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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Total Results: 2543

  • The use of point-of-care ultrasound to diagnose patent foramen ovale in elective hip and knee arthroplasty patients and its association with postoperative delirium. 2018 Gai, N. Lavi, R. Jones, P. M. Lee, H. Naudie, D. Bainbridge, D.. Can J Anaesth,
    • Title

      The use of point-of-care ultrasound to diagnose patent foramen ovale in elective hip and knee arthroplasty patients and its association with postoperative delirium.

    • Authors
      Gai, N. Lavi, R. Jones, P. M. Lee, H. Naudie, D. Bainbridge, D.
    • Year
      2018
    • Journal
      Can J Anaesth
    • URL
    • Abstract
      PURPOSE: Hip and knee arthroplasty surgeries are associated with embolism of materials such as air, cement, and fat. Patent foramen ovale (PFO) is a common congenital cardiac condition that has been reported to lead to paradoxical embolism. This observational study aimed to investigate if the presence of a PFO was associated with an increased risk of postoperative delirium in patients undergoing primary elective hip or knee arthroplasties. METHOD: This was a prospective cohort study at a tertiary teaching hospital. We enrolled patients undergoing primary elective hip or knee arthroplasty who did not have any risk factors for embolism or delirium. Bedside transthoracic echocardiography (TTE) with a bubble study was performed on all patients to detect the presence of PFO. The primary outcome was postoperative delirium as assessed by the standardized Confusion Assessment Method. Secondary outcomes included the ease of performing a TTE bubble study in the perioperative setting, the quality of the TTE images, length of stay, major cardiovascular and neurologic complications, and effects of anesthetic or analgesic management techniques on delirium. RESULTS: Two hundred two patients completed the study. The median [interquartile range] duration of stay was 2 [2-3] days. Only 16 patients (8%) had a positive bubble study. Postoperative delirium was observed in only one patient. Major adverse events were not seen. The inter-rater reliability for the TTE image quality scores was fair (kappa statistic = 0.22). CONCLUSION: Given the very low incidence of PFO and postoperative delirium in this study, we could not form any conclusions regarding the impact of a PFO on important outcomes including delirium or other major adverse events. No recommendation can be made regarding screening for PFO in patients scheduled for lower extremity arthroplasty surgery. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02400892). Registered 27 March 2015.
    • PubMed ID
  • Comparison of Lurasidone Versus Quetiapine for the Treatment of Delirium in Critically Ill Patients. 2018 Fox, M. A. Elefritz, J. L. Huang, B. M. Hunley, C.. J Intensive Care Med,
    • Title

      Comparison of Lurasidone Versus Quetiapine for the Treatment of Delirium in Critically Ill Patients.

    • Authors
      Fox, M. A. Elefritz, J. L. Huang, B. M. Hunley, C.
    • Year
      2018
    • Journal
      J Intensive Care Med
    • URL
    • Abstract
      OBJECTIVE: To evaluate the efficacy and safety of lurasidone compared with quetiapine for treatment of delirium in critically ill patients. DESIGN: Prospective, observational cohort study. SETTING: Single-center community teaching hospital. PATIENTS: Forty adult intensive care unit (ICU) patients with delirium (Confusion Assessment Method in the ICU positive), tolerating enteral nutrition, and without active alcohol withdrawal or prior use of atypical antipsychotics. INTERVENTIONS: Patients were treated at the discretion of the prescriber with either lurasidone or quetiapine for delirium. Dose escalation and/or discontinuation were determined at the discretion of individual providers. RESULTS: Baseline characteristics differed with a higher severity of illness in patients in the quetiapine group (n = 20) and a higher baseline QTc interval in the lurasidone group (n = 20). No significant difference was seen in the time to delirium resolution (3.2 vs 3.4 days), average daily haloperidol requirements (5.7 vs 6.9 mg), hospital length of stay (LOS; 23.6 vs 27.9 days), or ICU LOS (12.1 vs 14.2 days). Lurasidone was associated with fewer ventilator support days (4.0 [interquartile range, IQR: 2.3-6.8] days vs 7 [IQR: 4.0-9.8; P = .0295] days) but also a fewer number of delirium-free days (0 [IQR: 0-1.0] days vs 2 [IQR: 0-3.0; P = .0231] days). Additionally, no difference was seen for ICU mortality (20% vs 20%), percentage of time oversedated (2.8% vs 2.7%), or incidence of QTc prolongation (10.0% vs 10.0%). CONCLUSIONS: Lurasidone for the treatment of delirium in critically ill patients did not differ in the time to delirium resolution when compared to quetiapine. Additionally, the incidence of QTc prolongation between agents does not appear to be different. Future randomized trials should evaluate dose escalation schemes and a larger proportion of patients to evaluate differences in mortality, efficacy, and life-threatening arrhythmias associated with atypical antipsychotic use.
    • PubMed ID
  • Key components of the delirium syndrome and mortality: greater impact of acute change and disorganised thinking in a prospective cohort study. 2018 Diwell, R. A. Davis, D. H. Vickerstaff, V. Sampson, E. L.. BMC Geriatr, 18:1 (24)
    • Title

      Key components of the delirium syndrome and mortality: greater impact of acute change and disorganised thinking in a prospective cohort study.

    • Authors
      Diwell, R. A. Davis, D. H. Vickerstaff, V. Sampson, E. L.
    • Year
      2018
    • Journal
      BMC Geriatr
    • URL
    • Abstract
      BACKGROUND: Delirium increases the risk of mortality during an acute hospital admission. Full syndromal delirium (FSD) is associated with greatest risk and subsyndromal delirium (SSD) is associated with intermediate risk, compared to patients with no delirium - suggesting a dose-response relationship. It is not clear how individual diagnostic symptoms of delirium influence the association with mortality. Our objectives were to measure the prevalence of FSD and SSD, and assess the effect that FSD, SSD and individual symptoms of delirium (from the Confusion Assessment Method-short version (s-CAM)) have on mortality rates. METHODS: Exploratory analysis of a prospective cohort (aged >/=70 years) with acute (unplanned) medical admission (4/6/2007-4/11/2007). The outcome was mortality (data censored 6/10/2011). The principal exposures were FSD and SSD compared to no delirium (as measured by the CAM), along with individual delirium symptoms on the CAM. Cox regression was used to estimate the impact FSD and SSD and individual CAM items had on mortality. RESULTS: The cohort (n = 610) mean age was 83 (SD 7); 59% were female. On admission, 11% had FSD and 33% had SSD. Of the key diagnostic symptoms for delirium, 17% acute onset, 19% inattention, 17% disorganised thinking and 17% altered level of consciousness. Unadjusted analysis found FSD had an increased hazard ratio (HR) of 2.31 (95% CI 1.71, 3.12), for SSD the HR was 1.26 (1.00, 1.59). Adjusted analysis remained significant for FSD (1.55 95% CI 1.10, 2.18) but nonsignificant for SSD (HR = 0.92 95% CI 0.70, 1.19). Two CAM items were significantly associated with mortality following adjustment: acute onset and disorganised thinking. CONCLUSION: We observed a dose-response relationship between mortality and delirium, FSD had the greatest risk and SSD having intermediate risk. The CAM items "acute-onset" and "disorganised thinking" drove the associations observed. Clinically, this highlights the necessity of identifying individual symptoms of delirium.
    • PubMed ID
  • Postoperative Delirium in Indian Patients Following Major Abdominal Surgery for Cancer: Risk Factors and Associations. 2017 Dhakharia, V. Sinha, S. Bhaumik, J.. Indian J Surg Oncol, 8:4 (567-72)
    • Title

      Postoperative Delirium in Indian Patients Following Major Abdominal Surgery for Cancer: Risk Factors and Associations.

    • Authors
      Dhakharia, V. Sinha, S. Bhaumik, J.
    • Year
      2017
    • Journal
      Indian J Surg Oncol
    • URL
    • Abstract
      Postoperative delirium (POD) is not uncommon following major abdominal surgery with its incidence ranging between five and 51%. As cancer affects disproportionately, the population older than 65 years and as delirium is more common in the elderly, surgical oncology patients are at a higher risk of developing POD. The present study was undertaken to explore the impact and associations of POD in Indian patients undergoing oncological major abdominal surgery. A retrospective review of the electronic medical records in a tertiary cancer care institution of all postoperative patients who had undergone major gastrointestinal gynaecological and urological abdominal surgery for cancer and required psycho-oncology referral was performed. Patient, surgery and postoperative outcome-related data were collected. Statistical analysis was performed using univariate and multivariate logistic regression analysis. Out of 824 patients who underwent major abdominal surgery, 33 patients (4.0%) were diagnosed with POD. In univariate analysis, older age and history of addiction were found to be statistically significantly associated with POD (p < 0.001). Among the postoperative factors, respiratory complications (p < 0.001), sepsis (p < 0.05), ICU stay > 24 h (p < 0.05) and electrolyte impairment (p < 0.05) were the significant associations with the POD. Thirty-day mortality was higher in the POD group (p < 0.05). In multivariate logistic regression analysis, advanced age, addictions, respiratory complications and sepsis were found to be significant associations with POD, p < 0.001. Postoperative delirium is associated with higher mortality. Older age, postoperative respiratory complications and sepsis are common contributory factors of postoperative delirium.
    • PubMed ID
  • Effect of an interactive E-learning tool for delirium on patient and nursing outcomes in a geriatric hospital setting: findings of a before-after study. 2018 Detroyer, E. Dobbels, F. Teodorczuk, A. Deschodt, M. Depaifve, Y. Joosten, E. Milisen, K.. BMC Geriatr, 18:1 (19)
    • Title

      Effect of an interactive E-learning tool for delirium on patient and nursing outcomes in a geriatric hospital setting: findings of a before-after study.

    • Authors
      Detroyer, E. Dobbels, F. Teodorczuk, A. Deschodt, M. Depaifve, Y. Joosten, E. Milisen, K.
    • Year
      2018
    • Journal
      BMC Geriatr
    • URL
    • Abstract
      BACKGROUND: Education of healthcare workers is a core element of multicomponent delirium strategies to improve delirium care and, consequently, patient outcomes. However, traditional educational strategies are notoriously difficult to implement. E-learning is hypothesised to be easier and more cost effective, but research evaluating effectiveness of delirium education through e-learning is scarce at present. Aim is to determine the effect of a nursing e-learning tool for delirium on: (1) in-hospital prevalence, duration and severity of delirium or mortality in hospitalized geriatric patients, and (2) geriatric nurses' knowledge and recognition regarding delirium. METHODS: A before-after study in a sample of patients enrolled pre-intervention (non-intervention cohort (NIC); n = 81) and post-intervention (intervention cohort (IC); n = 79), and nurses (n = 17) of a geriatric ward (university hospital). The intervention included an information session about using the e-learning tool, which consisted of 11 e-modules incorporating development of knowledge and skills in the prevention, detection and management of delirium, and the completion of a delirium e-learning tool during a three-month period. Key patient outcomes included in-hospital prevalence and duration of delirium (Confusion Assessment Method), delirium severity (Delirium Index) and mortality (in-hospital; 12 months post-admission); key nurse outcomes included delirium knowledge (Delirium Knowledge Questionnaire) and recognition (Case vignettes). Logistic regression and linear mixed models were used to analyse patient data; Wilcoxon Signed Rank tests, McNemar's or paired t-tests for nursing data. RESULTS: No significant difference was found between the IC and NIC for in-hospital prevalence (21.5% versus 25.9%; p = 0.51) and duration of delirium (mean 4.2 +/- SD 4.8 days versus 4.9 +/- SD 4.8 days; p = 0.38). A trend towards a statistically significant lower delirium severity (IC versus NIC: difference estimate - 1.59; p = 0.08) was noted for delirious IC patients in a linear mixed model. No effect on patient mortality and on nurses' delirium knowledge (p = 0.43) and recognition (p = 1.0) was found. CONCLUSION: Our study, the first in its area to investigate effects of delirium e-learning on patient outcomes, demonstrated no benefits on both geriatric patients and nurses. Further research is needed to determine whether delirium e-learning nested within a larger educational approach inclusive of enabling and reinforcing strategies, would be effective. TRIAL REGISTRATION: ISRCTN ( 82,293,702 , 27/06/2017).
    • PubMed ID
  • Melatonin and the Prevention and Management of Delirium: A Scoping Study. 2017 Choy, S. W. Yeoh, A. C. Lee, Z. Z. Srikanth, V. Moran, C.. Front Med, (242)
    • Title

      Melatonin and the Prevention and Management of Delirium: A Scoping Study.

    • Authors
      Choy, S. W. Yeoh, A. C. Lee, Z. Z. Srikanth, V. Moran, C.
    • Year
      2017
    • Journal
      Front Med
    • URL
    • Abstract
      Background: The therapeutic benefit of melatonin in the prevention and treatment of delirium is uncertain. Objective: To perform a scoping study to describe the existing literature regarding the use of melatonin and ramelteon in the prevention and treatment of delirium. Methods: We performed a scoping study using the Arksey and O'Malley framework to explore our objective. Two independent panels searched MEDLINE, OVID, EMBASE, PubMed, Google Scholar, and Cochrane Library for relevant articles up to November 2017 describing the use of melatonin and ramelteon in the prevention or management of delirium. We extracted relevant summary data from the studies and attempted to draw conclusion regarding benefit. Results: We summarized evidence from 20 relevant articles. There were a total of nine articles: five randomized controlled trials (RCTs), two retrospective medical record reviews, one non-randomized observational study, and one case report describing the role of either melatonin or ramelteon in preventing delirium. There were a total of 11 studies studying the role of either melatonin or ramelteon in the management of established delirium. None of these were RCT and were predominantly case series and case reports. Four of the five trials studying the effect of melatonin analogs in preventing delirium reported a beneficial effect but study heterogeneity limited any broad recommendations. Similarly, the lack of any well-designed trials limits any recommendations regarding the effect of melatonin analogs in treating delirium. Conclusion: Large, well-designed clinical trials are required to explore the potential beneficial effects of melatonin and ramelteon on delirium prevention and management.
    • PubMed ID
  • The impact of sepsis, delirium, and psychological distress on self-rated cognitive function in ICU survivors-a prospective cohort study. 2018 Bruck, E. Schandl, A. Bottai, M. Sackey, P.. J Intensive Care, (2)
    • Title

      The impact of sepsis, delirium, and psychological distress on self-rated cognitive function in ICU survivors-a prospective cohort study.

    • Authors
      Bruck, E. Schandl, A. Bottai, M. Sackey, P.
    • Year
      2018
    • Journal
      J Intensive Care
    • URL
    • Abstract
      Background: Many intensive care unit (ICU) survivors develop psychological problems and cognitive impairment. The relation between sepsis, delirium, and later cognitive problems is not fully elucidated, and the impact of psychological symptoms on cognitive function is poorly studied in ICU survivors. The primary aim of this study was to examine the relationship between sepsis, ICU delirium, and later self-rated cognitive function. A second aim was to investigate the association between psychological problems and self-rated cognitive function 3 months after the ICU stay. Methods: Patients staying more than 24 h at the general ICU at the Karolinska University Hospital Solna, Stockholm, Sweden, were screened for delirium with the Confusion Assessment Method-ICU (CAM-ICU) during their ICU stay. Sepsis incidence and severity were recorded. Three months later, 216 patients received the Cognitive Failures Questionnaire (CFQ), Hospital Anxiety and Depression Scale (HADS), and Post-Traumatic Stress Symptoms-10 (PTSS-10) questionnaires via postal mail. Results: One hundred twenty-five patients (60%) responded to all questionnaires. Among respondents, the incidence of severe sepsis or septic shock was 42%. The overall incidence of delirium was 34%. Patients with severe sepsis/septic shock had a higher incidence of delirium, with an odds ratio (OR) of 3.7 (95% confidence interval (CI), 1.7-8.1). Self-rated cognitive problems 3 months post-ICU were found in 58% of the patients. We did not find any association between sepsis or delirium and late self-rated cognitive function. However, there was a correlation between psychological symptoms and self-rated cognitive function, with the strongest correlation between PTSS-10 scores and CFQ scores (r = 0.53; p < 0.001). Conclusions: ICU delirium is more common in severely septic/septic shock patients. In our cohort, neither severe sepsis nor ICU delirium was associated with self-rated cognitive function 3 months after the ICU stay. Ongoing psychological symptoms, particularly post-traumatic stress was associated with worse self-rated cognitive function. Psychological symptoms need to be taken into account when assessing cognitive function in ICU survivors.
    • PubMed ID
  • Falls and Delirium in an Acute Care Setting: A Retrospective Chart Review Before and After an Organization Wide Interprofessional Education. 2018 Babine, R. L. Hyrkas, K. E. Hallen, S. Wierman, H. R. Bachand, D. A. Chapman, J. L. Fuller, V. J.. J Clin Nurs,
    • Title

      Falls and Delirium in an Acute Care Setting: A Retrospective Chart Review Before and After an Organization Wide Interprofessional Education.

    • Authors
      Babine, R. L. Hyrkas, K. E. Hallen, S. Wierman, H. R. Bachand, D. A. Chapman, J. L. Fuller, V. J.
    • Year
      2018
    • Journal
      J Clin Nurs
    • URL
    • Abstract
      AIM AND OBJECTIVES: To describe and compare identification of delirium, length of stay, and discharge locations in two patient samples of falls, before and after an organization wide interprofessional delirium education and practice change along with implementation of a policy. BACKGROUND: Delirium is a common and severe problem for hospitalized patients, with occurrence ranging from 14-56%, morbidity and mortality from 25-33%. Recent studies report that 73-96% of patients who fell during a hospital stay had symptoms of delirium; however the delirium went undiagnosed and untreated in 75% of the cases. DESIGN: A descriptive, retrospective observational study using a pre-post design. METHODS: Two chart reviews were performed on patient falls as identified in the hospital safety reporting system in 2009-2010 (98 fallers) and 2012 (108 fallers). An organization wide education was planned and implemented with monitoring of policy compliance. RESULTS: After the education, documentation of the "diagnosis of delirium" and "no evidence of delirium" increased from 14.3% to 29.5% and from 27.6% to 44.4%. The documentation of "Evidence of Delirium" decreased significantly from 58.2% to 25.9% (p<0.001). The Confusion Assessment Method (CAM) identified the diagnosis of delirium at 76% accuracy. The length of stay decreased by 7.3 days. The fall rates in 2011 and 2012 were 3.01 and 2.82 falls per 1,000 patient days and in 2013 decreased to 2.16. CONCLUSION: The results indicate that improving delirium recognition and treatment through interprofessional education can reduce falls and length of stay. This article is protected by copyright. All rights reserved.
    • PubMed ID
  • Prognostic effects of delirium motor subtypes in hospitalized older adults: A prospective cohort study. 2018 Avelino-Silva, T. J. Campora, F. Curiati, J. A. E. Jacob-Filho, W.. PLoS One, 13:1
    • Title

      Prognostic effects of delirium motor subtypes in hospitalized older adults: A prospective cohort study.

    • Authors
      Avelino-Silva, T. J. Campora, F. Curiati, J. A. E. Jacob-Filho, W.
    • Year
      2018
    • Journal
      PLoS One
    • URL
    • Abstract
      OBJECTIVES: To investigate the association between delirium motor subtypes and hospital mortality and 12-month mortality in hospitalized older adults. DESIGN: Prospective cohort study conducted from 2009 to 2015. SETTING: Geriatric ward of a university hospital in Sao Paulo, Brazil. PARTICIPANTS: We included 1,409 consecutive admissions of acutely ill patients aged 60 years and over. We excluded admissions for end-of-life care, with missing data on the main variables, length of stay shorter than 48 hours, or when consent to participate was not given. MAIN OUTCOMES AND MEASURES: Delirium was detected using the Confusion Assessment Method and categorized in hypoactive, hyperactive, or mixed delirium. Primary outcomes were time to death in the hospital, and time to death in 12 months (for the discharged sample). Comprehensive geriatric assessment was performed at admission and included socio-demographic, clinical, functional, cognitive, and laboratory variables. Further clinical data were documented upon death or discharge. Multivariate analyses used Cox proportional hazards models adjusted for possible confounders. RESULTS: We included 1,409 admissions, with a mean age of 80 years. The proportion of in-hospital deaths was 19%, with a cumulative mortality of 38% in 12 months. Delirium occurred in 47% of the admissions. Hypoactive delirium was the predominant motor subtype (53%), followed by mixed delirium (30%) and hyperactive delirium (17%). Hospital mortality rates were respectively 33%, 34% and 15%. We verified that hypoactive and mixed delirium were independently associated with hospital mortality, with respective hazard ratios of 2.43 (95%CI = 1.64-3.59) and 2.31 (95%CI = 1.53-3.50). Delirium motor subtypes were not independently predictive of 12-month mortality. CONCLUSIONS: One in three acutely ill hospitalized older adults who suffered hypoactive or mixed delirium died in the hospital. Clinicians should be aware that hypoactive symptoms of delirium, whether shown exclusively or in alternation with hyperactive symptoms, are indicative of a worse prognosis in this population.
    • PubMed ID
  • Recognition of Delirium Features in Clinical Practice: Data from the "Delirium Day 2015" National Survey. 2017 Mossello, E. Tesi, F. Di Santo, S. G. Mazzone, A. Torrini, M. Cherubini, A. Bo, M. Musicco, M. Bianchetti, A. Ferrari, A. Ferrara, N. Trabucchi, M. Morandi, A. Bellelli, G.. J Am Geriatr Soc,
    • Title

      Recognition of Delirium Features in Clinical Practice: Data from the "Delirium Day 2015" National Survey.

    • Authors
      Mossello, E. Tesi, F. Di Santo, S. G. Mazzone, A. Torrini, M. Cherubini, A. Bo, M. Musicco, M. Bianchetti, A. Ferrari, A. Ferrara, N. Trabucchi, M. Morandi, A. Bellelli, G.
    • Year
      2017
    • Journal
      J Am Geriatr Soc
    • URL
    • Abstract
      BACKGROUND/OBJECTIVES: Delirium is underrecognized in clinical practice. The primary aim of the present multicenter study was to compare the ability of nurses to identify delirium features with a standardized assessment. The secondary aim was to identify predictors of missed or incorrect identifications of delirium by nurses. DESIGN: Point prevalence study in 120 wards across Italy. SETTING: "Delirium Day 2015." PARTICIPANTS: Inpatients aged 65 and older (N = 1,867). MEASUREMENTS: Participants and nurses were asked specific questions to investigate their perceptions of the presence of delirium features (acute cognitive change, inattention, cognitive fluctuations, impaired arousal). Delirium was identified according to the results of the Assessment Test for Delirium and Cognitive Impairment (4AT), completed by a physician. Comorbidities including dementia, disability, drug treatments, and delirium motor subtype according to the Delirium Motor Subtype Scale were recorded. RESULTS: Delirium was present in 429 subjects (23%) according to the 4AT. Cognitive fluctuations was the delirium feature that the nurses most often recognized. Nurses' perceptions of acute cognitive change, cognitive fluctuations, or impaired arousal had 84% sensitivity and 81% specificity for delirium. The nonmotor subtype of delirium was less likely to be recognized (80%) than the hyperactive (97%), mixed (92%), and hypoactive (90%) subtypes. Incorrect perception of delirium was more frequent in subjects with dementia (specificity 64%). CONCLUSIONS: The delirium feature that nurses were best able to recognize was cognitive fluctuations. The nonmotor subtype was associated with a lower recognition rate. Routine observation and registration of delirium features by nurses in clinical practice might be helpful to increase formal diagnosis of delirium.
    • PubMed ID
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