Gökcen UMURCA, Busra CAN, Birkan ILHAN, Asli TUFAN

Delirium and geriatric syndromes in hospitalized older patients: Results from World Delirium Awareness Day

Objective: To determine the point prevalence of delirium and the associated risk factors in geriatric inpatients. Patients and Methods: Sixty-two hospitalized patients aged 60 years and over were recruited. The Mini Nutritional Assessment-Short Form (MNA-SF), the FRAIL scale, Katz Activities of Daily Living (ADL), and Lawton-Brody Instrumental ADL (IADL) questionnaires were administered. A delirium evaluation test (Confusion Assessment Method-CAM) was performed for diagnosing delirium. Mortality was evaluated one month after the index date. Results: The median age was 71.5 (range, 60-96) years. Delirium was detected in 29% of the patients. Frailty and dementia were associated with delirium (p<0.001 and p=0.001; respectively). Polypharmacy, indwelling urinary catheter, and low albumin were also related to delirium (p=0.025, p=0.007, and p=0.002; respectively). Age over 70 years, low Katz ADL and low MNA-SF scores were found to be independently associated with delirium in multivariate regression analysis models. The median hospitalization time was longer in the delirium group (p=0.029). Survival analysis at one month showed no significant difference between the delirium and non-delirium groups. Conclusion: Age over 70 years, impaired functionality in ADL and malnutrition were independently associated with delirium.

Keywords:

Delirium Functionality, Geriatrics, Geriatric syndromes, Malnutrition,

PDF

___

[1] Savikko N, Pitkala KH, Strandberg TE, Tilvis RS, Laurila JV. Diagnostic agreement on delirium between the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; International Classification of Diseases, Tenth Revision; confusion assessment method [CAM]; and the five-item CAM in older adults with dementia. J Am Geriatr Soc 2013;61:662- 4. doi: 10.1111/jgs.12184
[2] Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet 2014;383[9920]:911-22. doi: 10.1016/S0140- 6736(13)60688-1
[3] Dani M, Owen LH, Jackson TA, Rockwood K, Sampson EL, Davis D. Delirium, frailty, and mortality: Interactions in a prospective study of hospitalized older people. J Gerontol A Biol Sci Med Sci 2018;73:415-8. doi:10.1093/gerona/glx214
[4] Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA 2010;304:443-51. doi: 10.1001/jama.2010.1013
[5] Bellelli G, Mazzola P, Morandi A, et al. Duration of postoperative delirium is an independent predictor of 6-month mortality in older adults after hip fracture. J Am Geriatr Soc 2014;62:1335-40. doi: 10.1111/jgs.12885
[6] Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med 2008;168:27-32. doi: 10.1001/archinternmed.2007.4
[7] Holt R, Young J, Heseltine D. Effectiveness of a multicomponent intervention to reduce delirium incidence in elderly care wards. Age Ageing 2013;42:721-7. doi: 10.1093/ ageing/aft120
[8] Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in – patients: a systematic literature review. Age Ageing 2006;35:350-64. doi: 10.1093/ageing/ afl005
[9] de la Cruz M, Fan J, Yennu S, et al. The frequency of missed delirium in patients referred to palliative care in a comprehensive cancer center. Support Care Cancer 2015;23:2427-33. doi: 10.1007/s00520.015.2610-3
[10] Guigoz Y, Vellas BJ. Malnutrition in the elderly: the Mini Nutritional Assessment [MNA]. Ther Umsch Rev Ther 1997;54:345-50.
[11] Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment [MNA-SF]. J Gerontol A Biol Sci Med Sci 2001;56:M366-72. doi: 10.1093/ gerona/56.6.m366
[12] Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of Adl: A standardized measure of biological and psychosocial function. JAMA 1963;185:914-9. doi: 10.1001/jama.1963.030.60120024016
[13] Lawton MP, Brody EM. Assessment of older people: selfmaintaining and instrumental activities of daily living. Gerontologist 1969;9:179-86.
[14] Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr 2017;17:230. doi: 10.1186/s12877-017- 0621-2
[15] Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire [FRAIL] predicts outcomes in middle aged African Americans. J Nutr Health Aging 2012;16:601-8. doi: 10.1007/s12603.012.0084-2
[16] Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990;113:941-8. doi: 10.7326/0003-4819-113-12-941
[17] Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients. BMC Geriatr 2014;14:1. doi: 10.1186/1471-2318-14-1
[18] Adamis D, Treloar A, Darwiche FZ, Gregson N, Macdonald AJ, Martin FC. Associations of delirium with in-hospital and in 6-months mortality in elderly medical inpatients. Age Ageing 2007;36:644-9. doi: 10.1093/ageing/afm094
[19] Verloo H, Goulet C, Morin D, von Gunten A. Association between frailty and delirium in older adult patients discharged from hospital. Clin Interv Aging 2016;11:55-63. doi: 10.2147/ CIA.S100576
[20] Eeles EM, White SV, O’Mahony SM, Bayer AJ, Hubbard RE. The impact of frailty and delirium on mortality in older inpatients. Age Ageing 2012;41:412-6. doi: 10.1093/ageing/ afs021
[21] Hubbard RE, Peel NM, Samanta M, Gray LC, Mitnitski A, Rockwood K. Frailty status at admission to hospital predicts multiple adverse outcomes. Age Ageing 2017;46:801-6. doi: 10.1093/ageing/afx081
[22] Cesari M, Calvani R, Marzetti E. Frailty in Older Persons. Clin Geriatr Med 2017;33:293-303. doi: 10.1016/j.cger.2017.02.002
[23] Leung JM, Tsai TL, Sands LP. Brief report: preoperative frailty in older surgical patients is associated with early postoperative delirium. Anesth Analg 2011;112:1199-201. doi: 10.1213/ ANE.0b013e31820c7c06
[24] Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013;381:752-62. doi: 10.1016/S0140- 6736(12)62167-9
[25] van Gool WA, van de Beek D, Eikelenboom P. Systemic infection and delirium: when cytokines and acetylcholine collide. Lancet 2010;375:773-5. doi: 10.1016/S0140- 6736(09)61158-2
[26] Bo M, Porrino P, Di Santo SG, Mazzone A, Cherubini A, et al. The association of indwelling urinary catheter with delirium in hospitalized patients and nursing home residents: an explorative analysis from the “Delirium Day 2015”. Aging Clin Exp Res 2019;31:411-20. doi: 10.3390/jpm11060445
[27] O’Regan NA, Fitzgerald J, Adamis D, Molloy DW, Meagher D, Timmons S. Predictors of Delirium Development in Older Medical Inpatients: Readily Identifiable Factors at Admission. J Alzheimers Dis 2018;64:775-85. doi: 10.3233/jad-180178
[28] Fick DM, Agostini JV, Inouye SK. Delirium superimposed on dementia: a systematic review. J Am Geriatr Soc 2002;50:1723- 32. doi:10.1046/j.1532-5415.2002.50468.x
[29] Cunningham C. Systemic inflammation and delirium: important co-factors in the progression of dementia. Biochem Soc Trans 2011;39:945-53. doi:10.1042/BST0390945
[30] Lach HW, Leach KM, Butcher HK. Evidence-Based Practice Guideline: Changing the Practice of Physical Restraint Use in Acute Care. J Gerontol Nurs 2016;42:17-26. doi:10.3928/00989.134.20160113-04
[31] Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA 1996;275:852-7. PMID: 8596223
[32] Young J, Murthy L, Westby M, Akunne A, O’Mahony R. Diagnosis, prevention, and management of delirium: summary of NICE guidance. BMJ 2010;341:c3704. PMID: 8596223
[33] Yue J, Tabloski P, Dowal SL, Puelle MR, Nandan R, Inouye SK. NICE to HELP: operationalizing National Institute for Health and Clinical Excellence guidelines to improve clinical practice. J Am Geriatr Soc 2014;62:754-61. doi:10.1111/jgs.12768
[34] Hein C, Forgues A, Piau A, Sommet A, Vellas B, Nourhashemi F. Impact of polypharmacy on occurrence of delirium in elderly emergency patients. J Am Med Dir Assoc 2014;15:850 e11-5. doi:10.1016/j.jamda.2014.08.012
[35] Trzepacz PT. Update on the neuropathogenesis of delirium. Dement Geriatr Cogn Disord 1999;10:330-4. doi: 10.1159/000017164
[36] van Eijsden WA, Raats JW, Mulder PG, van der Laan L. New aspects of delirium in elderly patients with critical limb ischemia. Clin Interv Aging 2015;10:1537-46. doi: 10.2147/ CIA.S87383
[37] Inouye SK, Baker DI, Fugal P, Bradley EH. Dissemination of the hospital elder life program: implementation, adaptation, and successes. J Am Geriatr Soc 2006;54:1492-9. doi:10.1111/ j.1532-5415.2006.00869.x
[38] Leslie DL, Zhang Y, Bogardus ST, Holford TR, Leo-Summers LS, Inouye SK. Consequences of preventing delirium in hospitalized older adults on nursing home costs. J Am Geriatr Soc 2005;53:405-9. doi: 10.1111/j.1532-5415.2005.53156.x
[39] Mazzola P, Ward L, Zazzetta S, et al. Association Between Preoperative Malnutrition and Postoperative Delirium After Hip Fracture Surgery in Older Adults. J Am Geriatr Soc 2017;65:1222-8. doi: 10.1111/jgs.14764
[40] Montejano Lozoya R, Martinez-Alzamora N, Clemente Marin G, Guirao-Goris SJA, Ferrer-Diego RM. Predictive ability of the Mini Nutritional Assessment Short Form [MNA-SF] in a free-living elderly population: a cross-sectional study. PeerJ 2017;5:e3345. doi: 10.7717/peerj.3345
[41] Carrasco MP, Villarroel L, Andrade M, Calderon J, Gonzalez M. Development and validation of a delirium predictive score in older people. Age Ageing 2014;43:346-51. doi: 10.1093/ ageing/aft141
[42] Watt J, Tricco AC, Talbot-Hamon C, et al. Identifying Older Adults at Risk of Delirium Following Elective Surgery: A Systematic Review and Meta-Analysis. J Gen Intern Med 2018;33:500-9. doi: 10.1007/s11606.017.4204-x
[43] Kim SY, Kim SW, Kim JM, et al. Differential associations between delirium and mortality according to delirium subtype and age: A Prospective Cohort Study. Psychosom Med 2015; 77:903–910. doi: 10.1097/PSY.000.000.0000000239
[44] Hamilton GM, Wheeler K, Di Michele J, Lalu MM, McIsaac DI. A Systematic Review and Meta-analysis Examining the Impact of Incident Postoperative Delirium on Mortality. Anesthesiology 2017;127:78-88. doi: 10.1097/ ALN.000.000.0000001660
[45] Dharmarajan K, Swami S, Gou RY, Jones RN, Inouye SK. Pathway from Delirium to Death: Potential In-Hospital Mediators of Excess Mortality. J Am Geriatr Soc 2017;65:1026- 33. doi: 10.1111/jgs.14743
[46] Pendlebury ST, Lovett NG, Smith SC, et al. Observational, longitudinal study of delirium in consecutive unselected acute medical admissions: age-specific rates and associated factors, mortality and re-admission. BMJ Open 2015;5:e007808. doi: 10.1136/bmjopen- 2015-007808
[47] Morandi A, Di Santo SG, Zambon A, et al. Delirium, Dementia, and In-Hospital Mortality: The Results From the Italian Delirium Day 2016, A National Multicenter Study. J Gerontol A Biol Sci Med Sci 2019;74:910-6. doi: 10.1093/ gerona/gly154
[48] McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E. Delirium predicts 12 – month mortality. Arch Intern Med 2002;162:457-63. doi:10.1001/archinte.162.4.457
[49] Oh ES, Fong TG, Hshieh TT, Inouye SK. Delirium in Older Persons: Advances in Diagnosis and Treatment. JAMA 2017;318:1161-74. doi: 10.1001/jama.2017.12067

ISSN: 1019-1941
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1988
Yayıncı: Marmara Üniversitesi

Arşiv