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: 3010

  • Medication and medical diagnosis as risk factors for falls in older hospitalized patients. 2019 Wedmann, F. Himmel, W. Nau, R.. Eur J Clin Pharmacol,
    • Title

      Medication and medical diagnosis as risk factors for falls in older hospitalized patients.

    • Authors
      Wedmann, F. Himmel, W. Nau, R.
    • Year
      2019
    • Journal
      Eur J Clin Pharmacol
    • URL
    • Abstract
      OBJECTIVE: To examine the impact of medication and medical conditions on the fall risk in older hospitalized patients. DESIGN: Matched case-control study. SETTING: Large regional hospital in a mid-sized German city. SUBJECTS: Four hundred eighty-one inpatients aged >/= 65 years who fell during hospitalization ("cases") and a control group of 481 controls, matched for age, gender, and hospital department. METHODS: Diagnosis, medication, vital parameters, and injuries were compared between cases and controls. Univariate and multivariable odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated. MAIN RESULTS: Several drugs were significantly associated with falls in multivariate analyses: long-acting benzodiazepines (adjusted OR = 3.49; 95%-CI = 1.16-10.52), serotonin-noradrenalin reuptake inhibitors (SNRI) (2.57; 1.23-5.12), Z-drugs (2.29; 1.38-3.59), low-potency neuroleptics (1.87; 1.08-3.23), ACE inhibitors/sartans (1.42; 1.07-1.89). Digoxin (0.32; 0.11-0.99) and aldosterone receptor antagonists (0.54; 0.33-0.88) were negatively associated with falls. No significant association in multivariate analyses was found for short- and intermediate-acting benzodiazepines, mirtazapine, and opioids. Hyponatremia (1.52; 1.15-2.03) and leukocytosis (1.39; 1.05-1.87) in blood examination on admission showed significant association with falls. As secondary diagnoses, Parkinson syndrome (2.38; 1.27-4.46) and delirium (3.74; 2.26-6.21) were strongly associated with falls. The use of more than one psychoactive drug was a separate risk factor for falls (p < 0.0001). CONCLUSION: Several drugs including SNRI, neuroleptics, and Z-drugs showed a significant association with inpatient falls. The frequently prescribed tetracyclic antidepressant mirtazapine did not appear to increase the risk of falls. Psychoactive polypharmacy should be avoided.
    • PubMed ID
  • The inclusion of delirium in version 2 of the National Early Warning Score will substantially increase the alerts for escalating levels of care: findings from a retrospective database study of emergency medical admissions in two hospitals. 2019 Mohammed, M. A. Faisal, M. Richardson, D. Scally, A. Howes, R. Beatson, K. Irwin, S. Speed, K.. Clin Med (London), 19:2 (104-8)
    • Title

      The inclusion of delirium in version 2 of the National Early Warning Score will substantially increase the alerts for escalating levels of care: findings from a retrospective database study of emergency medical admissions in two hospitals.

    • Authors
      Mohammed, M. A. Faisal, M. Richardson, D. Scally, A. Howes, R. Beatson, K. Irwin, S. Speed, K.
    • Year
      2019
    • Journal
      Clin Med (London)
    • URL
    • Abstract
      BACKGROUND: The National Early Warning Score (NEWS) is being replaced with NEWS2 which adds 3 points for new confusion or delirium. We estimated the impact of adding delirium on the number of medium/high level alerts that are triggers to escalate care. METHODS: Analysis of emergency medical admissions in two acute hospitals (York Hospital (YH) and Northern Lincolnshire and Goole NHS Foundation Trust hospitals (NH)) in England. Twenty per cent were randomly assigned to have delirium. RESULTS: The number of emergency admissions (YH: 35584; NH: 35795), mortality (YH: 5.7%; NH: 5.5%), index NEWS (YH: 2.5; NH: 2.1) and numbers of NEWS recorded (YH: 879193; NH: 884072) were similar in each hospital. The mean number of patients with medium level alerts per day increased from 55.3 (NEWS) to 69.5 (NEWS2), a 25.7% increase in YH and 64.1 (NEWS) to 77.4 (NEWS2), a 20.7% increase in NH. The mean number of patients with high level alerts per day increased from 27.3 (NEWS) to 34.4 (NEWS2), a 26.0% increase in YH and 29.9 (NEWS) to 37.7 (NEWS2), a 26.1% increase in NH. CONCLUSIONS: The addition of delirium in NEWS2 will have a substantial increase in medium and high level alerts in hospitalised emergency medical patients. Rigorous evaluation of NEWS2 is required before widespread implementation because the extent to which staff can cope with this increase without adverse consequences remains unknown.
    • PubMed ID
  • Factors Associated with Length of Stay in Hospital Patients with and Without Dementia. 2019 Möllers, T. Perna, L. Ihle, P. Schubert, I. Bauer, J. Brenner, H.. Journal of Alzheimer's Disease, 67:3 (1055-65)
    • Title

      Factors Associated with Length of Stay in Hospital Patients with and Without Dementia.

    • Authors
      Möllers, T. Perna, L. Ihle, P. Schubert, I. Bauer, J. Brenner, H.
    • Year
      2019
    • Journal
      Journal of Alzheimer's Disease
    • URL
    • Abstract
      BACKGROUND: Hospital care of older adults, especially of those with dementia, is associated with a high risk of complications and increased mortality. Adverse events are often triggered by hospital-related factors, hence the time spent in hospitals should be limited. There is little knowledge of the specific factors influencing hospitalizations of older persons. OBJECTIVES: To assess the duration of length of stay (LOS) and risk factors of increased LOS, and, specifically, the role of delirium and neuropsychiatric symptoms (NPS) among a large sample of older adults with and without dementia in Germany. METHODS: A claims data based dynamic retrospective cohort study from 2004 to 2015 was conducted. People with dementia (PWD) were identified using ICD-10 codes and the application of diagnostic measures. A control group without diagnosis of dementia (CG) were matched in a 3: 1 ratio. Multivariate methods were used to investigate the factors associated with LOS. RESULTS: 7,139 PWD and 21,417 controls were included. PWD had longer hospitalizations (first LOS: +4.3 days; second LOS: +0.2 days) than the CG. Diagnosis of delirium was associated with LOS, both for PWD (first LOS: +9.6 days; second LOS: +5.3 days) and CG (first LOS: +13.7 days; second LOS: +7.2 days). CONCLUSION: Major determinants of LOS were similar in PWD and the CG. The strongest association was found for the presence of delirium and NPS. Future research should focus on prevention and intervention strategies that may reduce the impact of delirium as well as NPS on the length of stay especially for PWD.
    • PubMed ID
  • Does a Year Have 6 Months or 12? Implications for Delirium Detection Among Hospitalized Older General Medicine Patients. 2019 Zhou, W. Ngo, L. H. Inouye, S. K. Gallagher, J. Husser, E. K. Fick, D. M. Marcantonio, E. R.. J Gen Intern Med, 34:3 (354-5)
    • Title

      Does a Year Have 6 Months or 12? Implications for Delirium Detection Among Hospitalized Older General Medicine Patients.

    • Authors
      Zhou, W. Ngo, L. H. Inouye, S. K. Gallagher, J. Husser, E. K. Fick, D. M. Marcantonio, E. R.
    • Year
      2019
    • Journal
      J Gen Intern Med
    • URL
    • Abstract
    • PubMed ID
  • Serum soluble fibrinogen-like protein 2 concentration predicts delirium after acute pancreatitis. 2019 Xu, W. B. Hu, Q. H. Wu, C. N. Fan, Z. K. Song, Z. F.. Brain Behav, (e01261)
    • Title

      Serum soluble fibrinogen-like protein 2 concentration predicts delirium after acute pancreatitis.

    • Authors
      Xu, W. B. Hu, Q. H. Wu, C. N. Fan, Z. K. Song, Z. F.
    • Year
      2019
    • Journal
      Brain Behav
    • URL
    • Abstract
      OBJECTIVE: Inflammation can cause delirium. Soluble fibrinogen-like protein 2 (sFGL2) is a modulator of the immune response and more recently found to be a biomarker for brain injury. This study was designed to discover the predictive capability of serum sFGL2 concentrations for delirium after acute pancreatitis (AP). MATERIALS AND METHODS: In this prospective, observational study, serum sFGL2 concentrations were quantified in 184 healthy controls and in 184 AP patients. Disease severity was assessed by Acute Physiology and Chronic Health Care Evaluation II score, Ranson score, multiple organ dysfunction score, and sequential organ failure assessment score. Delirium was recorded during hospital stay. Predictors of delirium were identified using multivariate analysis. RESULTS: Serum sFGL2 concentrations were substantially higher in AP patients than in controls. Serum sFGL2 concentrations were intimately correlated with the preceding severity parameters. Serum sFGL2 and the aforementioned severity parameters were independent predictors for delirium. Under receiver operating characteristic curve, the discriminatory ability of serum sFGL2 was equivalent to those of the above-mentioned severity parameters. Moreover, serum sFGL2 dramatically improved the predictive value of the aforementioned severity parameters. CONCLUSIONS: Elevation of serum sFGL2 concentrations is strongly associated with the AP severity and has the potential to distinguish delirium after AP.
    • PubMed ID
  • Use of the brief Confusion Assessment Method in a veteran palliative care population: A pilot validation study. 2019 Wilson, J. E. Boehm, L. Samuels, L. R. Unger, D. Leonard, M. Roumie, C. Ely, E. W. Dittus, R. S. Misra, S. Han, J. H.. Palliat Support Care, (1-5)
    • Title

      Use of the brief Confusion Assessment Method in a veteran palliative care population: A pilot validation study.

    • Authors
      Wilson, J. E. Boehm, L. Samuels, L. R. Unger, D. Leonard, M. Roumie, C. Ely, E. W. Dittus, R. S. Misra, S. Han, J. H.
    • Year
      2019
    • Journal
      Palliat Support Care
    • URL
    • Abstract
      OBJECTIVE: Many patients with advanced serious illness or at the end of life experience delirium, a potentially reversible form of acute brain dysfunction, which may impair ability to participate in medical decision-making and to engage with their loved ones. Screening for delirium provides an opportunity to address modifiable causes. Unfortunately, delirium remains underrecognized. The main objective of this pilot was to validate the brief Confusion Assessment Method (bCAM), a two-minute delirium-screening tool, in a veteran palliative care sample. METHOD: This was a pilot prospective, observational study that included hospitalized patients evaluated by the palliative care service at a single Veterans' Administration Medical Center. The bCAM was compared against the reference standard, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Both assessments were blinded and conducted within 30 minutes of each other.ResultWe enrolled 36 patients who were a median of 67 years (interquartile range 63-73). The primary reasons for admission to the hospital were sepsis or severe infection (33%), severe cardiac disease (including heart failure, cardiogenic shock, and myocardial infarction) (17%), or gastrointestinal/liver disease (17%). The bCAM performed well against the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, for detecting delirium, with a sensitivity (95% confidence interval) of 0.80 (0.4, 0.96) and specificity of 0.87 (0.67, 0.96).Significance of ResultsDelirium was present in 27% of patients enrolled and never recognized by the palliative care service in routine clinical care. The bCAM provided good sensitivity and specificity in a pilot of palliative care patients, providing a method for nonpsychiatrically trained personnel to detect delirium.
    • PubMed ID
  • Relative cerebral hyperperfusion during cardiopulmonary bypass is associated with risk for postoperative delirium: a cross-sectional cohort study. 2019 Thudium, M. Ellerkmann, R. K. Heinze, I. Hilbert, T.. BMC Anesthesiology, 19:1 (35)
    • Title

      Relative cerebral hyperperfusion during cardiopulmonary bypass is associated with risk for postoperative delirium: a cross-sectional cohort study.

    • Authors
      Thudium, M. Ellerkmann, R. K. Heinze, I. Hilbert, T.
    • Year
      2019
    • Journal
      BMC Anesthesiology
    • URL
    • Abstract
      BACKGROUND: Our objective was to evaluate if changes in on-pump cerebral blood flow, relative to the pre-bypass baseline, are associated with the risk for postoperative delirium (POD) following cardiac surgery. METHODS: In 47 consecutive adult patients, right middle cerebral artery blood flow velocity (MCAV) was assessed using transcranial Doppler sonography. Individual values, measured during cardiopulmonary bypass (CPB), were normalized to the pre-bypass baseline value and termed MCAVrel. An MCAVrel > 100% was defined as cerebral hyperperfusion. Prevalence of POD was assessed using the Confusion Assessment Method for the Intensive Care Unit. RESULTS: Overall prevalence of POD was 27%. In the subgroup without POD, 32% of patients had experienced relative cerebral hyperperfusion during CPB, compared to 67% in the subgroup with POD (p < 0.05). The mean averaged MCAVrel was 90 (+/-21) % in the no-POD group vs. 112 (+/-32) % in the POD group (p < 0.05), and patients developing delirium experienced cerebral hyperperfusion during CPB for about 39 (+/-35) min, compared to 6 (+/-11) min in the group without POD (p < 0.001). In a subcohort with pre-bypass baseline MCAV (MCAVbas) below the median MCAVbas of the whole cohort, prevalence of POD was 17% when MCAVrel during CPB was kept below 100%, but increased to 53% when these patients actually experienced relative cerebral hyperperfusion. CONCLUSIONS: Our results suggest a critical role for cerebral hyperperfusion in the pathogenesis of POD following on-pump open-heart surgery, recommending a more individualized hemodynamic management, especially in the population at risk.
    • PubMed ID
  • Prediction of postoperative delirium by comprehensive geriatric assessment among elderly patients with hip fracture. 2019 Tao, L. Xiaodong, X. Qiang, M. Jiao, L. Xu, Z.. Ir J Med Sci,
    • Title

      Prediction of postoperative delirium by comprehensive geriatric assessment among elderly patients with hip fracture.

    • Authors
      Tao, L. Xiaodong, X. Qiang, M. Jiao, L. Xu, Z.
    • Year
      2019
    • Journal
      Ir J Med Sci
    • URL
    • Abstract
      BACKGROUND: The purpose of this study is to investigate whether the preoperative comprehensive geriatric assessment (CGA) would predict postoperative delirium (POD) in elderly patients with hip fracture. METHODS: This is an observational study, performed in a tertiary hospital from June 2014 to May 2018, which enrolled patients with hip fracture aged over 65 years. The comprehensive geriatric assessment for recruited patients was carried out before surgery. POD was recorded prospectively until discharge. Delirium was diagnosed according to the Confusion Assessment Method (CAM) algorithm. RESULTS: POD occurred in 22.09% of the 507 patients who underwent hip surgery. The Barthel index, Mini-Mental State Examination (MMSE), instrumental activities of daily living (IADL), vitality index, and Geriatric Depression Scale (GDS) results were related to the occurrence of POD. All of them were independent factors related to the occurrence of POD after adjusting other traditional risk factors. CONCLUSIONS: The comprehensive geriatric assessment before hip fracture surgery can predict the occurrence of POD in elderly patients.
    • PubMed ID
  • The Overlap Between Falls and Delirium in Hospitalized Older Adults: A Systematic Review. 2019 Sillner, A. Y. Holle, C. L. Rudolph, J. L.. Clin Geriatr Med, 35:2 (221-236)
    • Title

      The Overlap Between Falls and Delirium in Hospitalized Older Adults: A Systematic Review.

    • Authors
      Sillner, A. Y. Holle, C. L. Rudolph, J. L.
    • Year
      2019
    • Journal
      Clin Geriatr Med
    • URL
    • Abstract
      Falls frequently occur in persons with cognitive impairment, including delirium. This article presents a systematic review of the association between falls and delirium in adults aged 65 years or older. For the studies that compared falls and delirium, the risk ratio was consistently elevated (median RR 4.5, range 1.4-12.6) and statistically significant in all but one study. These results suggest that falls and delirium are inextricably linked. There is a need to further refine fall risk assessment tools and protocols to specifically include delirium for consideration as a risk factor that needs additional assessment and management.
    • PubMed ID
  • Depth of sedation as an interventional target to reduce postoperative delirium: mortality and functional outcomes of the Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients randomised clinical trial. 2019 Sieber, F. Neufeld, K. J. Gottschalk, A. Bigelow, G. E. Oh, E. S. Rosenberg, P. B. Mears, S. C. Stewart, K. J. Ouanes, J. P. P. Jaberi, M. Hasenboehler, E. A. Wang, N. Y.. British Journal of Anaesthesia, 122:4 (480-9)
    • Title

      Depth of sedation as an interventional target to reduce postoperative delirium: mortality and functional outcomes of the Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients randomised clinical trial.

    • Authors
      Sieber, F. Neufeld, K. J. Gottschalk, A. Bigelow, G. E. Oh, E. S. Rosenberg, P. B. Mears, S. C. Stewart, K. J. Ouanes, J. P. P. Jaberi, M. Hasenboehler, E. A. Wang, N. Y.
    • Year
      2019
    • Journal
      British Journal of Anaesthesia
    • URL
    • Abstract
      Background: The Strategy to Reduce the Incidence of Postoperative Delirium in the Elderly trial tested the hypothesis that limiting sedation during spinal anaesthesia decreases in-hospital postoperative delirium after hip fracture repair. This manuscript reports the secondary outcomes of this trial, including mortality and function. Methods: Two hundred patients (≥65 yr) undergoing hip fracture repair with spinal anaesthesia were randomised to heavier [modified Observer's Assessment of Alertness/Sedation score (OAA/S) 0–2] or lighter (OAA/S 3–5) sedation, and were assessed for postoperative delirium. Secondary outcomes included mortality and return to pre-fracture ambulation level at 1 yr. Kaplan–Meier analysis, multivariable Cox proportional hazard model, and logistic regression were used to evaluate intervention effects on mortality and odds of ambulation return. Results: One-year mortality was 14% in both groups (log rank P=0.96). Independent risk factors for 1-yr mortality included: Charlson comorbidity index [hazard ratio (HR)=1.23, 95% confidence interval (CI), 1.02–1.49; P=0.03], instrumental activities of daily living [HR=0.74, 95% CI, 0.60–0.91; P=0.005], BMI [HR=0.91, 95% CI 0.84–0.998; P=0.04], and delirium severity [HR=1.20, 95% CI, 1.03–1.41; P=0.02]. Ambulation returned to pre-fracture levels, worsened, or was not obtained in 64%, 30%, and 6% of 1 yr survivors, respectively. Lighter sedation did not improve odds of ambulation return at 1 yr [odds ratio (OR)=0.76, 95% CI, 0.24–2.4; P=0.63]. Independent risk factors for ambulation return included Charlson comorbidity index [OR=0.71, 95% CI, 0.53–0.97; P=0.03] and delirium [OR=0.32, 95% CI, 0.10–0.97; P=0.04]. Conclusions: This study found that in elderly patients having hip fracture surgery with spinal anaesthesia supplemented with propofol sedation, heavier intraoperative sedation was not associated with significant differences in mortality or return to pre-fracture ambulation up to 1 yr after surgery. Clinical trial registration: ClinicalTrials.gov NCT00590707.
    • PubMed ID
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