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: 2700

  • An assistant workforce to improve screening rates and quality of care for older patients in the emergency department: findings of a pre- post, mixed methods study. 2018 Hullick, C. Conway, J. Higgins, I. Hewitt, J. Stewart, B. Dilworth, S. Attia, J.. BMC Geriatr, 18:1 (126)
    • Title

      An assistant workforce to improve screening rates and quality of care for older patients in the emergency department: findings of a pre- post, mixed methods study.

    • Authors
      Hullick, C. Conway, J. Higgins, I. Hewitt, J. Stewart, B. Dilworth, S. Attia, J.
    • Year
      2018
    • Journal
      BMC Geriatr
    • URL
    • Abstract
      BACKGROUND: Older people who present to the Emergency Department (ED) experience high rates of prevalent and incident delirium. This study aimed to determine whether an assistant workforce in the ED could effectively conduct screening to inform assessment and care planning for older people as well as enhance supportive care activities for prevention of delirium. METHODS: Using a pre-post design, data was collected before and after the introduction of Older Person Technical Assistants (OPTAs) in the ED. OPTA activity was recorded during the intervention period and a medical record audit undertaken prior to and 9 months after implementation. Data were analysed using descriptive statistics for OPTA activities. Weighted Kappa scores were calculated comparing concordance in screening scores between OPTAs and Aged Services Emergency Team Registered Nurses. Changes in the rates of documented screening and supportive care were analysed using Chi-square tests. Focus groups were conducted to explore clinicians' experiences of the OPTA role. RESULTS: Three thousand five hundred fourty two people were seen by OPTAs in 4563 ED Presentations between 1st July 2011 and 2012. The reproducibility of all screening tools were found to be high between the OPTAs and the RNs, with Kappas and ICCs generally all above 0.9. The medical record audit showed significant improvement in the rates of documented screening, including cognition from 1.5 to 38% (p < 0.001) and review of pain from 29 to 75% (p < 0.001). Supportive care such as being given fluids or food also improved from 13 to 49% (p < 0.001) and pressure care from 4.8 to 30% (p < 0.001). This was accomplished with no increase in ED length of stay among this age group. Focus group interviews described mixed responses and support for the OPTA role. CONCLUSIONS: An assistant workforce in an ED setting was found to provide comparable screening results and improve the rates of documented screening and supportive care provided to older people with or at risk of developing delirium in the ED. There is a need for a shared philosophy to the care of older people in the ED. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registration number is ACTRN12617000742370. It was retrospectively registered on 22nd May 2017.
    • PubMed ID
  • Cycling of Dexmedetomidine May Prevent Delirium After Liver Transplantation. 2018 Hong, K. S. Kim, N. R. Song, S. H. Hong, G.. Transplant Proc, 50:4 (1080-2)
    • Title

      Cycling of Dexmedetomidine May Prevent Delirium After Liver Transplantation.

    • Authors
      Hong, K. S. Kim, N. R. Song, S. H. Hong, G.
    • Year
      2018
    • Journal
      Transplant Proc
    • URL
    • Abstract
      BACKGROUND: Dexmedetomidine is useful for managing delirium. However, few studies have discussed the effect of dexmedetomidine on delirium after liver transplantation. Moreover, the studies have focused on treatment rather than prevention of delirium. This study found that dexmedetomidine cycling may prevent delirium by restoration of the circadian rhythm. METHODS: Of 38 patients who underwent liver transplantation between April 2013 and July 2016, 37 were retrospectively analyzed, except for 1 case of early mortality. The patients were divided into two groups, with 24 receiving dexmedetomidine for more than 3 days with cycling, and 13 receiving dexmedetomidine without cycling or for less than 3 days. Cycling was intended to restore circadian rhythm with high doses of dexmedetomidine at night and low doses during the day, while the patients remained intubated. After extubation, dexmedetomidine infusion was continued at night and discontinued during the day. The patients who used dexmedetomidine without cycling or for less than 3 days received dexmedetomidine without regard to circadian rhythm. RESULTS: Of the 24 patients who received dexmedetomidine for more than 3 days with cycling, 3 (12.5%) had delirium. In contrast, of the 12 patients who received dexmedetomidine without regard to circadian rhythm and the 1 who received dexmedetomidine cycling for less than 3 days, 6 (46.2%) had delirium (P = .042). Patients with hepatitis C showed higher prevalence of delirium (P = .022). CONCLUSION: Dexmedetomidine use for more than 3 days with cycling is useful for prevention of delirium after liver transplantation.
    • PubMed ID
  • Risk Factors for Postoperative Delirium After Gastrectomy in Gastric Cancer Patients. 2018 Honda, S. Furukawa, K. Nishiwaki, N. Fujiya, K. Omori, H. Kaji, S. Makuuchi, R. Irino, T. Tanizawa, Y. Bando, E. Kawamura, T. Terashima, M.. World J Surg,
    • Title

      Risk Factors for Postoperative Delirium After Gastrectomy in Gastric Cancer Patients.

    • Authors
      Honda, S. Furukawa, K. Nishiwaki, N. Fujiya, K. Omori, H. Kaji, S. Makuuchi, R. Irino, T. Tanizawa, Y. Bando, E. Kawamura, T. Terashima, M.
    • Year
      2018
    • Journal
      World J Surg
    • URL
    • Abstract
      PURPOSE: The incidence of postoperative delirium is reported to range from 9 to 87%; however, no report has focused on cases of postoperative delirium in gastric cancer surgery alone. Therefore, we investigated the incidence of and risk factors for postoperative delirium after gastrectomy in patients with gastric cancer. METHODS: A total of 1037 patients who underwent surgery were included in the study. Patients were divided into two groups-those with (delirium group) or without (non-delirium group) postoperative delirium-and their backgrounds were compared. The short-term outcomes and the overall survival were also investigated. RESULTS: Postoperative delirium was observed in 47 of 1037 patients (4.5%). A multivariate analysis revealed that male gender, age >/= 75 years, a history of cerebrovascular disease, and the habitual use of sleeping pills were independent predictive factors for postoperative delirium. The postoperative hospital stay was significantly longer in the postoperative delirium group than in the non-delirium group. Postoperative delirium was significantly associated with postoperative complications. The 3-year overall survival was 74.3% in the delirium group and 85.5% in the non-delirium group (log-rank p = 0.006). A multivariate analysis revealed that postoperative delirium was an independent prognostic factor, along with the age and cancer stage. CONCLUSION: The incidence of postoperative delirium was 4.5% in gastric cancer patients. Male gender, age >/= 75 years, a history of cerebrovascular disease, and the habitual use of narcoleptic agents were risk factors for postoperative delirium after gastrectomy in gastric cancer patients. Postoperative delirium was strongly associated with other postoperative complications and a poor survival after surgery.
    • PubMed ID
  • Factors Associated with the Effectiveness of Intravenous Administration of Chlorpromazine for Delirium in Patients with Terminal Cancer. 2018 Hasuo, H. Kanbara, K. Fujii, R. Uchitani, K. Sakuma, H. Fukunaga, M.. J Palliat Med,
    • Title

      Factors Associated with the Effectiveness of Intravenous Administration of Chlorpromazine for Delirium in Patients with Terminal Cancer.

    • Authors
      Hasuo, H. Kanbara, K. Fujii, R. Uchitani, K. Sakuma, H. Fukunaga, M.
    • Year
      2018
    • Journal
      J Palliat Med
    • URL
    • Abstract
      BACKGROUND: Delirium in patients with terminal cancer is irreversible and increases treatment resistance, which leads to a deterioration in quality of life. OBJECTIVE: To investigate factors affecting the effectiveness and safety of intravenous chlorpromazine for irreversible delirium in patients with terminal cancer. DESIGN/MEASUREMENTS: Multiple regression analysis for factors affecting treatment effectiveness was carried out based on a retrospective comparison between responders and nonresponders to intravenous chlorpromazine. SETTING/SUBJECTS: Ninety-seven patients with terminal cancer who were treated with intravenous chlorpromazine for irreversible delirium were included. RESULTS: The rate of patients with >/=50% improvement in mean Nursing Delirium Screening Scale score from pretreatment to day three of chlorpromazine treatment was 0.48 (95% confidence interval [CI]: 0.38-0.58). Factors affecting chlorpromazine treatment effectiveness were hyperactive delirium (odds ratio [OR]: 6.25, 95% CI: 1.14-34.5) and longer survival (OR: 1.096, 95% CI: 1.05-1.14). The mean chlorpromazine dose was low, at 17.9 mg/day. Adverse events were reported in 11 patients (11.3%) by day three of chlorpromazine treatment, and all were observed in patients who survived less than two weeks after chlorpromazine treatment. Patients who died, who had decreased blood pressure during chlorpromazine administration, and who showed acute akathisia all displayed shock index >/=1. CONCLUSIONS: Intravenous administration of low-dose chlorpromazine may be an effective and safe treatment option for delirium in patients with terminal cancer who have hyperactive delirium, longer predictive prognosis, and shock index <1.
    • PubMed ID
  • An evaluation of single question delirium screening tools in older emergency department patients. 2018 Han, J. H. Wilson, A. Schnelle, J. F. Dittus, R. S. Wesley Ely, E.. American Journal of Emergency Medicine,
    • Title

      An evaluation of single question delirium screening tools in older emergency department patients.

    • Authors
      Han, J. H. Wilson, A. Schnelle, J. F. Dittus, R. S. Wesley Ely, E.
    • Year
      2018
    • Journal
      American Journal of Emergency Medicine
    • URL
    • Abstract
      Objectives: To determine the diagnostic performances of several single question delirium screens. To the patient we asked: “Have you had any difficulty thinking clearly lately?” To the patient's surrogate, we asked: “Is the patient at his or her baseline mental status?” and “Have you noticed the patient's mental status fluctuate throughout the course of the day?” Methods: This was a prospective observational study that enrolled English speaking patients 65 years or older. A research assistant (RA) and emergency physician (EP) independently asked the patient and surrogate the single question delirium screens. The reference standard for delirium was a consultation-liaison psychiatrist's assessment using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria. All assessments were performed within 3 h and were all blinded to each other. Results: Of the 406 patients enrolled, 50 (12%) were delirious. A patient who was unable to answer the question “Have you had any difficulty thinking clearly lately?” was 99.7% (95% CI: 98.0%–99.9%) specific, but only 24.0% (95% CI: 14.3%–37.4%) sensitive for delirium when asked by the RA. The baseline mental status surrogate question was 77.1% (95% CI: 61.0%–87.9%) sensitive and 87.5% (95% CI: 82.8%–91.1%) specific for delirium when asked by the RA. The fluctuating course surrogate question was 77.1% (95% CI: 61.0%–87.9%) sensitive and 80.2% (95% CI: 74.8%–84.7%) specific. When asked by the EP, the single question delirium screens’ diagnostic performances were similar. Conclusions: The patient and surrogate single question delirium assessments may be useful for delirium screening in the ED.
    • PubMed ID
  • A contemporary population-based analysis of the incidence, cost, and outcomes of postoperative delirium following major urologic cancer surgeries. 2018 Ha, A. Krasnow, R. E. Mossanen, M. Nagle, R. Hshieh, T. T. Rudolph, J. L. Chang, S. L.. Urol Oncol,
    • Title

      A contemporary population-based analysis of the incidence, cost, and outcomes of postoperative delirium following major urologic cancer surgeries.

    • Authors
      Ha, A. Krasnow, R. E. Mossanen, M. Nagle, R. Hshieh, T. T. Rudolph, J. L. Chang, S. L.
    • Year
      2018
    • Journal
      Urol Oncol
    • URL
    • Abstract
      PURPOSE: Postoperative delirium (PD) is associated with poor outcomes and increased health care costs. The incidence, outcomes, and cost of delirium for major urologic cancer surgeries have not been previously characterized in a population-based analysis. MATERIALS AND METHODS: We performed a population-based, retrospective cohort study of patients with PD at 490 US hospitals between 2003 and 2013 to evaluate the incidence, outcomes, and cost of delirium after radical prostatectomy, radical nephrectomy, partial nephrectomy, and radical cystectomy (RC). Delirium was defined using ICD-9 codes in combination with postoperative antipsychotics, sitters, and restraints. Regression models were constructed to assess mortality, discharge disposition, length of stay (LOS), and direct hospital admission costs. Survey-weighted adjustment for hospital clustering achieved estimates generalizable to the US population. RESULTS: We identified 165,387 patients representing a weighted total of 1,097,355 patients. The overall incidence of PD was 2.7%, with the greatest incidence occurring after RC, with 6,268 cases (11%). Delirious patients had greater adjusted odds of in-hospital mortality (odds ratio [OR] = 3.65, P<0.001), 90-day mortality (OR = 1.47, P = 0.013), discharge with home health services (OR = 2.25, P<0.001), discharge to skilled nursing facilities (OR = 4.64, P<0.001), and a 0.9-day increase in median LOS (P<0.001). Patients with delirium also experienced a $2,697 increase in direct admission costs (P<0.001), with the greatest costs incurred in RC patients ($30,859 vs. $26,607; P<0.001). CONCLUSIONS: Patients with PD after urologic cancer surgeries experienced worse outcomes, prolonged LOS, and increased admission costs. The greatest incidence and costs were seen after RC. Further research is warranted to identify high-risk patients and devise preventative strategies.
    • PubMed ID
  • Risk Factors and Outcomes of Delirium in Older Patients Admitted to Postacute Care with and without Dementia. 2018 Gual, N. Morandi, A. Perez, L. M. Britez, L. Burbano, P. Man, F. Inzitari, M.. Dement Geriatr Cogn Disord, 45:1-2 (121-9)
    • Title

      Risk Factors and Outcomes of Delirium in Older Patients Admitted to Postacute Care with and without Dementia.

    • Authors
      Gual, N. Morandi, A. Perez, L. M. Britez, L. Burbano, P. Man, F. Inzitari, M.
    • Year
      2018
    • Journal
      Dement Geriatr Cogn Disord
    • URL
    • Abstract
      BACKGROUND: Delirium research is poorly studied in postacute care, a growing setting due to aging populations, as well as in dementia, a critical risk factor for delirium and particularly prevalent in postacute care. We investigated risk factors for delirium and its outcomes in older adults with and without dementia admitted to a subacute care unit (SCU) after exacerbated chronic conditions. METHODS: This is a prospective cohort study including patients >/=65 years old admitted to an SCU for 12 months. We collected demographics, comprehensive geriatric assessments, and presence of dementia and delirium at admission. Outcomes included discharge to previous living situation, mortality, and functional evolution. Due to the high prevalence of dementia, a subgroup analysis was performed to investigate specific risk factors for delirium and related outcomes. RESULTS: Of 909 patients (mean age [+/-SD] 85.8 +/- 6.7; 60% women, 47.5% with dementia), 352 (38.7%) developed delirium. The main risk factor for delirium was dementia (HR [95% CI] 5.2 [3.5-7.7]); age, functional status, and urinary tract infections were also independently associated with delirium. In dementia patients, only age (HR [95% CI] 1.0 [1.004-1.1]) and being male (HR [95% CI] 1.7 [1.04-2.6]) were associated with delirium. Delirium was associated with greater mortality (10.8 vs. 3.9%; p < 0.001) and greater functional decline in the entire sample (-12.3 vs. -6.4 Barthel index points; p < 0.001). In the dementia subgroup, patients with delirium experienced greater functional loss (p = 0.013) and less functional recovery (p = 0.025). CONCLUSIONS: In older patients admitted to postacute care, dementia is the main risk factor for delirium, and delirium carries worse clinical and functional outcomes. In patients with dementia, delirium is also relevant, since it entails a functional loss at admission and lower functional recovery.
    • PubMed ID
  • Frailty Assessment to Help Predict Patients at Risk of Delirium When Consulting the Emergency Department. 2018 Giroux, M. Sirois, M. J. Boucher, V. Daoust, R. Gouin, E. Pelletier, M. Berthelot, S. Voyer, P. Emond, M.. J Emerg Med,
    • Title

      Frailty Assessment to Help Predict Patients at Risk of Delirium When Consulting the Emergency Department.

    • Authors
      Giroux, M. Sirois, M. J. Boucher, V. Daoust, R. Gouin, E. Pelletier, M. Berthelot, S. Voyer, P. Emond, M.
    • Year
      2018
    • Journal
      J Emerg Med
    • URL
    • Abstract
      BACKGROUND: Delirium is underdiagnosed in seniors at emergency departments (EDs) even though it is a frequent complication and is associated with functional and cognitive decline. As frailty is an independent predictor of adverse events in seniors, screening for frailty in EDs may help identify those at risk of delirium. OBJECTIVES: To assess if screening older patients for frailty in EDs could help identify those at risk of delirium. METHODOLOGY: This study was part of the multicenter prospective cohort INDEED study. Patients aged >/= 65 years, initially free of delirium, with an ED stay >/= 8 h were followed up to 24 h after ward admission. Frailty was assessed at baseline using the Clinical Frailty Scale; seniors with a score >/= 5/7 were considered frail. Their delirium status was assessed twice daily using the Confusion Assessment Method. RESULTS: Among the 335 included patients, delirium occurred in 20/70 frail (28.6%) patients and in 20/265 (7.6%) robust ones. After adjusting for age and sex, the risk of delirium during ED stay was 3.13 (95% confidence interval 1.60-6.21) times higher in frail than in robust patients. Time between arrival to the ED and the incidence of delirium was also shorter for frail patients than for the robust ones (adjusted hazard ratio 2.44, 95% confidence interval 1.26-4.74). CONCLUSION: Increased frailty is associated with increased delirium during ED stays. Screening for frailty at emergency triage could help ED professionals identify seniors at higher risk of delirium.
    • PubMed ID
  • Performance of the French version of the 4AT for screening the elderly for delirium in the emergency department. 2018 Gagne, A. J. Voyer, P. Boucher, V. Nadeau, A. Carmichael, P. H. Pelletier, M. Gouin, E. Berthelot, S. Daoust, R. Wilchesky, M. Richard, H. Pelletier, I. Ballard, S. Lague, A. Emond, M.`. CJEM, (1-8)
    • Title

      Performance of the French version of the 4AT for screening the elderly for delirium in the emergency department.

    • Authors
      Gagne, A. J. Voyer, P. Boucher, V. Nadeau, A. Carmichael, P. H. Pelletier, M. Gouin, E. Berthelot, S. Daoust, R. Wilchesky, M. Richard, H. Pelletier, I. Ballard, S. Lague, A. Emond, M.`
    • Year
      2018
    • Journal
      CJEM
    • URL
    • Abstract
      CLINICIAN'S CAPSULE What is known about the topic? Delirium is frequent in older inpatients but often goes undetected. A short tool, the 4 A's Test (4AT), was created and validated for the detection of delirium. What did this study ask? This study compared the performance of the French version of the 4AT (4AT-F) with the Confusion Assessment Method (CAM) for the screening of delirium. What did this study find? The 4AT-F was a fast and reliable screening tool for delirium in the emergency department (ED). Why does this study matter to clinicians? Because of its quick administration time, it allows for systematic screening of patients at risk of delirium and cognitive impairment.
    • PubMed ID
  • Early rehabilitation to prevent postintensive care syndrome in patients with critical illness: a systematic review and meta-analysis 2018 Fuke, R. Hifumi, T. Kondo, Y. Hatakeyama, J. Takei, T. Yamakawa, K. Inoue, S. Nishida, O.. BMJ Open, 8:5
    • Title

      Early rehabilitation to prevent postintensive care syndrome in patients with critical illness: a systematic review and meta-analysis

    • Authors
      Fuke, R. Hifumi, T. Kondo, Y. Hatakeyama, J. Takei, T. Yamakawa, K. Inoue, S. Nishida, O.
    • Year
      2018
    • Journal
      BMJ Open
    • URL
    • Abstract
      INTRODUCTION: We examined the effectiveness of early rehabilitation for the prevention of postintensive care syndrome (PICS), characterised by an impaired physical, cognitive or mental health status, among survivors of critical illness. METHODS: We performed a systematic literature search of several databases (Medline, Embase and Cochrane Central Register of Controlled Trials) and a manual search to identify randomised controlled trials (RCTs) comparing the effectiveness of early rehabilitation versus no early rehabilitation or standard care for the prevention of PICS. The primary outcomes were short-term physical-related, cognitive-related and mental health-related outcomes assessed during hospitalisation. The secondary outcomes were the standardised, long-term health-related quality of life scores (EuroQol 5 Dimension (EQ5D) and the Medical Outcomes Study 36-Item Short Form Health Survey Physical Function Scale (SF-36 PF)). We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate the quality of evidence (QoE). RESULTS: Six RCTs selected from 5105 screened abstracts were included. Early rehabilitation significantly improved short-term physical-related outcomes, as indicated by an increased Medical Research Council scale score (standardised mean difference (SMD): 0.38, 95% CI 0.10 to 0.66, p=0.009) (QoE: low) and a decreased incidence of intensive care unit-acquired weakness (OR 0.42, 95% CI 0.22 to 0.82, p=0.01, QoE: low), compared with standard care or no early rehabilitation. However, the two groups did not differ in terms of cognitive-related delirium-free days (SMD: -0.02, 95% CI -0.23 to 0.20, QoE: low) and the mental health-related Hospital Anxiety and Depression Scale score (OR: 0.79, 95% CI 0.29 to 2.12, QoE: low). Early rehabilitation did not improve the long-term outcomes of PICS as characterised by EQ5D and SF-36 PF. CONCLUSIONS: Early rehabilitation improved only short-term physical-related outcomes in patients with critical illness. Additional large RCTs are needed.
    • PubMed ID
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