Delirium Bibliography

The searchable delirium bibliography page is one of our most popular features, allowing you to quickly gain access to the literature on delirium and acute care of older persons.  The HELP team keeps it updated for you on a monthly basis!  Feel free to search by author, title, keywords. It is primarily intended for clinicians and researchers interested in exploring these topics.

Each article is indexed by keywords taken from MEDLINE and other relevant databases.

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Please note that Pub Med Central (PMC) full text links are provided wherever available.  However, due to copyright restrictions, only abstracts can be provided for articles not available in PMC.

Total Results: 2035

  • Incidence, risk factors and outcomes of delirium in intensive care unit of universiti kebangsaan malaysia medical centre 2016 Vyveganathan, L., Izaham, A., Mohamad Yusof, A., Wan Mat, W. R., Abdul Rahman, R., Abdul Manap, N.. Anesthesia and Analgesia, 123:3 (157)
    • Title

      Incidence, risk factors and outcomes of delirium in intensive care unit of universiti kebangsaan malaysia medical centre

    • Authors
      Vyveganathan, L., Izaham, A., Mohamad Yusof, A., Wan Mat, W. R., Abdul Rahman, R., Abdul Manap, N.
    • Year
      2016
    • Journal
      Anesthesia and Analgesia
    • URL
    • Abstract
      Background & Objectives: Delirium is often seen among patients managed in intensive care units (ICUs) and this may cause added morbidity and mortality. The present study determined the incidence, risk factors and outcomes of delirium in the ICU of Universiti Kebangsaan Malaysia Medical Centre. Materials & Methods: This prospective cross sectional observational study was conducted over three months duration. Patients 18 years and above admitted for more than 24 hours in general ICU were recruited. Confusion Assessment Method (CAM-ICU) was done daily to assess delirium, if the patient had sedation score of above Richmond Agitation and Sedation Scale (RASS) -3. They were followed up till discharged. Environmental, predisposing and precipitating factors to delirium were collected. The outcomes of delirium measured were length of mechanical ventilation and ICU stay. Results: The overall incidence of delirium was 42%. Among patients who had delirium, 68% were hypoactive, 25% mixed and 7% were hyperactive in type. The significant predisposing risk factors for developing delirium were increasing with older age, higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, visual or hearing impairment, smoking, renal impairment, diabetes and hypertension. The factors precipitating delirium were sepsis, use of vasopressors, renal replacement therapies and Acute Respiratory Distress Syndrome (ARDS). The presence of catheters, higher Sequential Organ Failure Assessment (SOFA) scores, and abnormal urea and bilirubin levels further significantly increased risk of delirium. Environmental conditions increasing the risk of delirium were absence of daylight exposure, no visible clocks and use of physical restraints. Length of mechanical ventilation and ICU stay were significantly prolonged in patients with delirium. Conclusion: Recognising predisposing factors and optimising the modifiable risk factors of delirium is important as it significantly prolongs mechanical ventilation and ICU stay.
    • PubMed ID
  • Influence of acute delirium on short-term prognosis in elderly acute decompensated heart failure patients 2016 Tagahara, K., Azioka, M., Nakashima, Y., Osanai, H., Inoue, Y., Kanbara, T., Yoshida, T., Masutomi, T., Ohashi, H., Tobe, A.. Journal of Cardiac Failure, 22:9 (S229-S230)
    • Title

      Influence of acute delirium on short-term prognosis in elderly acute decompensated heart failure patients

    • Authors
      Tagahara, K., Azioka, M., Nakashima, Y., Osanai, H., Inoue, Y., Kanbara, T., Yoshida, T., Masutomi, T., Ohashi, H., Tobe, A.
    • Year
      2016
    • Journal
      Journal of Cardiac Failure
    • URL
    • Abstract
      Background: Acute decompensated heart failure (ADHF) is one of direct causes of acute delirium especially in elderly patients, and ADHF patients tend to be acute delirium because of required rest in bed and environmental changes. It was shown acute delirium associate with adverse in-hospital outcomes and subsequent increased institutionalization in patients with acute illness and acute delirium was common and predicted motility in non-intubated cardiac patients. We investigate influence of acute delirium on short-term prognosis in elderly ADHF patients. Methods: We analyzed 209 consecutive patients who were over 65 and urgently admitted due to ADHF in our hospital from April 2015 through March 2016, and we investigated retrospectively patient background, therapeutic procedure, and outcome. We diagnosed acute delirium based on the Confusion Assessment Method. Result: Of 209 patients, survival discharge was 191 patients (91.4%), and 30 days-survival was 183 patients (87.6%). Acute delirium was 48 patients (23.0%), and delirious patients had an decreased survival discharge (n = 40, 83.3% vs 93.8%, P = .0367) and 30 days-survival (n = 36, 75% vs 91.3%, P = .0052) compared to non-delirious patients. Conclusion: In elderly ADHF patients with acute delirium survival discharge and 30 days-survival was decreased compared to non-delirious patients. In elderly society delirium come to be more common and we need to pay attention to care patients.
    • PubMed ID
  • Implementing a delirium prevention programme can reduce falls in hospital geriatric medicine wards 2016 Solomonsz, A., Charalambous, L., Taylor, R., Blackshaw, E., Ali, A., Morris, R., Moorchilot, R., Poon, M., Blundell, A., Harwood, R., Masud, T.. European Geriatric Medicine, (S107)
    • Title

      Implementing a delirium prevention programme can reduce falls in hospital geriatric medicine wards

    • Authors
      Solomonsz, A., Charalambous, L., Taylor, R., Blackshaw, E., Ali, A., Morris, R., Moorchilot, R., Poon, M., Blundell, A., Harwood, R., Masud, T.
    • Year
      2016
    • Journal
      European Geriatric Medicine
    • URL
    • Abstract
      Background: Delirium is a common problem in older hospital inpatients and is associated with morbidity including an increased risk of falls. The aim of this analysis was to determine if implementing a delirium prevention service improvement intervention reduced falls in geriatric medicine wards. Methods: A delirium prevention package was implemented over a three month period on two 28 bedded female geriatric wards at a large teaching hospital. The intervention included specialised training for staff on assessment and management of cognitive impairment, mobility, pain, nutrition, sensory impairment, sleep disturbance, medications, dehydration, hypoxia and infection in addition to developing new ward systems to increase delirium awareness. The established hospital adverse incident reporting system (Datix) was used to compare the falls per month in the six month periods before and after implementing the intervention. Results: The mean fall rate before the intervention was 4.9/month (95%CI = 4.5-5.7) which fell to 2.5/month (95%CI = 1.5-3.4), the mean difference being 2.4/month (95%CI = 1.2-3.7) [p = 0.001]. There was no significant change in mean length of stay with the intervention [pre-intervention 13.3 days (95%CI = 12.4-14.1) vs post-intervention 14.8 days (95%CI = 13.5-16.0), NS]. Conclusion: Delirium and falls share many of the same risk factors and the former is an independent risk factor for the latter. These data show that better prevention and earlier diagnosis and treatment for delirium reduced falls by almost a half in geriatric medicine wards, although length of stay was not changed.
    • PubMed ID
  • Emergence delirium in adult patients after general anaesthesia-a prospective study from the caribbean 2016 Ramroop, R., Hariharan, S., Chen, D.. Anesthesia and Analgesia, 123:3 (507)
    • Title

      Emergence delirium in adult patients after general anaesthesia-a prospective study from the caribbean

    • Authors
      Ramroop, R., Hariharan, S., Chen, D.
    • Year
      2016
    • Journal
      Anesthesia and Analgesia
    • URL
    • Abstract
      Background & Objectives: Emergence Delirium (ED) is a relatively common phenomenon in the post-anaesthesia care unit (PACU) in patients after General Anaesthesia. This study sought to determine the incidence and risk factors of ED in adult patients in a Caribbean teaching hospital. Materials & Methods: A prospective observational study was conducted in patients with no existing neurological or psychiatric conditions undergoing general anaesthesia for non-neurological procedures. Demographic data recorded were age, gender and ethnicity, drug and alcohol use. Clinical data including type of airway used, number of attempts at endotracheal intubation, volatile agent used, use of nitrous oxide, total morphine and neuromuscular blocking agent dosage, hypotension, use of atropine and the length of surgery were recorded. The intensity of the ED in the PACU was recorded using a Nurses Delirium Screening Scale. Results: 417 patients were enrolled. Mean age of the patients was 48.3 years, mean surgical duration was 102.7 min. The overall observed incidence of ED in our setting was 11.8%. The factors significantly associated with ED were African ethnicity (p = 0.011), emergency surgery (p = 0.04), length of surgery (p = 0.007) and number of intubation attempts (p = 0.001). None of the other perioperative factors were significantly associated with ED. Conclusion: The incidence of ED in a Caribbean setting is comparable to other regions. The modifiable risk factors associated with the occurrence of ED in our setting may be addressed to further reduce the incidence of ED.
    • PubMed ID
  • Optimized anesthesia to reduce incidence of postoperative delirium in elderly undergoing elective, non-cardiac surgery: A randomized controlled trial 2016 Punjasawadwong, Y., Pipanmekaporn, T., Wongpakaran, N.. Anesthesia and Analgesia, 123:3 (211)
    • Title

      Optimized anesthesia to reduce incidence of postoperative delirium in elderly undergoing elective, non-cardiac surgery: A randomized controlled trial

    • Authors
      Punjasawadwong, Y., Pipanmekaporn, T., Wongpakaran, N.
    • Year
      2016
    • Journal
      Anesthesia and Analgesia
    • URL
    • Abstract
      Background & Objectives: Delirium is one of common post operative complications, particularly in the elderly surgical patients, which can affect the postoperative outcomes. The study was conducted to determine the effect of BIS-guided anesthesia on the incidence of postoperative delirium compared with the standard general anesthesia without BIS monitoring. Materials & Methods: After approval of the ethic committee, Faculty of Medicine, Chiang Mai patients aged 65 years or scheduled for non-cardiac surgery under general anesthesia. The control group (n=70) received standard general anesthesia without bispectral index monitoring. The study group (n=70) received general anesthesia guided by bispectral index (BIS) between 40 and 60. BIS monitoring was blinded in the control group. Delirium was assessed using Confusing Assessment Method for the ICU (CAM-ICU) and Confusing Assessment Method (CAM) by trained research assistants, who were blinded to the allocated groups at baseline, 2 hours, 24, 48, and 72 hours after the surgery. Unpaired-t test and chi-square test were analyzed as appropriate. p <0.05 was considered statistically significant. Results: All patients were extubated at the end of the operation and completed the study. Baseline characteristics of patients in both groups were comparable. Patients in control group had higher incidence of delirium compared to those in BIS group (2.9% versus 1.4%) but did not reach the statistically significant level at p = 0.05. Time to BIS values < 40 in control group was significantly longer than those in BIS group 5 (0-10) minutes versus 10 (2-60) minutes, p value = 0.007). Conclusion: Despite lower incidence of postoperative delirium in the BIS group compared with the control group, this study failed to demonstrate the statistical significance difference at p=0.05. This may be due to the low incidence of postoperative incidence of delirium in our setting. Further large study is required to determine the impact of BIS-guided anesthesia on the incidence of postoperative delirium in surgical patients with high risk of POD.
    • PubMed ID
  • Evaluation of the idea (identification and interventions for dementia in elderly Africans) brief cognitive screening tool for identification of delirium in older hospitalised adults in Tanzania 2016 Paddick, S. M., Lewis, E. G., Duinmaijer, A. T., Banks, J., Urasa, S., Tucker, L., Kisoli, A., Cletus, J., Lissu, C., Kisima, J., Dotchin, C., Gray, W. K., Mushi, D., Walker, R.. Alzheimer's and Dementia, 12:7 (P364-P365)
    • Title

      Evaluation of the idea (identification and interventions for dementia in elderly Africans) brief cognitive screening tool for identification of delirium in older hospitalised adults in Tanzania

    • Authors
      Paddick, S. M., Lewis, E. G., Duinmaijer, A. T., Banks, J., Urasa, S., Tucker, L., Kisoli, A., Cletus, J., Lissu, C., Kisima, J., Dotchin, C., Gray, W. K., Mushi, D., Walker, R.
    • Year
      2016
    • Journal
      Alzheimer's and Dementia
    • URL
    • Abstract
      Background: In sub-Saharan Africa, (SSA) there are no validated screening tools for delirium in older adults, despite the known vulnerability of this group to delirium and the associated adverse outcomes. The IDEA brief cognitive assessment has previously been validated for dementia and major cognitive impairment in low literacy settings in Tanzania and Nigeria. This study aims to assess the effectiveness of this brief assessment in identification of delirium in older hospitalised adults when compared to a widely validated assessment for delirium diagnosis, the confusion assessment method (CAM). Methods: Consecutive individuals aged 60 and over were screened on admission to medical wards of a tertiary referral hospital in Northern Tanzania using the IDEA brief cognitive assessment. All participants were subsequently assessed by a research doctor using the CAM alongside bedside cognitive assessment, neurological examination and informant history, blinded to the outcome of the IDEA cognitive assessment. Delirium was defined as a positive CAM score. Dementia and other diagnoses were defined according to DSM-V criteria. Interim. Results: 456 individuals were assessed using the CAM, of whom, 39 were unable to complete the cognitive screen due to reduced consciousness level or physical illness and were excluded. Complete data were therefore available for 417 individuals (43% female) of whom 20% were illiterate. Prevalence of delirium on admission was 62/417 and of major cognitive impairment (dementia or delirium) 98/417. The AUROC for delirium was 0.876 (95% CI 0.833-0.920) and 0.876 (95% CI 0.836-0.917) for major cognitive impairment. Conclusions: Provisional results indicate that the IDEA brief cognitive assessment was effective in screening for delirium in this setting. Data collection is ongoing, with follow up and confirmation of dementia diagnoses due to be completed in May 2016. Further analysis on completion of the study and evaluation of the IDEA brief cognitive assessment against DSM-V diagnosis of delirium by a specialist are awaited.
    • PubMed ID
  • Effectiveness of Educational Enhancement for Clinicians Regarding Understanding and Applying Confusion Assessment Method in the ICU (CAM-ICU) 2016 Pandya, T., Hanna, M., Ghazarian, Z., Sekhon, R., Ismail, M.. CHEST, (222A)
    • Title

      Effectiveness of Educational Enhancement for Clinicians Regarding Understanding and Applying Confusion Assessment Method in the ICU (CAM-ICU)

    • Authors
      Pandya, T., Hanna, M., Ghazarian, Z., Sekhon, R., Ismail, M.
    • Year
      2016
    • Journal
      CHEST
    • URL
    • Abstract
    • PubMed ID
  • Impact of delirium on postoperative frailty and long term cardiovascular events after cardiac surgery 2016 Ogawa, M., Izawa, K., Kobayashi, S., Tsuboi, Y., Komaki, K., Gotake, Y., Tanaka, H., Hirata, K. I., Sakai, Y., Okita, Y.. Journal of Cardiac Failure, 22:9 (S190)
    • Title

      Impact of delirium on postoperative frailty and long term cardiovascular events after cardiac surgery

    • Authors
      Ogawa, M., Izawa, K., Kobayashi, S., Tsuboi, Y., Komaki, K., Gotake, Y., Tanaka, H., Hirata, K. I., Sakai, Y., Okita, Y.
    • Year
      2016
    • Journal
      Journal of Cardiac Failure
    • URL
    • Abstract
      Background: Postoperative delirium (POD) is a transient mental syndromes whose development is associated with high risk of mortality and long-term cognitive impairment. However, the contributing effect of POD to adverse long-term outcomes is unclear. This study aimed to assess the incidence of POD and its effect on clinical, functional, and long-term outcomes in patients who underwent cardiac surgery. Methods: We studied 233 consecutive patients who underwent cardiac surgery from December 2013 to June 2015. The assessment of delirium was conducted using the Intensive Care Delirium Screening Checklist. Postoperative functional decline was diagnosed with frailty criteria assessed by handgrip strength and gait speed. The primary composite endpoint was major adverse cardiac events (MACE) after cardiac surgery. Results: POD has developed in 37(15.9%) patients. The ratio of patients with frailty in the POD group was higher than that in the non-POD group (54.1% vs. 23.1%, P < .0001). After adjustment for potential cofounders, multivariate analysis showed the independent predictors of MACE to be POD (HR, 3.45; 95% CI, 1.62-6.90; P=.01) and postoperative frailty (HR, 3.40; 95% CI, 1.52-7.94; P=.004). Conclusion: POD appeared to be one trigger of the development of postoperative frailty. POD and postoperative frailty were strong predictors of MACE after cardiac surgery. Our results indicate that the risk stratification focused on POD is useful to predict outcomes of patients undergoing cardiac surgery.
    • PubMed ID
  • Improving the detection of delirium, depression and suspected dementia in community hospital settings 2016 North, C., Russell, G., Hayes, N.. European Geriatric Medicine, (S254)
    • Title

      Improving the detection of delirium, depression and suspected dementia in community hospital settings

    • Authors
      North, C., Russell, G., Hayes, N.
    • Year
      2016
    • Journal
      European Geriatric Medicine
    • URL
    • Abstract
      Introduction: Mental health disorders in older people are significant contributors to poor outcomes for hospital patients. Literature suggests hospital mental health liaison services must enable general hospital staff to better detect and manage the most common disorders. Methodology: This pilot study introduced a combined screening tool in community hospitals for delirium, depression and dementia (the 3Ds). Three PDSA improvement cycles across three community hospitals over 18 months implemented a 3Ds Triple Screen supported by formal teaching, supervised practice and clinical pathway guidance delivered by an older people's mental health liaison team. Mixed methodology included pre- and post-implementation questionnaires gathering nurses' perspectives on confidence, competence and knowledge around detection and management of the 3Ds. Quantitative analysis related to referral rates to the liaison service, usage of the Triple Screen, incidence rates for the 3Ds and uptake of appropriate clinical pathways. Results: Results indicate 50% reduction in referrals to the mental health liaison team, and incidence rates of delirium (22%), depression (59%) and dementia (32%) in keeping with UK national estimates for this population. 75% of nurses reported improved confidence in detection and management despite initial versions of the tool proving complex and burdensome. Informal feedback highlighted practice change towards more discussion with families to establish accurate clinical histories. Conclusions: These results justify wider roll-out of the pilot to other community hospitals and have precipitated tool re-design and process enhancements derived directly from nurses' feedback. Greater focus is required on data quality and quantity to enable improved analysis of the project effects.
    • PubMed ID
  • 127 Emergency Department Interventions and Their Effect on Delirium's Natural Course: The Folly May Be in the Foley 2016 Noel, C., Cirbus, K., Han, J.H.. Annals of Emergency Medicine, (S50)
    • Title

      127 Emergency Department Interventions and Their Effect on Delirium's Natural Course: The Folly May Be in the Foley

    • Authors
      Noel, C., Cirbus, K., Han, J.H.
    • Year
      2016
    • Journal
      Annals of Emergency Medicine
    • URL
    • Abstract
    • PubMed ID
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