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.

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Total Results: 2543

  • Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model. 2018 Zietlow, K. McDonald, S. R. Sloane, R. Browndyke, J. Lagoo-Deenadayalan, S. Heflin, M. T.. J Am Geriatr Soc,
    • Title

      Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model.

    • Authors
      Zietlow, K. McDonald, S. R. Sloane, R. Browndyke, J. Lagoo-Deenadayalan, S. Heflin, M. T.
    • Year
      2018
    • Journal
      J Am Geriatr Soc
    • URL
    • Abstract
      OBJECTIVES: To compare postoperative outcomes of individuals with and without cognitive impairment enrolled in the Perioperative Optimization of Senior Health (POSH) program at Duke University, a comanagement model involving surgery, anesthesia, and geriatrics. DESIGN: Retrospective analysis of individuals enrolled in a quality improvement program. SETTING: Tertiary academic center. PARTICIPANTS: Older adults undergoing surgery and referred to POSH (N = 157). MEASUREMENTS: Cognitive impairment was defined as a score less than 25 out of 30 (adjusted for education) on the St. Louis University Mental Status (SLUMS) Examination. Median length of stay (LOS), mean number of postoperative complications, rates of postoperative delirium (POD, %), 30-day readmissions (%), and discharge to home (%) were compared using bivariate analysis. RESULTS: Seventy percent of participants met criteria for cognitive impairment (mean SLUMS score 20.3 for those with cognitive impairment and 27.7 for those without). Participants with and without cognitive impairment did not significantly differ in demographic characteristics, number of medications (including anticholinergics and benzodiazepines), or burden of comorbidities. Participants with and without cognitive impairment had similar LOS (P = .99), cumulative number of complications (P = .70), and 30-day readmission (P = .20). POD was more common in those with cognitive impairment (31% vs 24%), but the difference was not significant (P = .34). Participants without cognitive impairment had higher rates of discharge to home (80.4% vs 65.1%, P = .05). CONCLUSION: Older adults with and without cognitive impairment referred to the POSH program fared similarly on most postoperative outcomes. Individuals with cognitive impairment may benefit from perioperative geriatric comanagement. Questions remain regarding the validity of available measures of cognition in the preoperative period.
    • PubMed ID
  • Identifying Older Adults at Risk of Delirium Following Elective Surgery: A Systematic Review and Meta-Analysis. 2018 Watt, J. Tricco, A. C. Talbot-Hamon, C. Pham, B. Rios, P. Grudniewicz, A. Wong, C. Sinclair, D. Straus, S. E.. J Gen Intern Med,
    • Title

      Identifying Older Adults at Risk of Delirium Following Elective Surgery: A Systematic Review and Meta-Analysis.

    • Authors
      Watt, J. Tricco, A. C. Talbot-Hamon, C. Pham, B. Rios, P. Grudniewicz, A. Wong, C. Sinclair, D. Straus, S. E.
    • Year
      2018
    • Journal
      J Gen Intern Med
    • URL
    • Abstract
      BACKGROUND: Postoperative delirium is a common preventable complication experienced by older adults undergoing elective surgery. In this systematic review and meta-analysis, we identified prognostic factors associated with the risk of postoperative delirium among older adults undergoing elective surgery. METHODS: Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and AgeLine were searched for articles published between inception and April 21, 2016. A total of 5692 titles and abstracts were screened in duplicate for possible inclusion. Studies using any method for diagnosing delirium were eligible. Two reviewers independently completed all data extraction and quality assessments using the Cochrane Risk-of-Bias Tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for cohort studies. Random effects meta-analysis models were used to derive pooled effect estimates. RESULTS: Forty-one studies (9384 patients) reported delirium-related prognostic factors. Among our included studies, the pooled incidence of postoperative delirium was 18.4% (95% confidence interval [CI] 14.3-23.3%, number needed to follow [NNF] = 6). Geriatric syndromes were important predictors of delirium, namely history of delirium (odds ratio [OR] 6.4, 95% CI 2.2-17.9), frailty (OR 4.1, 95% CI 1.4-11.7), cognitive impairment (OR 2.7, 95% CI 1.9-3.8), impairment in activities of daily living (ADLs; OR 2.1, 95% CI 1.6-2.6), and impairment in instrumental activities of daily living (IADLs; OR 1.9, 95% CI 1.3-2.8). Potentially modifiable prognostic factors such as psychotropic medication use (OR 2.3, 95% CI 1.4-3.6) and smoking status (OR 1.8 95% CI 1.3-2.4) were also identified. Caregiver support was associated with lower odds of postoperative delirium (OR 0.69, 95% CI 0.52-0.91). DISCUSSION: Though caution must be used in interpreting meta-analyses of non-randomized studies due to the potential influence of unmeasured confounding, we identified potentially modifiable prognostic factors including frailty and psychotropic medication use that should be targeted to optimize care.
    • PubMed ID
  • Sedative Plasma Concentrations and Delirium Risk in Critical Illness. 2018 Stollings, J. L. Thompson, J. L. Ferrell, B. A. Scheinin, M. Wilkinson, G. R. Hughes, C. G. Shintani, A. K. Ely, E. W. Girard, T. D. Pandharipande, P. P. Patel, M. B.. Ann Pharmacother,
    • Title

      Sedative Plasma Concentrations and Delirium Risk in Critical Illness.

    • Authors
      Stollings, J. L. Thompson, J. L. Ferrell, B. A. Scheinin, M. Wilkinson, G. R. Hughes, C. G. Shintani, A. K. Ely, E. W. Girard, T. D. Pandharipande, P. P. Patel, M. B.
    • Year
      2018
    • Journal
      Ann Pharmacother
    • URL
    • Abstract
      BACKGROUND: The relationship between plasma concentration of sedatives and delirium is unknown. OBJECTIVE: We hypothesized that higher plasma concentrations of lorazepam are associated with increased delirium risk, whereas higher plasma concentrations of dexmedetomidine are associated with reduced delirium risk. METHODS: This prospective cohort study was embedded in a double-blind randomized clinical trial, where ventilated patients received infusions of lorazepam and dexmedetomidine. Plasma concentrations of these drugs and delirium assessments were measured at least daily. A multivariable logistic regression model accounting for repeated measures was used to analyze associations between same-day plasma concentrations of lorazepam and dexmedetomidine (exposures) and the likelihood of next-day delirium (outcome), adjusting for same-day mental status (delirium, coma, or normal) and same-day fentanyl doses. RESULTS: This critically ill cohort (n = 103) had a median age of 60 years (IQR: 48-66) with APACHE II score of 28 (interquartile range [IQR] = 24-32), where randomization resulted in assignment to lorazepam (n = 51) or dexmedetomidine (n = 52). After adjusting for same-day fentanyl dose and mental status, higher plasma concentrations of lorazepam were associated with increased probability of next-day delirium (comparing 500 vs 0 ng/mL; odds ratio [OR] = 13.2; 95% CI = 1.4-120.1; P = 0.02). Plasma concentrations of dexmedetomidine were not associated with next-day delirium (comparing 1 vs 0 ng/mL; OR = 1.1; 95% CI = 0.9-1.3; P = 0.45). CONCLUSIONS: In critically ill patients, higher lorazepam plasma concentrations were associated with delirium, whereas dexmedetomidine plasma concentrations were not. This implies that the reduced delirium risk seen in patients sedated with dexmedetomidine may be a result of avoidance of benzodiazepines, rather than a dose-dependent protective effect of dexmedetomidine.
    • PubMed ID
  • A feasibility study of a randomised controlled trial to examine the impact of the ABCDE bundle on quality of life in ICU survivors. 2018 Sosnowski, K. Mitchell, M. L. White, H. Morrison, L. Sutton, J. Sharratt, J. Lin, F.. Pilot Feasibility Stud, (32)
    • Title

      A feasibility study of a randomised controlled trial to examine the impact of the ABCDE bundle on quality of life in ICU survivors.

    • Authors
      Sosnowski, K. Mitchell, M. L. White, H. Morrison, L. Sutton, J. Sharratt, J. Lin, F.
    • Year
      2018
    • Journal
      Pilot Feasibility Stud
    • URL
    • Abstract
      Background: Early rehabilitation has been found to prevent delirium and weakness that can hamper the recovery of intensive care unit (ICU) survivors. Integrated clinical practice guidelines for managing patient pain, agitation and delirium (PAD) have been developed. The Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility (ABCDE) bundle provides a strategy to implement PAD guidelines into everyday clinical practice. However, there is limited evidence on the effectiveness of the ABCDE bundle in the literature.The purpose of this study was to evaluate the feasibility of conducting a full-scale randomised controlled trial comparing the ABCDE bundle to standard care in an ICU. Trial feasibility was defined as the successful recruitment and retention of trial participants, adherence to the intervention, identification of barriers to the intervention, and the rigorous collection of outcome data. Methods: A prospective, single-centre, randomised controlled feasibility study was conducted. Thirty adult mechanically ventilated participants were recruited from an eight-bed ICU in south east Queensland, Australia, between April 2015 and December 2015. Participants were randomised to receive either the ABCDE bundle or standard routine management. The ABCDE bundle integrated prescribed awakening and breathing trials, delirium monitoring and management, and prescribed exercise and mobility regimes. Feasibility outcomes measured included recruitment and retention rates, intervention fidelity, and the feasibility of participant outcome data collection. Outcome measurement assessors were blinded to participant assignment. It was not possible to blind the research team or the participant to group assignment. Results: In total, 30 (81.1%) of 37 eligible participants consented and were randomised to the intervention group (n = 15) or the control group (n = 15). Of these, 23 (76.6%) participants successfully completed the 90-day post discharge assessment. A lengthy recruitment period of 8 months was related to overly stringent inclusion and exclusion criteria. Intervention adherence exceeded defined success rates with participation in awakening and breathing trials, delirium monitoring and exercise interventions performed on 80.2, 97.4 and 90.2% of ventilated days respectively. Outcome assessments were successfully and accurately performed at ICU and hospital discharge and 90-day post hospital discharge. Intervention participants were deemed to be delirious on 39.6% of mechanically ventilated days indicating a requirement for a scripted regime to prevent delirium. Conclusions: With minor adjustment of inclusion and exclusion criteria, the inclusion of delirium management protocols, and encouragement of family engagement and involvement, a large-scale definitive randomised controlled trial to test the impact of the ABCDEF bundle will be feasible. Trial registration: Australian New Zealand Clinical Trials Registry 12614000763640 Date registered 17/08/2014.
    • PubMed ID
  • Potentially Modifiable Risk Factors for Long-Term Cognitive Impairment After Critical Illness: A Systematic Review. 2018 Sakusic, A. O'Horo, J. C. Dziadzko, M. Volha, D. Ali, R. Singh, T. D. Kashyap, R. Farrell, A. M. Fryer, J. D. Petersen, R. Gajic, O. Rabinstein, A. A.. Mayo Clin Proc, 93:1 (68-82)
    • Title

      Potentially Modifiable Risk Factors for Long-Term Cognitive Impairment After Critical Illness: A Systematic Review.

    • Authors
      Sakusic, A. O'Horo, J. C. Dziadzko, M. Volha, D. Ali, R. Singh, T. D. Kashyap, R. Farrell, A. M. Fryer, J. D. Petersen, R. Gajic, O. Rabinstein, A. A.
    • Year
      2018
    • Journal
      Mayo Clin Proc
    • URL
    • Abstract
      Long-term cognitive impairment is common in survivors of critical illness. Little is known about the etiology of this serious complication. We sought to summarize current scientific knowledge about potentially modifiable risk factors during intensive care unit (ICU) treatment that may play a substantial role in the development of long-term cognitive impairment. All searches were run on October 1, 2017. The search strategy included Ovid MEDLINE, Ovid Embase, Ovid CDR, Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effect, Scopus, and Web of Science, and included MeSH headings and keywords related to intensive care, critical care, and cognitive disorders. Searches were restricted to adult subjects. Inclusion required follow-up cognitive evaluation at least 2 months after ICU discharge. Studies assessing patients with cardiac arrest, traumatic brain injury, and cardiac surgery history were excluded. The search strategy resulted in 3180 studies. Of these, 28 studies (.88%) met our inclusion criteria and were analyzed. Delirium and duration of delirium were associated with long-term cognitive impairment after ICU admission in 6 of 9 studies in which this factor was analyzed. Weaker and more inconsistent associations have been reported with hypoglycemia, hyperglycemia, fluctuations in serum glucose levels, and in-hospital acute stress symptoms. Instead, most of the studies did not find significant associations between long-term cognitive impairment and mechanical ventilation; use of sedatives, vasopressors, or analgesic medications; enteral feeding; hypoxia; extracorporeal membrane oxygenation; systolic blood pressure; pulse rate; or length of ICU stay. Prolonged delirium may be a risk factor for long-term cognitive impairment after critical illness, though this association has not been entirely consistent across studies. Other potentially preventable factors have not been shown to have strong or consistent associations with long-term cognitive dysfunction in survivors of critical illness.
    • PubMed ID
  • Prevalence of Potentially Inappropriate Medication Use in Older Inpatients with and without Cognitive Impairment: A Systematic Review. 2018 Redston, M. R. Hilmer, S. N. McLachlan, A. J. Clough, A. J. Gnjidic, D.. J Alzheimers Dis, 61:4 (1639-52)
    • Title

      Prevalence of Potentially Inappropriate Medication Use in Older Inpatients with and without Cognitive Impairment: A Systematic Review.

    • Authors
      Redston, M. R. Hilmer, S. N. McLachlan, A. J. Clough, A. J. Gnjidic, D.
    • Year
      2018
    • Journal
      J Alzheimers Dis
    • URL
    • Abstract
      BACKGROUND: Older people with cognitive impairment, including dementia and delirium, are high users of acute care services internationally. Potentially inappropriate medication (PIM) use may be associated with adverse outcomes, including hospital re-admission, functional disability, and mortality. OBJECTIVE: This systematic review aimed to quantify and compare the prevalence of PIMs in older inpatients with and without cognitive impairment. METHODS: A systematic search of observational studies was performed independently assessed by two reviewers in Embase, Medline, PsycINFO, International Pharmaceutical Abstracts, Scopus, and Informit. Articles published in English during the period January 2007-June 2017 that reported PIM prevalence in hospital inpatients >/= 65 years were included. PIMs were defined as the presence of polypharmacy (multiple medication use) and using implicit or explicit tools, such as the Beers criteria, and 'Screening Tool of Older Person's Prescriptions' (STOPP). RESULTS: 47 articles were included. In studies measuring polypharmacy (n = 15), the prevalence of PIMs ranged from 53.2% to 89.8% and 30.4% to 97.1% for inpatients with and without cognitive impairment, respectively, and 24.0% to 80.0% when cognitive status was unreported. In studies employing explicit and implicit tools (n = 35), the prevalence of PIMs when cognitive impairment was reported ranged from 20.6% to 80.5% using the Beers criteria, and 39.3% to 88.5% using STOPP. When cognitive status was unreported, the prevalence of PIMs ranged from 7.0% to 79.2% using the Beers criteria, and 20.0% to 63.4% using STOPP. CONCLUSION: Our findings suggest a high prevalence of PIMs in older inpatients with and without cognitive impairment. Future studies should investigate the impact of PIM use on patient-centered outcomes, such as functional status and quality of life, to inform enhanced acute care services.
    • PubMed ID
  • Identification of delirium and dementia in older medical inpatients in Tanzania: A comparison of screening and diagnostic methods. 2018 Paddick, S. M. Lewis, E. G. Duinmaijer, A. Banks, J. Urasa, S. Tucker, L. Kisoli, A. Cletus, J. Lissu, C. Kissima, J. Dotchin, C. Gray, W. K. Muaketova-Ladinska, E. Cosker, G. Walker, R. W.. Journal of the Neurological Sciences, (156-163)
    • Title

      Identification of delirium and dementia in older medical inpatients in Tanzania: A comparison of screening and diagnostic methods.

    • Authors
      Paddick, S. M. Lewis, E. G. Duinmaijer, A. Banks, J. Urasa, S. Tucker, L. Kisoli, A. Cletus, J. Lissu, C. Kissima, J. Dotchin, C. Gray, W. K. Muaketova-Ladinska, E. Cosker, G. Walker, R. W.
    • Year
      2018
    • Journal
      Journal of the Neurological Sciences
    • URL
    • Abstract
      Background In sub-Saharan Africa, there are no validated screening tools for delirium in older adults. This study assesses clinical utility of two instruments, the IDEA cognitive screen and the Confusion Assessment Method (CAM) for identification of delirium in older adults admitted to medical wards of a tertiary referral hospital in Tanzania. Method The IDEA cognitive screen and CAM were administered to a consecutive cohort of older individuals on admission to Kilimanjaro Christian Medical Centre using a blinded protocol. Consensus diagnosis for delirium was established against DSM-5 criteria and dementia by DSM-IV criteria. Results Of 507 admission assessments, 95 (18.7%) had DSM-5 delirium and 95 (18.7%) had DSM-IV dementia (33 (6.5%) delirium superimposed on dementia). The CAM and IDEA cognitive screen had very good diagnostic accuracy for delirium (AUROC curve 0.94 and 0.87 respectively). However, a number of participants (10.5% and 16.4% respectively) were unable to complete these screening assessments due to reduced consciousness, or other causes of reduced verbal response and were excluded from this analysis; many of whom met DSM-5 criteria for delirium. Secondary analysis suggests that selected cognitive and observational items from the CAM and IDEA cognitive screen may be as effective as the full screening tools in identifying delirium even in unresponsive patients. Conclusion Both instruments appeared useful for delirium screening in this inpatient setting, but had significant limitations. The combination of assessment items identified may form the basis of a brief, simple delirium screening tool suitable for use by non-specialist clinicians. Further development work is needed.
    • PubMed ID
  • Interactions between drugs and geriatric syndromes in nursing home and home care: results from Shelter and IBenC projects. 2018 Onder, G. Giovannini, S. Sganga, F. Manes-Gravina, E. Topinkova, E. Finne-Soveri, H. Garms-Homolova, V. Declercq, A. van der Roest, H. G. Jonsson, P. V. van Hout, H. Bernabei, R.. Aging Clinical and Experimental Research,
    • Title

      Interactions between drugs and geriatric syndromes in nursing home and home care: results from Shelter and IBenC projects.

    • Authors
      Onder, G. Giovannini, S. Sganga, F. Manes-Gravina, E. Topinkova, E. Finne-Soveri, H. Garms-Homolova, V. Declercq, A. van der Roest, H. G. Jonsson, P. V. van Hout, H. Bernabei, R.
    • Year
      2018
    • Journal
      Aging Clinical and Experimental Research
    • URL
    • Abstract
      AIM: Drugs may interact with geriatric syndromes by playing a role in the continuation, recurrence or worsening of these conditions. Aim of this study is to assess the prevalence of interactions between drugs and three common geriatric syndromes (delirium, falls and urinary incontinence) among older adults in nursing home and home care in Europe. METHODS: We performed a cross-sectional multicenter study among 4023 nursing home residents participating in the Services and Health for Elderly in Long-TERm care (Shelter) project and 1469 home care patients participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Exposure to interactions between drugs and geriatric syndromes was assessed by 2015 Beers criteria. RESULTS: 790/4023 (19.6%) residents in the Shelter Project and 179/1469 (12.2%) home care patients in the IBenC Project presented with one or more drug interactions with geriatric syndromes. In the Shelter project, 288/373 (77.2%) residents experiencing a fall, 429/659 (65.1%) presenting with delirium and 180/2765 (6.5%) with urinary incontinence were on one or more interacting drugs. In the IBenC project, 78/172 (45.3%) participants experiencing a fall, 80/182 (44.0%) presenting with delirium and 36/504 (7.1%) with urinary incontinence were on one or more interacting drugs. CONCLUSION: Drug-geriatric syndromes interactions are common in long-term care patients. Future studies and interventions aimed at improving pharmacological prescription in the long-term care setting should assess not only drug-drug and drug-disease interactions, but also interactions involving geriatric syndromes.
    • PubMed ID
  • Development of dementia in patients with femoral neck fracture who experience postoperative delirium-A three-year follow-up study. 2018 Olofsson, B. Persson, M. Bellelli, G. Morandi, A. Gustafson, Y. Stenvall, M.. Int J Geriatr Psychiatry,
    • Title

      Development of dementia in patients with femoral neck fracture who experience postoperative delirium-A three-year follow-up study.

    • Authors
      Olofsson, B. Persson, M. Bellelli, G. Morandi, A. Gustafson, Y. Stenvall, M.
    • Year
      2018
    • Journal
      Int J Geriatr Psychiatry
    • URL
    • Abstract
      OBJECTIVES: It remains unclear to what extent postoperative delirium (POD) affects the incidence of dementia in hip fracture patients, and the methods used to detect delirium and dementia require validation. The aim of this study was to investigate the development of dementia within 3 years of femoral neck fracture repair surgery, with a focus on POD as a potential predictive factor. METHODS: Patients were assessed for cognition, delirium, depression, psychological well-being, and nutritional status during their hospitalization as well as 4, 12, and 36 months after the operation. Logistic regression models were used to analyse factors associated with POD and factors associated with the development of dementia. RESULTS: The study sample consisted of 135 patients without a history of dementia, of whom 20 (14.8%) were delirious preoperatively and 75 (55.5%) postoperatively. Three years after their operations, 43/135 patients (31.8%) were diagnosed with dementia. A greater portion of patients diagnosed with dementia (39/43, 90.6%) than patients with no dementia (36/92, 39.1%) were included among the 75 patients who had experienced POD (P < 0.001). In a logistic regression model, after adjustment for covariates (age, sex, diabetes, delirium pre-and postoperatively, hyperactive delirium, days with delirium, urinary tract infection, and Mini Nutritional Assessment score), POD emerged an independent predictor for the development of new dementia (odds ratio, 15.6; 95% confidence interval, 2.6-91.6) within 3 years after the operation. CONCLUSION: Geriatric hip fracture patients who exhibit POD should be monitored closely for the development of dementia.
    • PubMed ID
  • Prediction and early detection of delirium in the intensive care unit by using heart rate variability and machine learning. 2018 Oh, J. Cho, D. Park, J. Na, S. H. Kim, J. Heo, J. Shin, C. S. Kim, J. J. Park, J. Y. Lee, B.. Physiol Meas,
    • Title

      Prediction and early detection of delirium in the intensive care unit by using heart rate variability and machine learning.

    • Authors
      Oh, J. Cho, D. Park, J. Na, S. H. Kim, J. Heo, J. Shin, C. S. Kim, J. J. Park, J. Y. Lee, B.
    • Year
      2018
    • Journal
      Physiol Meas
    • URL
    • Abstract
      OBJECTIVE: Delirium is an important syndrome in intensive care unit (ICU), however, it is usually under-recognized during the treatment. This study was performed to investigate whether the delirious patients can be successfully distinguished from the non-delirious patients by using heart rate variability (HRV) and machine learning.Approach: Electrocardiography (ECG) data of 140 patients was acquired during daily ICU care, and HRV were analyzed. Delirium, including its type, severity, and etiologies, was evaluated daily by trained psychiatrists. HRV data and various machine learning algorithms including linear support vector machine (SVM), SVM with radial basis function (RBF) kernels, linear extreme learning machine (ELM), ELM with RBF kernels, linear discriminant analysis, and quadratic discriminant analysis were utilized to distinguish delirium from non-delirium patients. Main results: HRV data of 4,797 ECGs were included, and 39 patients had delirium at least once during their ICU stay. The maximum classification accuracy was acquired using SVM with RBF kernels. Our prediction method based on HRV with machine learning was comparable to previous delirium prediction models using massive amounts of clinical information. Significance: Our results showed that autonomic alterations could be a significant feature of patients with delirium in the ICU, suggesting the potential for the automatic prediction and early detection of delirium based on HRV with machine learning.
    • PubMed ID
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