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: 3042

  • Screening for delirium after surgery: validation of the 4 A's test (4AT) in the post-anaesthesia care unit. 2019 Saller, T. MacLullich, A. M. J. Schafer, S. T. Crispin, A. Neitzert, R. Schule, C. von Dossow, V. Hofmann-Kiefer, K. F.. Anaesthesia,
    • Title

      Screening for delirium after surgery: validation of the 4 A's test (4AT) in the post-anaesthesia care unit.

    • Authors
      Saller, T. MacLullich, A. M. J. Schafer, S. T. Crispin, A. Neitzert, R. Schule, C. von Dossow, V. Hofmann-Kiefer, K. F.
    • Year
      2019
    • Journal
      Anaesthesia
    • URL
    • Abstract
      Postoperative delirium is common and has multiple adverse consequences. Guidelines recommend routine screening for postoperative delirium beginning in the post-anaesthesia care unit. The 4 A's test (4AT) is a widely used assessment tool for delirium but there are no studies evaluating its use in the post-anaesthesia care unit. We evaluated the performance of the 4AT in the post-anaesthesia care unit in a tertiary German medical centre. Adults who were able to provide informed consent, were not scheduled for postoperative intensive care, and who did not have dementia or severe neuropsychiatric disorders underwent screening by trained research staff with the Nurse Delirium Screening Scale and a new German translation of the 4AT in a random order at the point of discharge from the post-anaesthesia care unit. Reference standard assessment of delirium was psychiatric evaluation by experienced clinicians. Five hundred and forty-three patients (mean age (SD) 52 (18) years) were analysed; 22 (4.1%) patients developed delirium. The sensitivity and specificity of the 4AT were 95.5% (95%CI 77.2-99.9) and 99.2% (95%CI 98.1-99.8), respectively. The area under the receiver operator characteristic curve was 0.998 (95%CI 0.995-1.000). The Nursing Delirium Screening Scale had a sensitivity of 27.3% (95%CI 10.7-50.2) and specificity of 99.4% (95%CI 98.3-99.9), with an area under the curve of 0.761 (95%CI 0.629-0.894). These findings suggest that the 4AT is an effective and robust instrument for delirium detection in the post-anaesthesia care unit.
    • PubMed ID
  • Measuring the distress related to delirium in older surgical patients and their relatives. 2019 Partridge, J. S. L. Crichton, S. Biswell, E. Harari, D. Martin, F. C. Dhesi, J. K.. Int J Geriatr Psychiatry,
    • Title

      Measuring the distress related to delirium in older surgical patients and their relatives.

    • Authors
      Partridge, J. S. L. Crichton, S. Biswell, E. Harari, D. Martin, F. C. Dhesi, J. K.
    • Year
      2019
    • Journal
      Int J Geriatr Psychiatry
    • URL
    • Abstract
      OBJECTIVES: Delirium is a common postoperative complication with implications on morbidity and mortality. Less is known about the psychological impact of delirium in patients and relatives. This study aimed to quantitatively describe distress related to postoperative delirium in older surgical patients and their relatives using the distress thermometer, examine the association between degree of distress and features of delirium on the Delirium Rating Scale (DRS), and examine the association between recall of delirium and features of delirium on the DRS. METHODS: This prospective study recruited postoperative patients and their relatives following delirium. The distress thermometer was used to examine the degree of distress pertaining to delirium and was conducted during the hospitalization on resolution of delirium and then at 12-month follow-up. Associations between delirium-related distress in patient and relative participants and severity and features of delirium (DRS) were examined. RESULTS: One hundred two patients and 49 relatives were recruited. Median scores on the distress thermometer in patients who recalled delirium were 8/10. Relatives also showed distress (median distress thermometer score of 8/10). Associations were observed between severity and phenotypic features of delirium (delusions, labile affect, and agitation). Distress persisted at 12 months in patients and relatives. CONCLUSION: Distress related to postoperative delirium can be measured using a distress thermometer. Alongside approaches to reduce delirium incidence, interventions to minimize distress from postoperative delirium should be sought. Such interventions should be developed through robust research and if effective administered to patients, relatives, or carers.
    • PubMed ID
  • Functional Outcomes After Hip Fracture in Independent Community-Dwelling Patients. 2019 Ouellet, J. A. Ouellet, G. M. Romegialli, A. M. Hirsch, M. Berardi, L. Ramsey, C. M. Cooney, L. M., Jr. Walke, L. M.. Journal of Hospital Medicine, (E1-E3)
    • Title

      Functional Outcomes After Hip Fracture in Independent Community-Dwelling Patients.

    • Authors
      Ouellet, J. A. Ouellet, G. M. Romegialli, A. M. Hirsch, M. Berardi, L. Ramsey, C. M. Cooney, L. M., Jr. Walke, L. M.
    • Year
      2019
    • Journal
      Journal of Hospital Medicine
    • URL
    • Abstract
    • PubMed ID
  • Clinical characteristics and prognosis for delirium in Spanish internal medicine departments: An analysis from a large clinical-administrative database. 2019 Marco, J. Mendez, M. Cruz-Jentoft, A. J. Garcia Klepzig, J. L. Calvo, E. Canora, J. Zapatero, A. Barba, R.. Rev Clin Esp,
    • Title

      Clinical characteristics and prognosis for delirium in Spanish internal medicine departments: An analysis from a large clinical-administrative database.

    • Authors
      Marco, J. Mendez, M. Cruz-Jentoft, A. J. Garcia Klepzig, J. L. Calvo, E. Canora, J. Zapatero, A. Barba, R.
    • Year
      2019
    • Journal
      Rev Clin Esp
    • URL
    • Abstract
      OBJECTIVES: To investigate the prevalence of reported delirium and its associated factors and costs. DESIGN: Retrospective and descriptive analysis of a national clinical-administrative database that includes all patients hospitalised in Spain in internal medicine departments from January 2007 to December 2014. MATERIAL AND METHOD: The study included the patients' sociodemographic and clinical data (sex, age, diagnosis and procedures). RESULTS: The prevalence of reported delirium was 2.5% (114,343 of 4,628,397 discharge reports). Delirium was most common in the 81-90-year age group (48%) and in institutionalised patients (4.5% vs. 2.9%; P<.001). The diagnoses most associated with delirium were dementia (14% vs. 7% for patients without delirium), cerebrovascular disease (17% vs. 11%), malnutrition (4% vs. 2%), pressure ulcers (4% vs. 2%), dysphagia (2% vs. 0.2%) and hyponatraemia (5% vs. 2%) (P<.001 in all cases). Patients with delirium also had longer mean stays (11.85+/-13.15days vs. 9.49+/-11.17) and higher hospital mortality (OR: 1.41; 95%CI: 1.39-1.43; P=.0001). The costs attributable to delirium in 8years exceeded euro100 million (almost euro1,000 per hospitalisation/patient). We developed a predictive model for the risk of developing delirium, which has insufficient sensitivity but is useful for identifying low-risk patients. CONCLUSIONS: Patients who develop delirium during their hospitalisation in internal medicine have a longer stay, greater mortality and an increased risk of being institutionalised at discharge. Delirium is probably poorly reported in the discharge reports prepared by internists.
    • PubMed ID
  • Reducing Delirium and Improving Patient Satisfaction With a Perioperative Mindfulness Intervention: A Mixed-Methods Pilot Study. 2019 Lisann-Goldman, L. R. Pagnini, F. Deiner, S. G. Langer, E. J.. Holistic Nursing Practice, 33:3 (163-176)
    • Title

      Reducing Delirium and Improving Patient Satisfaction With a Perioperative Mindfulness Intervention: A Mixed-Methods Pilot Study.

    • Authors
      Lisann-Goldman, L. R. Pagnini, F. Deiner, S. G. Langer, E. J.
    • Year
      2019
    • Journal
      Holistic Nursing Practice
    • URL
    • Abstract
      Postoperative delirium (incidence estimated up to 82%) can be ameliorated with nonpharmacologic methods. Mindfulness has not yet been incorporated into these methods, although mindfulness has been demonstrated to help patients adapt to illness and hospitalization. To reduce postoperative delirium incidence and increase patient satisfaction, this study employs a program of thought exercises based on Langerian mindfulness. Preoperatively, cardiac surgical patients listened to a mindfulness or informational audio; mindfulness subjects were also guided by the principal investigator through mindfulness exercises. Postoperatively, mindfulness subjects were visited twice daily for mindfulness exercises. For all patients, delirium screening was performed twice daily. Before discharge, affective status and satisfaction with hospital stay were assessed. No patients who completed the study screened positive for delirium. Trends include (1) lower (improved) median anxiety and depression scores postoperatively when considering both study groups together; (2) both groups rated the hospital more favorably on global satisfaction measures; (3) both groups shared generally positive comments regarding the audio files (qualitative data). Audio files and mindfulness exercises are associated with patient satisfaction among cardiothoracic surgery patients. The absence of delirium precludes determination of the effectiveness of the intervention in reducing delirium incidence.
    • PubMed ID
  • Association between Inpatient Delirium and Hospital Readmission in Patients >/= 65 Years of Age: A Retrospective Cohort Study. 2019 LaHue, S. C. Douglas, V. C. Kuo, T. Conell, C. A. Liu, V. X. Josephson, S. A. Angel, C. Brooks, K. B.. J Hosp Med, 14:4 (201-6)
    • Title

      Association between Inpatient Delirium and Hospital Readmission in Patients >/= 65 Years of Age: A Retrospective Cohort Study.

    • Authors
      LaHue, S. C. Douglas, V. C. Kuo, T. Conell, C. A. Liu, V. X. Josephson, S. A. Angel, C. Brooks, K. B.
    • Year
      2019
    • Journal
      J Hosp Med
    • URL
    • Abstract
      BACKGROUND: Delirium affects more than seven million hospitalized adults in the United States annually. However, its impact on postdischarge healthcare utilization remains unclear. OBJECTIVE: To determine the association between delirium and 30-day hospital readmission. DESIGN: A retrospective cohort study. SETTING: A general community medical and surgical hospital. PATIENTS: All adults who were at least 65 years old, without a history of delirium or alcohol-related delirium, and were hospitalized from September 2010 to March 2015. MEASUREMENTS: The patients deemed at risk for or displaying symptoms of delirium were screened by nurses using the Confusion Assessment Method with a followup by a staff psychiatrist for a subset of screen-positive patients. Patients with delirium confirmed by a staff psychiatrist were compared with those without delirium. The primary outcome was the 30-day readmission rate. The secondary outcomes included emergency department (ED) visits 30 days postdischarge, mortality during hospitalization and 30 days postdischarge, and discharge location. RESULTS: The cohort included 718 delirious patients and 7,927 nondelirious patients. Using an unweighted multivariable logistic regression, delirium was determined to be significantly associated with the increased odds of readmission within 30 days of discharge (odds ratio (OR): 2.60; 95% CI, 1.96-3.44; P < .0001). Delirium was also significantly (P < .0001) associated with ED visits within 30 days postdischarge (OR: 2.18; 95% CI: 1.77-2.69) and discharge to a facility (OR: 2.52; 95% CI: 2.09-3.01). CONCLUSIONS: Delirium is a significant predictor of hospital readmission, ED visits, and discharge to a location other than home. Delirious patients should be targeted to reduce postdischarge healthcare utilization.
    • PubMed ID
  • Feasibility and acceptability of family administration of delirium detection tools in the intensive care unit: a patient-oriented pilot study. 2019 Krewulak, K. D. Sept, B. G. Stelfox, H. T. Ely, E. W. Davidson, J. E. Ismail, Z. Fiest, K. M.. CMAJ Open, 7:2 (e294-e299)
    • Title

      Feasibility and acceptability of family administration of delirium detection tools in the intensive care unit: a patient-oriented pilot study.

    • Authors
      Krewulak, K. D. Sept, B. G. Stelfox, H. T. Ely, E. W. Davidson, J. E. Ismail, Z. Fiest, K. M.
    • Year
      2019
    • Journal
      CMAJ Open
    • URL
    • Abstract
      BACKGROUND: Family-administered delirium detection tools may serve as valuable diagnostic adjuncts because family caregivers may be better able than providers to detect changes in patient cognition and behaviour from pre-illness levels of functioning. The aim of this pilot study was to assess the feasibility and acceptability of family-administered tools to detect delirium in critically ill patients. METHODS: In this single-centre pilot tool validation study conducted in August and September 2017, eligible family caregivers used the Family Confusion Assessment Method (FAM-CAM) and the Sour Seven questionnaire to detect delirium during the patient's intensive care unit (ICU) stay. We calculated descriptive statistics for all study variables. Patients and family caregivers were involved as research partners throughout the study. A patient-orient research approach was taken, engaging patients and family caregivers as full partners. RESULTS: Of 141 patients admitted to the ICU, 75 were eligible, of whom 53 were approached; 21 patients (40%), 23/38 family caregivers (60%) and 17/38 dyads (i.e., patient and family caregiver enrolled together) (45%) consented to participate. The most common reason for nonenrolment was refusal by the family, who commonly reported feeling overwhelmed. The completion rate for the FAM-CAM and Sour Seven questionnaire was 74% (17/23). Among 13 dyads, family caregivers detected delirium in 5 patients (38%) using the FAM-CAM, and delirium or possible delirium in 8 patients (62%) using the Sour Seven questionnaire, whereas trained research assistants detected delirium in 8 patients (62%) using the Confusion Assessment Method for the Intensive Care Unit 7 and the Richmond Agitation-Sedation Scale (kappa coefficient for agreement between the former and the FAM-CAM and Sour Seven questionnaire 0.62 and 0.85, respectively). INTERPRETATION: Administration of the FAM-CAM and Sour Seven questionnaire by family caregivers to detect delirium in the ICU is feasible and acceptable, although, as with most family engagement strategies, it was not desired by all. Results from this pilot study support a definitive study with a larger sample to enable calculation of inferential statistics, but additional recruitment strategies are necessary to improve the response rate. Trial registration: Clinicaltrials.gov, no. NCT03379129.
    • PubMed ID
  • Diabetes and elevated preoperative hba1c level as risk factors for postoperative delirium after cardiac surgery: An observational cohort study. 2019 Kotfis, K. Szylińska, A. Listewnik, M. Brykczyński, M. Ely, E. W. Rotter, I.. Neuropsychiatric Disease and Treatment, (511-521)
    • Title

      Diabetes and elevated preoperative hba1c level as risk factors for postoperative delirium after cardiac surgery: An observational cohort study.

    • Authors
      Kotfis, K. Szylińska, A. Listewnik, M. Brykczyński, M. Ely, E. W. Rotter, I.
    • Year
      2019
    • Journal
      Neuropsychiatric Disease and Treatment
    • URL
    • Abstract
      Introduction: Postoperative delirium (POD) is a common complication of cardiac surgery associated with increased mortality, morbidity, and long-term cognitive dysfunction. Diabetic patients, especially those with poor diabetes control and long-standing hyperglycemia, may be at risk of developing delirium. The aim of this study was to analyze whether the occurrence of POD in cardiac surgery is associated with diabetes or elevated preoperative glycated hemoglobin (HbA1c) level. Materials and methods: We performed a cohort analysis of prospectively collected data from a register of cardiac surgery department of a university hospital. Delirium assessment was performed twice a day during the first 5 days after the operation based on Diagnostic Statistical Manual of Mental Disorders, fifth edition criteria. Results: We analyzed a cohort of 3,178 consecutive patients, out of which 1,010 (31.8%) were diabetic and 502 (15.8%) were diagnosed with POD. Patients with delirium were more often diabetic (42.03% vs 29.86%, P<0.001) and on oral diabetic medications (34.66% vs 24.07%, P<0.001), no difference was found in patients with insulin treatment. Preoperative HbA1c was elevated above normal (≥6%) in more delirious than nondelirious patients (44.54% vs 33.04%, P<0.001), but significance was reached only in nondiabetic patients (20.44% vs 14.86%, P=0.018). In univariate analysis, the diagnosis of diabetes was associated with an increased risk of developing POD (OR: 1.703, 95% CI: 1.401-2.071, P<0.001), but only for patients on oral diabetic medications (OR: 1.617, 95% CI: 1.319-1.983, P<0.001) and an association was noted between HbA1c and POD (OR: 1.269, 95% CI: 1.161-1.387, P<0.001). Multivariate analysis controlled for diabetes showed that POD was associated with age, heart failure, preoperative creatinine, extracardiac arteriopathy, and preoperative HbA1c level. Conclusion: More diabetic patients develop POD after cardiac surgery than nondiabetic patients. Elevated preoperative HbA1c level is a risk factor for postcardiac surgery delirium regardless of the diagnosis of diabetes.
    • PubMed ID
  • Evaluation of Changes in Functional Status in the Year after Aortic Valve Replacement. 2019 Kim, D. H. Afilalo, J. Shi, S. M. Popma, J. J. Khabbaz, K. R. Laham, R. J. Grodstein, F. Guibone, K. Lux, E. Lipsitz, L. A.. JAMA Intern Med, 179:3 (383-391)
    • Title

      Evaluation of Changes in Functional Status in the Year after Aortic Valve Replacement.

    • Authors
      Kim, D. H. Afilalo, J. Shi, S. M. Popma, J. J. Khabbaz, K. R. Laham, R. J. Grodstein, F. Guibone, K. Lux, E. Lipsitz, L. A.
    • Year
      2019
    • Journal
      JAMA Intern Med
    • URL
    • Abstract
      Importance: Functional status is a patient-centered outcome that is important for a meaningful gain in health-related quality of life after aortic valve replacement. Objective: To determine functional status trajectories in the year after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Design, Setting, and Participants: A prospective cohort study with a 12-month follow-up was conducted at a single academic center in 246 patients undergoing TAVR or SAVR for severe aortic stenosis. The study was conducted between February 1, 2014, and June 30, 2017; data analysis was performed from December 27, 2017, to May 7, 2018. Exposures: Preoperative comprehensive geriatric assessment was performed and a deficit-accumulation frailty index (CGA-FI) (range, 0-1; higher values indicate greater frailty) was calculated. Main Outcomes and Measures: Telephone interviews were conducted to assess self-reported ability to perform 22 activities and physical tasks at 1, 3, 6, 9, and 12 months after the procedure. Results: Of the 246 patients included in the study, 143 underwent TAVR (74 [51.7%] women; mean [SD] age, 84.2 [5.9] years), and 103 underwent SAVR (46 [44.7%] women; age, 78.1 [5.3] years). Five trajectories were identified based on functional status at baseline and during the follow-up: from excellent at baseline to improvement at follow-up (excellent baseline-improvement), good (high baseline-full recovery), fair (moderate baseline-minimal decline), poor (low baseline-moderate decline), and very poor (low baseline-large decline). After TAVR, the most common trajectory was fair (54 [37.8%]), followed by good (33 [23.1%]), poor (21 [14.7%]), excellent (20 [14.0%]), and very poor (12 [8.4%]) trajectories. After SAVR, the most common trajectory was good (39 [37.9%]), followed by excellent (38 [36.9%]), fair (20 [19.4%]), poor (3 [2.9%]), and very poor (1 [1.0%]) trajectories. Preoperative frailty level was associated with lower probability of functional improvement and greater probability of functional decline. After TAVR, patients with CGA-FI level of 0.20 or lower had excellent (3 [50.0%]) or good (3 [50.0%]) trajectories, whereas most patients with CGA-FI level of 0.51 or higher had poor (10 [45.5%]) or very poor (5 [22.7%]) trajectories. After SAVR, most patients with CGA-FI level of 0.20 or lower had excellent (24 [58.5%]) or good (15 [36.6%]) trajectories compared with a fair trajectory (5 [71.4%]) in those with CGA-FI levels of 0.41 to 0.50. Postoperative delirium and major complications were associated with functional decline after TAVR (delirium present vs absent: 14 [50.0%] vs 11 [13.4%]; complications present vs absent: 14 [51.9%] vs 19 [16.4%]) or lack of improvement after SAVR (delirium present vs absent: 27 [69.2%] vs 31 [81.6%]; complications present vs absent: 10 [62.5%] vs 69 [79.3%]). Conclusions and Relevance: The findings suggest that functional decline or lack of improvement is common in older adults with severe frailty undergoing TAVR or SAVR. Although this nonrandomized study does not allow comparison of the effectiveness between TAVR and SAVR, anticipated functional trajectories may inform patient-centered decision making and perioperative care to optimize functional outcomes..
    • PubMed ID
  • Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: an early sign of postoperative complications. 2019 Hesse, S. Kreuzer, M. Hight, D. Gaskell, A. Devari, P. Singh, D. Taylor, N. B. Whalin, M. K. Lee, S. Sleigh, J. W. García, P. S.. British Journal of Anaesthesia, 122:5 (622-634)
    • Title

      Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: an early sign of postoperative complications.

    • Authors
      Hesse, S. Kreuzer, M. Hight, D. Gaskell, A. Devari, P. Singh, D. Taylor, N. B. Whalin, M. K. Lee, S. Sleigh, J. W. García, P. S.
    • Year
      2019
    • Journal
      British Journal of Anaesthesia
    • URL
    • Abstract
      Background: Postoperative delirium is associated with an increased risk of morbidity and mortality, especially in the elderly. Delirium in the postanaesthesia care unit (PACU) could predict adverse clinical outcomes. Methods: We investigated a potential link between intraoperative EEG patterns and PACU delirium as well as an association of PACU delirium with perioperative outcomes, readmission and length of hospital stay. The risk factors for PACU delirium were also explored. Data were collected from 626 patients receiving general anaesthesia for procedures that would not interfere with frontal EEG recording. Results: Of the 626 subjects enrolled, 125 tested positive for PACU delirium. Whilst age, renal failure, and pre-existing neurological disease were associated with PACU delirium in the univariable analysis, the multivariable analysis revealed the importance of information derived from the EEG, anaesthetic technique, anaesthesia duration, and history of stroke or neurodegenerative disease. The occurrence of EEG burst suppression during maintenance [odds ratio (OR)=1.86 (1.13–3.05)] and the type of EEG emergence trajectory may be predictive of PACU delirium. Specifically, EEG emergence trajectories lacking significant spindle power were strongly associated with PACU delirium, especially in cases that involved ketamine or nitrous oxide [OR=6.51 (3.00–14.12)]. Additionally, subjects with PACU delirium were at an increased risk for readmission [OR=2.17 (1.13–4.17)] and twice as likely to stay >6 days in the hospital. Conclusions: Specific EEG patterns were associated with PACU delirium. These findings provide valuable information regarding how the brain reacts to surgery and anaesthesia that may lead to strategies to predict PACU delirium and identify key areas of investigation for its prevention.
    • PubMed ID
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