Hostname: page-component-6766d58669-7fx5l Total loading time: 0 Render date: 2026-05-17T20:25:17.626Z Has data issue: false hasContentIssue false
  • English
  • Français

Core symptoms not meeting criteria for delirium are associated with cognitive and functional impairment and mood and behavior problems in older long-term care residents

Published online by Cambridge University Press:  13 March 2014

Martin G. Cole ,
Jane McCusker ,
Philippe Voyer ,
Johanne Monette ,
Nathalie Champoux ,
Antonio Ciampi ,
Eric Belzile  and
Minh Vu
Martin G. Cole*
Affiliation:
Department of Psychiatry, St. Mary's Hospital Center & McGill University, Montreal, Quebec, Canada St. Mary's Research Centre, St Mary's Hospital Center, Montreal, Quebec, Canada
Jane McCusker
Affiliation:
St. Mary's Research Centre, St Mary's Hospital Center, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
Philippe Voyer
Affiliation:
Faculty of Nursing Sciences, Laval University, Quebec, Quebec, Canada
Johanne Monette
Affiliation:
Division of Geriatric Medicine, Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec, Canada Donald Berman Maimonides Geriatric Center, Montreal, Quebec, Canada
Nathalie Champoux
Affiliation:
Institut Universitaire de Gériatrie de Montréal; Département de médecine familiale, Université de Montréal, Montreal, Quebec, Canada
Antonio Ciampi
Affiliation:
St. Mary's Research Centre, St Mary's Hospital Center, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
Eric Belzile
Affiliation:
St. Mary's Research Centre, St Mary's Hospital Center, Montreal, Quebec, Canada
Minh Vu
Affiliation:
Division of Geriatric Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
*
Correspondence should be addressed to: Dr. Martin G. Cole, Department of Psychiatry, St. Mary's Hospital Center, 3830 Avenue Lacombe, Montreal, Quebec H3T 1M5, Canada. Phone: +514-345-3511; ext. 3839; Fax: +514-734-2652. Email: martin.cole@ssss.gouv.qc.ca.
Get access

Abstract

Background:

The immediate clinical significance of Confusion Assessment Method (CAM)-defined core symptoms of delirium not meeting criteria for delirium is unclear. This study proposed to determine if such symptoms are associated with cognitive and functional impairment, mood and behavior problems and increased Burden of Care (BOC) in older long-term care (LTC) residents.

Methods:

The study was a secondary analysis of data collected for a prospective cohort study of delirium. Two hundred and fifty-eight LTC residents aged 65 years and older in seven LTC facilities had monthly assessments (for up to six months) of CAM – defined core symptoms of delirium (fluctuation, inattention, disorganized thinking, and altered level of consciousness) and five outcome measures: Mini-Mental State Exam, Barthel Index, Cornell Scale for Depression, Nursing Home Behavioral Problems Scale, and Burden of Care. Associations between core symptoms and the five outcome measures were analyzed using generalized estimating equations.

Results:

Core symptoms of delirium not meeting criteria for delirium among residents with and without dementia were associated with cognitive and functional impairment and mood and behavior problems but not increased BOC. The associations appear to be intermediate between those of full delirium and no core symptoms and were greater for residents with than without dementia.

Conclusion:

CAM-defined core symptoms of delirium not meeting criteria for delirium appear to be associated with cognitive and functional impairment and mood and behavior problems in LTC residents with or without dementia. These findings may have implications for the prevention and management of such impairments and problems in LTC settings.

Keywords

core symptoms of deliriumsubsyndromal deliriumcognitionfunctionmoodbehavior

Information

Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 7 , July 2014 , pp. 1181 - 1189
Copyright
Copyright © International Psychogeriatric Association 2014 

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.)

Article purchase

Temporarily unavailable

References

Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell Scale for depression in dementia. Biological Psychiatry, 23, 271–284.Google Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th Text Revision DSM-IV-TR). Washington, DC: American Psychiatric Publishing, Inc.Google Scholar
Charlson, M. E., Pompei, P., Ales, K. L. and MacKenzie, R. C. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40, 373–383.CrossRefGoogle ScholarPubMed
Cole, M. G., McCusker, J., Dendukuri, N. and Han, L. (2002). Symptoms of delirium among elderly medical inpatients with or without dementia. Journal of Neuropsychiatry and Clinical Neurosciences, 14, 167–175.Google Scholar
Cole, M. G. et al. (2011). Subsyndromal delirium in older long-term care residents: incidence, risk factors, and outcomes. Journal of the American Geriatrics Society, 59, 1829–1836.Google Scholar
Cole, M. G. et al. (2012). Symptoms of delirium occurring before and after episodes of delirium in older long-term care residents. Journal of the American Geriatrics Society, 60, 2302–2307.CrossRefGoogle ScholarPubMed
Cole, M. G. et al. (2013). Symptoms of delirium predict incident delirium in older long-term care residents. International Psychogeriatrics, 25, 887–894.Google Scholar
Fitzmaurice, G. M., Laird, N. M. and Ware, J. H. (2004). Applied Longitudinal Analysis. Hoboken, NJ: John Wiley & Sons Inc.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Fries, B. E., Mehr, D. R., Schneider, D., Foley, W. J. and Burke, R. (1993). Mental dysfunction and resource use in nursing homes. Medical Care, 31, 898–920.CrossRefGoogle ScholarPubMed
Inouye, S. K. et al. (1990). Clarifying confusion: the Confusion Assessment Method, a new method for detection of delirium. Annals of Internal Medicine, 113, 941–948.CrossRefGoogle Scholar
Kiely, D. K. et al. (2003). Delirium among newly admitted postacute facility patients: prevalence, symptoms, and severity. The Journals of Gerontology Series A, Biological Sciences and Medical Sciences, 58, M441–M445.CrossRefGoogle ScholarPubMed
Korner, A. et al. (2006). The geriatric depression scale and the cornell scale for depression in dementia. A validity study. Nordic Journal of Psychiatry, 60, 360–364.CrossRefGoogle ScholarPubMed
Landreville, P., Voyer, P. and Carmichael, P. H. (2013). Relationship between delirium and behavioral symptoms of dementia. International Psychogeriatrics, 25, 635–643.Google Scholar
Mahoney, F. I. and Barthel, D. W. (1965). Functional evaluation: the Barthel index. Maryland State Medical Journal, 14, 61–65.Google ScholarPubMed
McCusker, J., Cole, M. G., Dendukuri, N. and Belzile, E. (2004). The delirium Index: a measure of the severity of delirium: new findings on reliability, validity and responsiveness. Journal of the American Geriatrics Society, 52, 1744–1749.Google Scholar
McCusker, J. et al. (2011a). Prevalence and incidence of delirium in long-term care. International Journal of Geriatric Psychiatry, 26, 1152–1161.Google Scholar
McCusker, J. et al. (2011b). Use of nurse-observed symptoms of delirium in long-term care: effects on prevalence and outcomes of delirium. International Psychogeriatrics, 23, 602–608.Google Scholar
McCusker, J. et al. (2013). Environmental factors predict the severity of delirium symptoms in long-term care residents with and without delirium. Journal of the American Geriatrics Society, 61, 502–511.Google Scholar
Meagher, D. J. et al. (2010). A comparison of neuropsychiatric and cognitive profiles in delirium, dementia, comorbid delirium–dementia and cognitively intact controls. Journal of Neurology, Neurosurgery, and Psychiatry, 81, 876–881.Google Scholar
Pan, W. (2001). Akaike's information criterion in generalized estimating equations. Biometrics, 57, 120–125.CrossRefGoogle ScholarPubMed
Pitkala, K. H., Laurila, J. V., Strandberg, T. E. and Tilvis, R. S. (2005). Prognostic significance of delirium in frail older people. Dementia and Geriatric Cognitive Disorders, 19, 158–163.Google Scholar
Ray, W. A., Taylor, J. A., Lichtenstein, M. J. and Meador, K. G. (1992). The Nursing Home Behavior Problem Scale. Journal of Gerontology, 47, M9–16.CrossRefGoogle ScholarPubMed
Rovner, B. W., German, P. S., Broadhead, J., Morriss, R. K. and Brant, L. J. (1990). The prevalence and management of dementia and other psychiatric disorders in nursing homes. International Psychogeriatrics, 2, 13–24.Google Scholar
Sandberg, O., Gustafson, Y., Brannstrom, B. and Bucht, G. (1998). Prevalence of dementia, delirium and psychiatric symptoms in various care settings for the elderly. Scandinavian Journal of Social Medicine, 26, 56–62.CrossRefGoogle ScholarPubMed
Shah, S., Vanclay, F. and Cooper, B. (1989). Improving the sensitivity of the Barthel Index for stroke rehabilitation. Journal of Clinical Epidemiology, 42, 703–709.Google Scholar
Sourial, R., McCusker, J., Cole, M. G. and Abrahamowicz, M. (2001). Agitation in demented patients in an acute care hospital: Prevalence, disruptiveness and staff burden. International Psychogeriatrics, 13, 183–197.Google Scholar
Voyer, P., Richard, S., Doucet, L. and Carmichael, P. (2009). Detecting delirium and subsyndromal delirium using different diagnostic criteria among demented long-term care residents. Journal of the American Medical Directors Association, 10, 181–188.Google Scholar
Zarit, S. H., Reever, K. E. and Bach-Peterson, J. (1980). Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist, 20, 649–655.Google Scholar
Zuidema, S. U., Derksen, E., Verhey, F. R. and Koopmans, R. T. (2007). Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry, 22, 632–638.CrossRefGoogle Scholar