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: 2543

  • Preoperative exercise capacity is associated with the prevalence of postoperative delirium in elective cardiac surgery. 2018 Ogawa, M. Izawa, K. P. Satomi-Kobayashi, S. Kitamura, A. Tsuboi, Y. Komaki, K. Ono, R. Sakai, Y. Tanaka, H. Okita, Y.. Aging Clinical and Experimental Research, 30:1 (27-34)
    • Title

      Preoperative exercise capacity is associated with the prevalence of postoperative delirium in elective cardiac surgery.

    • Authors
      Ogawa, M. Izawa, K. P. Satomi-Kobayashi, S. Kitamura, A. Tsuboi, Y. Komaki, K. Ono, R. Sakai, Y. Tanaka, H. Okita, Y.
    • Year
      2018
    • Journal
      Aging Clinical and Experimental Research
    • URL
    • Abstract
      BACKGROUND: Postoperative delirium (POD) is a critical complication that is closely associated with mortality and major morbidity in elective cardiac surgery. The identification of patients at risk for POD is crucial but has not been fully explored. AIMS: The aim of this study was to determine the predictive value of the assessment of preoperative exercise capacity for POD. METHODS: We enrolled 313 consecutive patients (mean age, 68.6 +/- 14.8 years) undergoing elective cardiac surgery. We measured physical functions such as the 6-minute walking distance (6MWD) and Timed Up-and-Go test (TUG) before surgery. The assessment of delirium was conducted every 8 h from the day of surgery to 5 days after surgery using the Intensive Care Delirium Screening Checklist. RESULTS: POD occurred in 46 patients (14.6%). Age, 6MWD, TUG, serum hemoglobin, estimated glomerular filtration rate, and length of intensive care unit stay were significantly different based on the presence or absence of POD (p < 0.05 for each). After multivariate analysis, 6MWD remained a statistically significant indicator for developing POD (OR 0.98; p = 0.02). The cut-off value of 6MWD for predicting POD was 345 m (AUC = 0.75; p = 0.001). CONCLUSIONS: Poor exercise capacity was found to be an independent predictor of POD following elective cardiac surgery. This finding suggests the importance of preoperative functional evaluation in the prevention and management of POD in cardiac surgery patients.
    • PubMed ID
  • Effectiveness of multicomponent interventions on incidence of delirium in hospitalized older patients with hip fracture: a systematic review. 2018 Oberai, T. Laver, K. Crotty, M. Killington, M. Jaarsma, R.. Int Psychogeriatr, (1-12)
    • Title

      Effectiveness of multicomponent interventions on incidence of delirium in hospitalized older patients with hip fracture: a systematic review.

    • Authors
      Oberai, T. Laver, K. Crotty, M. Killington, M. Jaarsma, R.
    • Year
      2018
    • Journal
      Int Psychogeriatr
    • URL
    • Abstract
      BACKGROUND: Delirium is the most frequent complication among the hospitalized elderly with hip fracture. Although, delirium is associated with longer hospital stay, higher mortality rates, worse functional outcomes, and higher institutionalization rates yet health service planners have hugely ignored its existence. This review aims to identify the effectiveness of multicomponent interventions to prevent delirium in hospitalized elderly patients with hip fracture. METHODS: This review includes experimental, non-experimental, and observational studies. Electronic searches were conducted in MEDLINE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, Embase, and Web of science. RESULTS: After inclusion and exclusion criteria were applied, nine full text articles were included in the review. The studies reported the following effect on delirium: We pooled data regarding incidence of delirium from the three RCTs. The effect was in favor of the intervention group (odds ratio 0.64, 95% CI 0.46-0.87). All three RCTs reported that duration of delirium was shorter in the intervention group than in the usual care group (mean 2.9 vs. 3.1 days, median 3 vs. 4 days, median 5.0 vs. 10.2 days). Four other studies reported on the duration of delirium with Milisen and colleagues reported shorter duration of delirium within the intervention group. Four studies reported on severity of delirium with two research groups reporting significant results. CONCLUSION: Early engagement of multidisciplinary staff who addresses the risk factors of delirium as soon as the patient presents to the acute care environment is the key element of a successful delirium prevention program. Once delirium had developed, the multicomponent interventions did not appear to make a difference to the duration or severity of delirium.
    • PubMed ID
  • Controlled pre-post, mixed-methods study to determine the effectiveness of a national delirium clinical care standard to improve the diagnosis and care of patients with delirium in Australian hospitals: a protocol. 2018 Mumford, V. Kulh, M. A. Hughes, C. Braithwaite, J. Westbrook, J.. BMJ Open, 8:1
    • Title

      Controlled pre-post, mixed-methods study to determine the effectiveness of a national delirium clinical care standard to improve the diagnosis and care of patients with delirium in Australian hospitals: a protocol.

    • Authors
      Mumford, V. Kulh, M. A. Hughes, C. Braithwaite, J. Westbrook, J.
    • Year
      2018
    • Journal
      BMJ Open
    • URL
    • Abstract
      INTRODUCTION: Delirium, an acute confusional state, affects up to 29% of acute inpatients aged 65 years and over. The Australian Delirium Clinical Care Standard (the Standard) contains evidence-based, multicomponent interventions, to identify and reduce delirium. This study aims to: (1) conduct a controlled, before-and-after study to assess the clinical effectiveness of the Standard to improve diagnosis and treatment of delirium; (2) conduct a cost-effectiveness study of implementing the Standard and (3) evaluate the implementation process. METHODS AND ANALYSIS: The study will use a controlled, preimplementation and postimplementation mixed-methods study design, including: medical record reviews, activity-based costing analysis and interviews with staff, patients and their family members. The study population will comprise patients 65 years and over, admitted to surgical, medical and intensive care wards in four intervention hospitals and one control hospital. The primary clinical outcome will be the incidence of delirium. Secondary outcomes include: length of stay, severity and duration of delirium, inhospital mortality rates, readmission rates and use of psychotropic drugs. Cost-effectiveness will be evaluated through activity-based costing analysis and outcome data, and the implementation process appraised through the qualitative results. ETHICS AND DISSEMINATION: Ethics approval has been received for two hospitals. Additional hospitals have been identified and ethics applications will be submitted once the tools in the pilot study have been tested.The results will be submitted for publication in peer-reviewed journals and presented to national and international conferences. Results seminars will provide a quality feedback mechanism for staff and health policy bodies.
    • PubMed ID
  • Incidence and Risk Factors of Postoperative Delirium following Pancreatic Surgery: Does the Administration of TJ-54 Reduce the Incidence of Delirium. 2018 Mizuno, S. Takeuchi, S. Kishiwada, M. Mizutani, N. Matsuda, M. Sekoguchi, N. Iizawa, Y. Azumi, Y. Kuriyama, N. Usui, M. Sakurai, H. Maruyama, K. Okuda, M. Okada, M. Isaji, S.. Dig Surg, 35:1 (1-10)
    • Title

      Incidence and Risk Factors of Postoperative Delirium following Pancreatic Surgery: Does the Administration of TJ-54 Reduce the Incidence of Delirium.

    • Authors
      Mizuno, S. Takeuchi, S. Kishiwada, M. Mizutani, N. Matsuda, M. Sekoguchi, N. Iizawa, Y. Azumi, Y. Kuriyama, N. Usui, M. Sakurai, H. Maruyama, K. Okuda, M. Okada, M. Isaji, S.
    • Year
      2018
    • Journal
      Dig Surg
    • URL
    • Abstract
      PURPOSES: To clarify the incidence and risk factors of postoperative delirium in patients following pancreatic surgery, and the impact of yokukansan (TJ-54) administered to reduce delirium. METHODS: Fifty-nine consecutive patients who underwent pancreatic surgery (2012.4-2013.5) were divided into 2 groups: TJ-54 group: patients who received TJ-54 (n = 21) due to insomnia and the No-TJ-54 group: patients who did not receive TJ-54 (n = 38), and the medical records including the delirium rating scale - Japanese version (DRS-J) were retrospectively reviewed. RESULTS: Postoperative delirium occurred in 2 patients (9.5%) in the TJ-54 group and in 4 (10.5%) patients in the No-TJ-54 group (p = 0.90). The DRS-J on 5 days after surgery was lower in the TJ-54 group than in the No-TJ-54 group (rough p = 0.006), however, without any statistically significant differences with the Bonferroni correction. As for the hospital cost, there was no difference between the TJ-54 and the No-TJ-54 groups (p = 0.78). History of delirium was identified as an independent risk factor of postoperative delirium. CONCLUSION: The patients with preoperative insomnia, who were treated with TJ-54, did not have a higher incidence of postoperative delirium, compared to those without preoperative insomnia. The patients who had a history of delirium have an increased risk of postoperative delirium and should be cared for and treated prophylactically to prevent it.
    • PubMed ID
  • Association of Integrated Care Coordination With Postsurgical Outcomes in High-Risk Older Adults: The Perioperative Optimization of Senior Health (POSH) Initiative. 2018 McDonald, S. R. Heflin, M. T. Whitson, H. E. Dalton, T. O. Lidsky, M. E. Liu, P. Poer, C. M. Sloane, R. Thacker, J. K. White, H. K. Yanamadala, M. Lagoo-Deenadayalan, S. A.. JAMA Surg,
    • Title

      Association of Integrated Care Coordination With Postsurgical Outcomes in High-Risk Older Adults: The Perioperative Optimization of Senior Health (POSH) Initiative.

    • Authors
      McDonald, S. R. Heflin, M. T. Whitson, H. E. Dalton, T. O. Lidsky, M. E. Liu, P. Poer, C. M. Sloane, R. Thacker, J. K. White, H. K. Yanamadala, M. Lagoo-Deenadayalan, S. A.
    • Year
      2018
    • Journal
      JAMA Surg
    • URL
    • Abstract
      Importance: Older adults undergoing elective surgery experience higher rates of preventable postoperative complications than younger patients. Objective: To assess clinical outcomes for older adults undergoing elective abdominal surgery via a collaborative intervention by surgery, geriatrics, and anesthesia focused on perioperative health optimization. Design, Setting, and Participants: Perioperative Optimization of Senior Health (POSH) is a quality improvement initiative with prospective data collection. Participants in an existing geriatrics-based clinic within a single-site academic health center were included if they were at high risk for complications (ie, older than 85 years or older than 65 years with cognitive impairment, recent weight loss, multimorbidity, or polypharmacy) undergoing elective abdominal surgery. Outcomes were compared with a control group of patients older than 65 years who underwent similar surgeries by the same group of general surgeons immediately before implementation of POSH. Main Outcomes and Measures: Primary outcomes included length of stay, 7- and 30-day readmissions, and level of care at discharge. Secondary outcomes were delirium and other major postoperative complications. Outcomes data were derived from institutional databases linked with electronic health records and billing data sets. Results: One hundred eighty-three POSH patients were compared with 143 patients in the control group. On average, patients in the POSH group were older compared with those in the control group (75.6 vs 71.9 years; P < .001; 95% CI, 2.27 to 5.19) and had more chronic conditions (10.6 vs 8.5; P = .001; 95% CI, 0.86 to 3.35). Median length of stay was shorter among POSH patients (4 days vs 6 days; P < .001; 95% CI, -1.06 to -4.21). Patients in the POSH group had lower readmission rates at 7 days (5 of 180 [2.8%] vs 14 of 142 [9.9%]; P = .007; 95% CI, 0.09 to 0.74) and 30 days (14 of 180 [7.8%] vs 26 of 142 [18.3%]; P = .004; 95% CI, 0.19 to 0.75) and were more likely to be discharged home with self-care (114 of 183 [62.3%] vs 73 of 143 [51.1%]; P = .04; 95% CI, 1.02 to 2.47). Patients in the POSH group experienced fewer mean number of complications (0.9 vs 1.4; P < .001; 95% CI, -0.13 to -0.89) despite higher rates of documented delirium (52 of 183 [28.4%] vs 8 of 143 [5.6%]; P < .001; 95% CI, 3.06 to 14.65). A greater proportion of POSH patients underwent laparoscopic procedures (92 of 183 [50%] vs 55 of 143 [38.5%]; P = .001; 95% CI, 1.04 to 2.52). Tests for interactions between POSH patients and procedure type were insignificant for all outcomes. Conclusions and Relevance: Despite higher mean age and morbidity burden, older adults who participated in an interdisciplinary perioperative care intervention had fewer complications, shorter hospitalizations, more frequent discharge to home, and fewer readmissions than a comparison group.
    • PubMed ID
  • Effect of motor subtypes of delirium in the intensive care unit on fast-track failure after cardiac surgery 2018 Lee, A. Mu, J. L. Chiu, C. H. Gin, T. Underwood, M. J. Joynt, G. M.. J Thorac Cardiovasc Surg, 155:1
    • Title

      Effect of motor subtypes of delirium in the intensive care unit on fast-track failure after cardiac surgery

    • Authors
      Lee, A. Mu, J. L. Chiu, C. H. Gin, T. Underwood, M. J. Joynt, G. M.
    • Year
      2018
    • Journal
      J Thorac Cardiovasc Surg
    • URL
    • Abstract
      OBJECTIVE: The purpose of the study was to evaluate the association between motor subtypes of postoperative delirium in the intensive care unit and fast-track failure (a composite outcome of prolonged stay in the intensive care unit >48 hours, intensive care unit readmission, and 30-day mortality) after cardiac surgery. METHODS: This was a secondary analysis of a prospective cohort study of 600 consecutive adults undergoing cardiac surgery at a university hospital in Hong Kong (July 2013 to July 2015). The motor subtypes of delirium were classified using the Richmond Agitation Sedation Score and Confusion Assessment Method intensive care unit assessments performed by trained bedside nurses. A generalized estimating equation was used to estimate a common relative risk of fast-track failure associated with motor subtypes. RESULTS: The incidences of hypoactive, hyperactive, and mixed motor subtypes were 4.3% (n = 26), 4.0% (n = 24), and 5.5% (n = 33), respectively. Fast-track failure occurred in 88 patients (14.7%). There was an association between delirium (all subtypes) and fast-track failure (P = .048); hyperactive delirium (relative risk, 1.95; 95% confidence interval, 0.96-3.94); hypoactive delirium (relative risk, 2.79; 95% confidence interval, 1.34-5.84); and mixed delirium (relative risk, 2.55; 95% confidence interval, 1.11-5.88). Hypoactive and mixed subtypes were associated with prolonged intensive care unit stay (both P = .001). CONCLUSIONS: Patients with pure hypoactive delirium had a similar risk of developing fast-track failure as other motor subtypes. Differentiation of motor subtypes is unlikely to be clinically important for prognostication of fast-track failure. However, because delirium is associated with poor outcomes, potential treatment strategies should address all subtypes equally.
    • PubMed ID
  • Preoperative medication use and its association with postoperative length of hospital stay in surgical oncology patients receiving comprehensive geriatric assessment. 2018 Jeong, Y. M. Lee, K. E. Lee, E. S. Kim, K. I. Chung, J. E. Lee, B. K. Gwak, H. S.. Geriatrics & Gerontology International, 18:1 (12-19)
    • Title

      Preoperative medication use and its association with postoperative length of hospital stay in surgical oncology patients receiving comprehensive geriatric assessment.

    • Authors
      Jeong, Y. M. Lee, K. E. Lee, E. S. Kim, K. I. Chung, J. E. Lee, B. K. Gwak, H. S.
    • Year
      2018
    • Journal
      Geriatrics & Gerontology International
    • URL
    • Abstract
      AIM: The present study aimed to investigate whether preoperative medication use is associated with postoperative length of hospital stay in older adults undergoing cancer surgery. METHODS: Patients aged >/=65 years who were scheduled for cancer surgery and presented for preoperative comprehensive geriatric assessment were included in the present study. Cognitive function evaluation and preoperative medication review were carried out, as well as baseline characteristics of participants collected from electronic medical records. The primary efficacy variable was the postoperative length of stay (LOS) in hospital. RESULTS: A total of 475 cancer patients were included for the analysis. Baseline characteristics of participants including older age, lower body mass index (BMI) and male sex were associated with longer postoperative stay. Among the clinical variables, cancer type, number of medications, potentially inappropriate medication (PIM) and delirium-inducing medication were found as statistically significant factors for postoperative LOS. In multivariate analysis, variables independently associated with postoperative LOS were cancer type, PIM use, BMI, and the number of medications after controlling for age, BMI, sex, cancer type, the number of medications, PIM, and delirium-inducing medication. In subgroup analysis of gastrointestinal cancer, multiple linear regression analysis showed that PIM use and BMI were significantly associated with LOS after adjustment for age, sex, and number of medication. CONCLUSIONS: The present study supports the impact of medication use on postoperative LOS in geriatric oncology patients. The results add a further aspect to medication optimization in older patients undergoing cancer surgery. Geriatr Gerontol Int 2018; 18: 12-19.
    • PubMed ID
  • Postoperative Delirium in Cardiac Surgery Patients. 2018 Järvelä, K. Porkkala, H. Karlsson, S. Martikainen, T. Selander, T. Bendel, S.. Journal of Cardiothoracic and Vascular Anesthesia,
    • Title

      Postoperative Delirium in Cardiac Surgery Patients.

    • Authors
      Järvelä, K. Porkkala, H. Karlsson, S. Martikainen, T. Selander, T. Bendel, S.
    • Year
      2018
    • Journal
      Journal of Cardiothoracic and Vascular Anesthesia
    • URL
    • Abstract
      Objective: The authors studied the incidence of postoperative delirium among cardiac surgery patients using the Intensive Care Delirium Screening Checklist (ICDSC). Design: Prospective screening. Setting: Two university hospitals. Participants: A total of 1,036 consecutive patients. Interventions: None. Measurements and Main Results: Patients were prospectively screened from day 1 to day 10 after surgery or until hospital discharge. Appropriate perioperative data were collected. The overall incidence of postoperative delirium was 11.5%. In the multivariate logistic regression analysis, age over 70 years, higher EuroSCORE points, longer aortic occlusion time, and profuse drainage increased the incidence of delirium. The duration of mechanical ventilation and intensive care unit length of stay were longer in the group of patients with delirium (10.6 hours [6.6-19.5] v 6.4 hours [4.9-8.6], p < 0.001, and 1.7 days [0.9-4.2] v 0.9 days [0.9-1], p < 0.001). Conclusions: Postoperative delirium is common after cardiac surgery, and it is associated with the duration of mechanical ventilation.
    • PubMed ID
  • “Eight Days of Nightmares … ” – Octogenarian Patients’ Experiences of Postoperative Delirium after Transcatheter or Surgical Aortic Valve Replacement. 2018 Instenes, I. Gjengedal, E. Eide, L. S. P. Kuiper, K. K. J. Ranhoff, A. H. Norekvål, T. M.. Heart Lung and Circulation, 27:2 (260-6)
    • Title

      “Eight Days of Nightmares … ” – Octogenarian Patients’ Experiences of Postoperative Delirium after Transcatheter or Surgical Aortic Valve Replacement.

    • Authors
      Instenes, I. Gjengedal, E. Eide, L. S. P. Kuiper, K. K. J. Ranhoff, A. H. Norekvål, T. M.
    • Year
      2018
    • Journal
      Heart Lung and Circulation
    • URL
    • Abstract
      Background Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are increasingly performed in octogenarian patients with severe aortic stenosis (AS), including those with high surgical risk. Postoperative delirium (PD) is a common and serious complication in older patients, characterised by reduced awareness, change in consciousness, disturbance in logical thinking and hallucinations. Methods To explore how octogenarian patients experienced PD, a qualitative study was conducted including five women and five men between 81 and 88 years. The incidence of PD was assessed for five days using the Confusion Assessment Method. Cognitive function was assessed preoperatively and at a 6-month follow-up using the Mini-Mental State Examination. In-depth interviews were conducted 6–12 months post-discharge, transcribed, and analysed using Giorgi's phenomenological method. Results Postoperative delirium experiences were grouped into six themes: “Like dreaming while awake” “Disturbed experiences of time” “Existing in a twilight zone” “Trapped in medical tubes” “Moving between different surroundings” and “Meeting with death and the deceased”. Conclusions For the first time, we show that octogenarian patients who undergo SAVR or TAVI have strong and distressing memories of their delirious state that can persist for up to 12 months later. These findings provide valuable new information that will likely improve delivery of health services and enhance professional and empathic care of octogenarians after SAVR and TAVI.
    • PubMed ID
  • General Anesthesia for Transcatheter Aortic Valve Replacement: Total Intravenous Anesthesia is Associated with Less Delirium as Compared to Volatile Agent Technique. 2018 Goins, A. E. Smeltz, A. Ramm, C. Strassle, P. D. Teeter, E. G. Vavalle, J. P. Kolarczyk, L.. Journal of Cardiothoracic and Vascular Anesthesia,
    • Title

      General Anesthesia for Transcatheter Aortic Valve Replacement: Total Intravenous Anesthesia is Associated with Less Delirium as Compared to Volatile Agent Technique.

    • Authors
      Goins, A. E. Smeltz, A. Ramm, C. Strassle, P. D. Teeter, E. G. Vavalle, J. P. Kolarczyk, L.
    • Year
      2018
    • Journal
      Journal of Cardiothoracic and Vascular Anesthesia
    • URL
    • Abstract
      Objective: Investigate the effect of volatile anesthesia versus total intravenous anesthesia on the incidence of postoperative delirium and length of stay in patients undergoing transcatheter aortic valve replacement under general anesthesia. Design: Retrospective study. Setting: Single institution, academic medical center. Participants: Adult patients who underwent transcatheter aortic valve replacement under general anesthesia between November 2014 and February 2017. Interventions: This study was not an interventional study. Measurements and Main Results: Electronic medical records were reviewed for intraoperative maintenance anesthetic technique, hospital and intensive care unit length of stay, 30-day mortality, and documentation of delirium. Delirium was defined as either 1) positive Confusion Assessment Method for the Intensive Care Unit score or 2) documentation of delirium or confusion by the care team within 2 days of surgery. Overall, 116 patients were included and 84 (72%) received a total intravenous anesthesia technique. Twenty-three patients (20%) had postoperative delirium. The odds of delirium were lower in patients undergoing transcatheter aortic valve replacement with total intravenous anesthesia, compared with volatile anesthesia, even after adjusting for procedure approach (odds ratio 0.22, 95% confidence interval 0.06, 0.79, p = 0.02). No significant difference in hospital or intensive care unit length of stay was seen after adjusting for procedural characteristics. Conclusions: While postoperative delirium is a complex and multifactorial problem, the type of general anesthetic maintenance may contribute to the incidence of postoperative delirium in patients undergoing transcatheter aortic valve replacement, and total intravenous anesthesia may be an attractive alternative to volatile-based general anesthesia maintenance.
    • PubMed ID
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