the chart instrument was three times more likely to identify patients incorrectly than with none of the factors present. A chart-based instrument for delirium, which should be useful for patient safety and quality-improvement programs in older persons, was validated. Because of potential misclassification, the chart-based instrument is not recommended for individual patient care or diagnostic purposes.

0 comments Cited 163 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): Can Geriatr J

Journal ID (iso-abbrev): Can Geriatr J

Title: Canadian Geriatrics Journal

Publisher: Canadian Geriatrics Society

ISSN (Electronic): 1925-8348

Publication date Collection: March 2017

Publication date (Electronic): 31 March 2017

Volume: 20

Issue: 1

Pages: 10-14

Affiliations

[1 ]Centre d’Excellence sur le Vieillissement de Québec, Québec, QC, Canada

[2 ]CHU de Québec–Hôpital de l’Enfant-Jésus, Québec, QC, Canada

[3 ]Département de médecine familiale et de médecine d’urgence, Université Laval, Québec, QC, Canada

[4 ]Ottawa Health Research Institute, Ottawa, ON, Canada

[5 ]Sunnybrook Health Sciences Centre, Toronto, ON, Canada

Article

Publisher ID: cgj-20-10

DOI: 10.5770/cgj.20.246

PMC ID: 5383401

PubMed ID: 28396704

SO-VID: ba7b6ac7-bd47-4c94-802c-ff024f8d8e37

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No-Derivative license ( http://creativecommons.org/licenses/by-nc-nd/2.5/ca/), which permits unrestricted non-commercial use and distribution, provided the original work is properly cited.

Emergency Department Stay Associated Delirium in Older Patients*

Read this article at

Abstract

Background

Methods

Results

Conclusions

Related collections

Hearing Loss and Restoration

Most cited references 23

Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.

Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability.

A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method.

Author and article information

Journal

Affiliations

Article

History

Categories

Comments

Comment on this article

Similar content 621

Cited by 18

Most referenced authors 389