Hostname: page-component-76fb5796d-45l2p Total loading time: 0 Render date: 2024-04-28T22:37:29.138Z Has data issue: false hasContentIssue false
  • English
  • Français

The prevalence rates and sequelae of delirium at age older than 90 years

Published online by Cambridge University Press:  07 December 2020

Samuel Gehrke ,
Leonie Bode ,
Annina Seiler Open the ORCID record for Annina Seiler [Opens in a new window] ,
Jutta Ernst ,
Roland von Känel  and
Soenke Boettger Open the ORCID record for Soenke Boettger [Opens in a new window]
Samuel Gehrke
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Ramistrasse 100, 8091Zurich, Switzerland
Leonie Bode
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Ramistrasse 100, 8091Zurich, Switzerland
Annina Seiler
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Ramistrasse 100, 8091Zurich, Switzerland
Jutta Ernst
Affiliation:
University of Zurich, University Hospital Zurich, Institute of Nursing Science, Ramistrasse 100, 8091Zurich, Switzerland
Roland von Känel
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Ramistrasse 100, 8091Zurich, Switzerland
Soenke Boettger*
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Ramistrasse 100, 8091Zurich, Switzerland
*
Author for correspondence: Soenke Boettger, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland. E-mail: soenke.boettger@usz.ch
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Although age and pre-existent dementia are robust risk factors for developing delirium, evidence for patients older than 90 years is lacking. Therefore, this study assesses the delirium prevalence rates and sequelae in this age group.

Method

Based on a Diagnostic and Statistical Manual (DSM)-5, Delirium Observation screening scale (DOS), and Intensive Care Delirium Screening Checklist (ICDSC) construct, in this prospective cohort study, the prevalence rates and sequelae of delirium were determined in 428 patients older than 90 years by simple logistic regressions and corresponding odds ratios (ORs).

Results

The overall prevalence delirium rate was 45.2%, with a wide range depending upon specialty: intermediate and intensive care services (83.1%), plastic surgery and palliative care (75%), neurology (72%), internal medicine (69%) vs. dermatology (26.5%), and angiology (14.5%). Delirium occurred irrespective of age and gender; however, pre-existent dementia was the strongest delirium predictor (OR 36.05). Delirious patients were less commonly admitted from home (OR 0.47) than from assisted living (OR 2.24), indicating functional impairment. These patients were more severely ill, as indicated by emergency (OR 3.25) vs. elective admission (OR 0.3), requirement for intensive care management (OR 2.12) and ventilation (OR 5.56–8.33). At discharge, one-third did not return home (OR 0.22) and almost half were transferred to assisted living (OR 2.63), or deceased (OR 47.76).

Significance of results

At age older than 90 years, the prevalence and sequelae of delirium are substantial. In particular, functional impairment and pre-existent dementia predicted delirium and subsequently, the loss of independence and death were imminent.

Keywords

DeliriumImpact of deliriumOlder than 90 yearsPrevalence rateSequelae
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 5 , October 2021 , pp. 552 - 557
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Association.Google Scholar
Bellelli, G, Morandi, A, Di Santo, SG, et al. (2016) “Delirium Day”: A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool. BMC Medicine 14, 106. doi:10.1186/s12916-016-0649-8.CrossRefGoogle ScholarPubMed
Bergeron, N, Dubois, MJ, Dumont, M, et al. (2001) Intensive care delirium screening checklist: Evaluation of a new screening tool. Intensive Care Medicine 27, 859–864.10.1007/s001340100909CrossRefGoogle ScholarPubMed
Friedman, SM, Mendelson, DA, Bingham, KW, et al. (2008) Hazards of hospitalization: Residence prior to admission predicts outcomes. Gerontologist 48, 537–541.CrossRefGoogle ScholarPubMed
Gonzalez, M, Martinez, G, Calderon, J, et al. (2009) Impact of delirium on short-term mortality in elderly inpatients: A prospective cohort study. Psychosomatics 50, 234–238.CrossRefGoogle ScholarPubMed
Handley, M, Bunn, F and Goodman, C (2019) Supporting general hospital staff to provide dementia sensitive care: A realist evaluation. International Journal of Nursing Studies 96, 61–71. doi:10.1016/j.ijnurstu.2018.10.004.CrossRefGoogle ScholarPubMed
Hunstein, D, Sippel, B, Rode, D, et al. (2012). ePAAC© : ergebnisorientiertes PflegeAssessment AcuteCare (Version 2.0). pp. 1–72.Google Scholar
Inouye, SK, Westendorp, RG and Saczynski, JS (2014) Delirium in elderly people. Lancet 383, 911–922.CrossRefGoogle ScholarPubMed
Lawlor, PG, Gagnon, B and Mancini, IL (2000) Occurrence, causes, and outcomeof delirium in patients with advanced cancer: A prospective study. Archives of Internal Medicine 160, 786–794.CrossRefGoogle Scholar
Maldonado, JR (2017) Acute brain failure: Pathophysiology, diagnosis, management, and sequelae of delirium Critical Care Clinics 33, 461–519.CrossRefGoogle ScholarPubMed
McCoy, TH Jr., Snapper, L, Stern, TA, et al. (2016) Underreporting of delirium in statewide claims data: Implications for clinical care and predictive modeling. Psychosomatics 57, 480–488.CrossRefGoogle ScholarPubMed
Meagher, D, O'Regan, N, Ryan, D, et al. (2014) Frequency of delirium and subsyndromal delirium in an adult acute hospital population. British Journal of Psychiatry 205, 478–485.CrossRefGoogle Scholar
Ryan, DJ, O'Regan, NA, Caoimh, RO, et al. (2013) Delirium in an adult acute hospital population: Predictors, prevalence and detection. BMJ Open 3, e001772. doi:10.1136/bmjopen-2012-001772.CrossRefGoogle Scholar
Schubert, M, Schurch, R, Boettger, S, et al. (2018) A hospital-wide evaluation of delirium prevalence and outcomes in acute care patients – A cohort study. BMC Health Services Research 18, 550–3345.CrossRefGoogle ScholarPubMed
Schuurmans, MJ, Shortridge-Baggett, LM and Duursma, SA (2003) The delirium observation screening scale: A screening instrument for delirium. Research and Theory for Nursing Practice 17, 31–50.10.1891/rtnp.17.1.31.53169CrossRefGoogle ScholarPubMed
Siddiqi, N, House, AO and Holmes, JD (2006) Occurrence and outcome of delirium in medical in-patients: A systematic literature review. Age and Ageing 35, 350–364.10.1093/ageing/afl005CrossRefGoogle ScholarPubMed
Sommerlad, A, Perera, G, Singh-Manoux, A, et al. (2018) Accuracy of general hospital dementia diagnoses in England: Sensitivity, specificity, and predictors of diagnostic accuracy 2008–2016. Alzheimer's & Dementia 14, 933–943.CrossRefGoogle ScholarPubMed
Vandenbroucke, JP, von Elm, E, Altman, DG, et al. (2014) Strengthening the reporting of observational studies in epidemiology (STROBE): Explanation and elaboration. International Journal of Surgery 12, 1500–1524.10.1016/j.ijsu.2014.07.014CrossRefGoogle ScholarPubMed
Vasilevskis, EE, Han, JH, Hughes, CG, et al. (2012) Epidemiology and risk factors for delirium across hospital settings. Best Practice & Research, Clinical Anaesthesiology 26, 277–287.CrossRefGoogle ScholarPubMed
Supplementary material: File

Gehrke et al. supplementary material

Gehrke et al. supplementary material

Download Gehrke et al. supplementary material(File)
File 15.8 KB