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: 3105

  • 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.. Journal of Hospital Medicine, 14:4 (201-206)
    • 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
      Journal of Hospital Medicine
    • 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 follow-up 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
  • Cerebral microbleeds are not associated with postoperative delirium and postoperative cognitive dysfunction in older individuals. 2019 Lachmann, G. Kant, I. Lammers, F. Windmann, V. Spies, C. Speidel, S. Borchers, F. Hadzidiakos, D. Hendrikse, J. Winterer, G. de Bresser, J.. PLoS One, 14:6 (e0218411)
    • Title

      Cerebral microbleeds are not associated with postoperative delirium and postoperative cognitive dysfunction in older individuals.

    • Authors
      Lachmann, G. Kant, I. Lammers, F. Windmann, V. Spies, C. Speidel, S. Borchers, F. Hadzidiakos, D. Hendrikse, J. Winterer, G. de Bresser, J.
    • Year
      2019
    • Journal
      PLoS One
    • URL
    • Abstract
      BACKGROUND: Cerebral microbleeds (CMB) occur in the context of cerebral small vessel disease. Other brain MRI markers of cerebral small vessel disease are associated with the occurrence of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD), but for CMB this is unknown. We aimed to study the association between CMB and the occurrence of POD and POCD in older individuals. METHODS: The current study consists of 65 patients (72+/-5 years) from the BIOCOG study, which is a prospective, observational study of patients who underwent an elective surgery of at least 60 minutes. Patients in the current study received a preoperative cerebral MRI scan including a 3D susceptibility-weighted imaging sequence to detect CMB. The occurrence of POD was screened for twice a day until postoperative day 7 by using the DSM-5, NuDesc, CAM, and CAM-ICU. The occurrence of POCD was determined by the reliable change index model at 7 days after surgery or discharge, respectively, and 3 months after surgery. Statistical analyses consisted of logistic regression adjusted for age and gender. RESULTS: A total of 39 CMB were detected in 17 patients (26%) prior to surgery. POD occurred in 14 out of 65 patients (22%). POCD at 7 days after surgery occurred in 11 out of 54 patients (20%) and in 3 out of 40 patients at the 3 month follow-up (8%). Preoperative CMB were not associated with the occurrence of POD (OR (95%-CI): 0.28 (0.05, 1.57); p = 0.147) or POCD at 7 days after surgery (0.76 (0.16, 3.54); p = 0.727) or at 3 months follow-up (0.61 (0.03, 11.64); p = 0.740). CONCLUSION: We did not find an association between preoperative CMB and the occurrence of POD or POCD. TRIAL REGISTRATION: clinicaltrials.gov (NCT02265263) on 23 September 2014.
    • PubMed ID
  • Multimodal prehabilitation to reduce the incidence of delirium and other adverse events in elderly patients undergoing elective major abdominal surgery: An uncontrolled before-and-after study. 2019 Janssen, T. L. Steyerberg, E. W. Langenberg, J. C. M. de Lepper, Cchavh Wielders, D. Seerden, T. C. J. de Lange, D. C. Wijsman, J. H. Ho, G. H. Gobardhan, P. D. van Alphen, R. van der Laan, L.. PLoS One, 14:6 (e0218152)
    • Title

      Multimodal prehabilitation to reduce the incidence of delirium and other adverse events in elderly patients undergoing elective major abdominal surgery: An uncontrolled before-and-after study.

    • Authors
      Janssen, T. L. Steyerberg, E. W. Langenberg, J. C. M. de Lepper, Cchavh Wielders, D. Seerden, T. C. J. de Lange, D. C. Wijsman, J. H. Ho, G. H. Gobardhan, P. D. van Alphen, R. van der Laan, L.
    • Year
      2019
    • Journal
      PLoS One
    • URL
    • Abstract
      BACKGROUND: Delirium is a common and serious complication in elderly patients undergoing major abdominal surgery, with significant adverse outcomes. Successful strategies or therapies to reduce the incidence of delirium are scarce. The objective of this study was to assess the role of prehabilitation in reducing the incidence of delirium in elderly patients. METHODS: A single-center uncontrolled before-and-after study was conducted, including patients aged 70 years or older who underwent elective abdominal surgery for colorectal carcinoma or an abdominal aortic aneurysm between January 2013 and October 2015 (control group) and between November 2015 and June 2018 (prehabilitation group). The prehabilitation group received interventions to improve patients' physical health, nutritional status, factors of frailty and preoperative anaemia prior to surgery. The primary outcome was incidence of delirium, diagnosed with the DSM-V criteria or the confusion assessment method. Secondary outcomes were additional complications, length of stay, unplanned ICU admission, length of ICU stay, readmission rate, institutionalization, and in-hospital or 30-day mortality. RESULT: A total of 360 control patients and 267 prehabilitation patients were included in the final analysis. The mean number of prehabilitation days was 39 days. The prehabilitation group had a higher burden of comorbidities and was more physically and visually impaired at baseline. At adjusted logistic regression analysis, delirium incidence was reduced significantly from 11.7 to 8.2% (OR 0.56; 95% CI 0.32-0.98; P = 0.043). No statistically significant effects were seen on secondary outcomes. CONCLUSION: Current prehabilitation program is feasible and safe, and can reduce delirium incidence in elderly patients undergoing elective major abdominal surgery. This program merits further evaluation. TRIAL REGISTRATION: Dutch Trial Registration, NTR5932.
    • PubMed ID
  • The importance of increased awareness for delirium in elderly patients with rib fractures after blunt chest wall trauma: a retrospective cohort study on risk factors and outcomes. 2019 Janssen, T. L. Hosseinzoi, E. Vos, D. I. Veen, E. J. Mulder, P. G. H. van der Holst, A. M. van der Laan, L.. BMC Emerg Med, 19:1 (34)
    • Title

      The importance of increased awareness for delirium in elderly patients with rib fractures after blunt chest wall trauma: a retrospective cohort study on risk factors and outcomes.

    • Authors
      Janssen, T. L. Hosseinzoi, E. Vos, D. I. Veen, E. J. Mulder, P. G. H. van der Holst, A. M. van der Laan, L.
    • Year
      2019
    • Journal
      BMC Emerg Med
    • URL
    • Abstract
      BACKGROUND: Rib fractures are common in ageing people after trauma and delirium is a complication often seen in acutely hospitalized elderly patients. For both conditions, elderly have an increased risk for institutionalization, morbidity, and mortality. This study is the first to investigate risk factors of delirium in elderly patients with rib fractures after trauma. METHODS: A retrospective chart review was performed on patients >/=65 years admitted with rib fractures after blunt chest wall trauma to the Amphia hospital Breda, the Netherlands, between July 2013 and June 2018. Baseline patient, trauma- and treatment-related characteristics were identified. The main objectives were identification of risk factors of delirium and investigation of the effect of delirium on outcomes after rib fractures. Outcomes were additional complications, length of hospital stay, need for institutionalization and mortality within six months. RESULTS: Forty-seven (24.6%) of 191 patients developed a delirium. Independent risk factors for delirium were increased age, physical impairment (lower KATZ-ADL score), nutritional impairment (higher SNAQ score) and the need for a urinary catheter, with odds ratios of 1.07, 0.78, 1.53 and 8.53 respectively. Overall, more complications were observed in patients with delirium. Median ICU and hospital length of stay were 4 and 7 days respectively, of which the latter was significantly longer for delirious patients (p < 0.001). Significantly more patients with delirium were discharged to a nursing home or rehabilitation institution (p < 0.001). The 6-month mortality in delirious patients was nearly twice as high as in non-delirious patients; however, differences did not reach statistical significance. CONCLUSION: Delirium in elderly patients with rib fractures is a serious and common complication, with a longer hospital stay and a higher risk of institutionalization as a consequence. Increased awareness for delirium is imperative, most importantly in older patients, in physically or nutritionally impaired patients and in patients in need of a urinary catheter.
    • PubMed ID
  • The Better Assessment of Illness Study for Delirium Severity: Study Design, Procedures, and Cohort Description. 2019 Hshieh, T. T. Fong, T. G. Schmitt, E. M. Marcantonio, E. R. D'Aquila, M. L. Gallagher, J. Xu, G. Guo, Y. R. Abrantes, T. F. Bertrand, S. E. Jones, R. N. Inouye, S. K. Hshie, T. T. Racine, A. Schulman-Green, D. Tabloski, P. A. Travison, T. Armstrong, B. Bu. Gerontology, 65:1 (20-29)
    • Title

      The Better Assessment of Illness Study for Delirium Severity: Study Design, Procedures, and Cohort Description.

    • Authors
      Hshieh, T. T. Fong, T. G. Schmitt, E. M. Marcantonio, E. R. D'Aquila, M. L. Gallagher, J. Xu, G. Guo, Y. R. Abrantes, T. F. Bertrand, S. E. Jones, R. N. Inouye, S. K. Hshie, T. T. Racine, A. Schulman-Green, D. Tabloski, P. A. Travison, T. Armstrong, B. Bu
    • Year
      2019
    • Journal
      Gerontology
    • URL
    • Abstract
      Background/Objectives: To describe the design, procedures, and cohort for the Better ASsessment of ILlness -(BASIL) study, which is conducted to develop and test new delirium severity measures, compare them with existing measures, and examine related clinical outcomes. Methods: Prospective cohort study with 1 year follow-up of study participants at a large teaching hospital in Boston, Massachusetts. After brief cognitive testing and the Delirium Symptom Interview, delirium and delirium severity were rated daily in the hospital using the Confusion Assessment Method (CAM) and CAM-Severity score, the Delirium Rating Scale-Revised-98 (DRS-R-98), and the Memorial Delirium Assessment Scale (MDAS). Other key study variables included comorbidity, physical function (basic and instrumental activities of daily living [ADL]), ratings of subjective health and well-being, and clinical outcomes (length of stay, 30 day rehospitalization, nursing home admission, healthcare utilization). Follow-up interviews occurred at 1- and 12-month with patients and families. In 42 patient interviews, inter-rater reliability for key variables was assessed. Results: Of 768 eligible patients approached, 469 were screened and 352 enrolled, yielding an overall study response rate of 67% for potentially eligible participants. The mean participant was 80.3 years old (SD 6.8) and 203 (58%) were female. The majority of patients were medically complex with Charlson Comorbidity Scores ≥2 (192 patients, 55%), and 102 (29%) met criteria for dementia. Inter-rater reliability assessments (n = 42 pairs) were high for overall ratings of presence or absence of delirium by CAM (κ = 1.0), delirium severity by DRS-R-98 and MDAS (weighted kappa, κ = 1.0 for each) and for ADL impairment (κ = 1.0). For eligible participants at each time point, 278 out of 308 (90%) completed the 1-month follow-up and 132 out of 256 (53%) have completed the 12-month follow-up to date, which is still in progress. Among those who completed interviews, there was only 1-3% missing data on most major outcomes (delirium, basic ADL, and readmission). Conclusion: The BASIL study presents an innovative effort to advance the conceptualization and measurement of delirium severity. Unique strengths include the diverse cohort with complete high quality data and longitudinal follow-up, along with detailed collection of multiple delirium measures daily during hospitalization.
    • PubMed ID
  • Inclusion, characteristics and outcomes of people requiring palliative care in studies of non-pharmacological interventions for delirium: A systematic review. 2019 Hosie, A. Siddiqi, N. Featherstone, I. Johnson, M. Lawlor, P. G. Bush, S. H. Amgarth-Duff, I. Edwards, L. Cheah, S. L. Phillips, J. Agar, M.. Palliat Med,
    • Title

      Inclusion, characteristics and outcomes of people requiring palliative care in studies of non-pharmacological interventions for delirium: A systematic review.

    • Authors
      Hosie, A. Siddiqi, N. Featherstone, I. Johnson, M. Lawlor, P. G. Bush, S. H. Amgarth-Duff, I. Edwards, L. Cheah, S. L. Phillips, J. Agar, M.
    • Year
      2019
    • Journal
      Palliat Med
    • URL
    • Abstract
      BACKGROUND: Delirium is common, distressing, serious and under-researched in specialist palliative care settings. OBJECTIVES: To examine whether people requiring palliative care were included in non-pharmacological delirium intervention studies in inpatient settings, how they were characterised and what their outcomes were. DESIGN: Systematic review (PROSPERO 2017 CRD42017062178). DATA SOURCES: Systematic search in March 2017 for non-pharmacological delirium intervention studies in adult inpatients. Database search terms were 'delirium', 'hospitalisation', 'inpatient', 'palliative care', 'hospice', 'critical care' and 'geriatrics'. Scottish Intercollegiate Guidelines Network methodological checklists guided risk of bias assessment. RESULTS: The 29 included studies were conducted between 1994 and 2015 in diverse settings in 15 countries (9136 participants, mean age = 76.5 years (SD = 8.1), 56% women). Most studies tested multicomponent interventions (n = 26) to prevent delirium (n = 19). Three-quarters of the 29 included studies (n = 22) excluded various groups of people requiring palliative care; however, inclusion criteria, participant diagnoses, illness severity and mortality indicated their presence in almost all studies (n = 26). Of these, 21 studies did not characterise participants requiring palliative care or report their specific outcomes (72%), four reported outcomes for older people with frailty, dementia, cancer and comorbidities, and one was explicitly focused on people receiving palliative care. Study heterogeneity and limitations precluded definitive determination of intervention effectiveness and only allowed interpretations of feasibility for people requiring palliative care. Acceptability outcomes (intervention adverse events and patients' subjective experience) were rarely reported overall. CONCLUSION: Non-pharmacological delirium interventions have frequently excluded and under-characterised people requiring palliative care and infrequently reported their outcomes.
    • PubMed ID
  • Optimizing the month of the year backwards test for delirium screening of older patients in the emergency department. 2019 Hasemann, W. Grossmann, F. F. Bingisser, R. Hafner, M. Breil, D. Kressig, R. W. Nickel, C. H.. Am J Emerg Med,
    • Title

      Optimizing the month of the year backwards test for delirium screening of older patients in the emergency department.

    • Authors
      Hasemann, W. Grossmann, F. F. Bingisser, R. Hafner, M. Breil, D. Kressig, R. W. Nickel, C. H.
    • Year
      2019
    • Journal
      Am J Emerg Med
    • URL
    • Abstract
      INTRODUCTION: Different scoring methods exist for the Month of the Year Backward Test (MBT), which is designed to detect inattention, the core feature of delirium. When used as a part of the modified Confusion Assessment Method for the Emergency Department (mCAM-ED), each error in the MBT scores one point. Because this scoring procedure is complex, we aimed to simplify the scoring method of the MBT. METHODS: This is a secondary analysis of a single center prospective validation study of the mCAM-ED comprising a sample of Emergency Department (ED) patients aged 65 or older presenting to our ED. DATA COLLECTION: Research assistants (RAs) who were trained nurses conducted the MBT. Geriatricians conducted the reference standard delirium assessment within 1h of the RA. RESULTS: For the scoring method "number of errors", optimal performance according the Youden index was achieved when 8 or more errors were reached resulting in an overall sensitivity of 0.95 and overall specificity of 0.94. The scoring method "number of errors in combination with time needed" resulted in a comparable result with minimally lower positive likelihood ratios. For the scoring method "last month in correct order", optimal performance according the Youden index was achieved with the month of September resulting in an overall sensitivity of 0.90 and an overall specificity of 0.89. DISCUSSION: We suggest omitting the factor time and using a more practical scoring method with good performance: "last month in correct order" with the requirement to reach September to rule out delirium.
    • PubMed ID
  • Efficacy of music on sedation, analgesia and delirium in critically ill patients. A systematic review of randomized controlled trials. 2019 Garcia Guerra, G. Almeida, L. Zorzela, L. King-Jones, S. Joffe, A. R. Hartling, L. Jou, H. Vohra, S.. J Crit Care, (75-80)
    • Title

      Efficacy of music on sedation, analgesia and delirium in critically ill patients. A systematic review of randomized controlled trials.

    • Authors
      Garcia Guerra, G. Almeida, L. Zorzela, L. King-Jones, S. Joffe, A. R. Hartling, L. Jou, H. Vohra, S.
    • Year
      2019
    • Journal
      J Crit Care
    • URL
    • Abstract
      PURPOSE: To systematically synthesize randomized controlled trial data on the efficacy of music to provide sedation and analgesia, and reduce incidence of delirium, in critically ill patients. MATERIAL AND METHODS: Relevant databases (Medline, PubMed, Embase, CINAHL, Cochrane, Alt Healthwatch, LILACS, PsycINFO, CAIRSS, RILM) were searched from inception to April 26, 2018. We also searched the reference lists of included publications and for ongoing trials. The selection of relevant articles was conducted by two researchers at two levels of screening. Data collection followed the recommendations from the Cochrane Systematic Reviews Handbook. We used the Cochrane Collaboration's tool for assessing risk of bias. Quality of the evidence was rated according to GRADE. RESULTS: The review identified six adult studies and no neonatal or pediatric studies. A descriptive analysis of study results was performed. Meta-analysis was not feasible due to heterogeneity. One study reported a reduction in sedation requirements with the use of music while the other five did not find any significant differences across groups. CONCLUSIONS: This systematic review revealed limited evidence to support or refute the use of music to reduce sedation/analgesia requirements, or to reduce delirium in critically ill adults, and no evidence in pediatric and neonatal critically ill patients.
    • PubMed ID
  • Comparison of Lurasidone Versus Quetiapine for the Treatment of Delirium in Critically Ill Patients. 2019 Fox, M. A. Elefritz, J. L. Huang, B. M. Hunley, C.. Journal of Intensive Care Medicine, 34:2 (172)
    • 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
      2019
    • Journal
      Journal of Intensive Care Medicine
    • URL
    • Abstract
    • PubMed ID
  • Postoperative Delirium and Postoperative Cognitive Dysfunction: Overlap and Divergence. 2019 Daiello, L. A. Racine, A. M. Yun Gou, R. Marcantonio, E. R. Xie, Z. Kunze, L. J. Vlassakov, K. V. Inouye, S. K. Jones, R. N. Alsop, D. Travison, T. Arnold, S. Cooper, Z. Dickerson, B. Fong, T. Metzger, E. Pascual-Leone, A. Schmitt, E. M. Shafi, M. Cavalla. Anesthesiology,
    • Title

      Postoperative Delirium and Postoperative Cognitive Dysfunction: Overlap and Divergence.

    • Authors
      Daiello, L. A. Racine, A. M. Yun Gou, R. Marcantonio, E. R. Xie, Z. Kunze, L. J. Vlassakov, K. V. Inouye, S. K. Jones, R. N. Alsop, D. Travison, T. Arnold, S. Cooper, Z. Dickerson, B. Fong, T. Metzger, E. Pascual-Leone, A. Schmitt, E. M. Shafi, M. Cavalla
    • Year
      2019
    • Journal
      Anesthesiology
    • URL
    • Abstract
      WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Postoperative delirium and postoperative cognitive dysfunction both occur in a substantial number of older surgical patientsPostoperative delirium and postoperative cognitive dysfunction share risk factors and may co-occur, although their relationship is unclear WHAT THIS ARTICLE TELLS US THAT IS NEW: Postoperative delirium increased the risk of postoperative cognitive dysfunction at 1 month postoperatively but there was no association between postoperative delirium and cognitive dysfunction at 2 and 6 months after major noncardiac surgeryPostoperative delirium and longer-term postoperative cognitive dysfunction may be different disorders BACKGROUND:: Postoperative delirium and postoperative cognitive dysfunction share risk factors and may co-occur, but their relationship is not well established. The primary goals of this study were to describe the prevalence of postoperative cognitive dysfunction and to investigate its association with in-hospital delirium. The authors hypothesized that delirium would be a significant risk factor for postoperative cognitive dysfunction during follow-up. METHODS: This study used data from an observational study of cognitive outcomes after major noncardiac surgery, the Successful Aging after Elective Surgery study. Postoperative delirium was evaluated each hospital day with confusion assessment method-based interviews supplemented by chart reviews. Postoperative cognitive dysfunction was determined using methods adapted from the International Study of Postoperative Cognitive Dysfunction. Associations between delirium and postoperative cognitive dysfunction were examined at 1, 2, and 6 months. RESULTS: One hundred thirty-four of 560 participants (24%) developed delirium during hospitalization. Slightly fewer than half (47%, 256 of 548) met the International Study of Postoperative Cognitive Dysfunction-defined threshold for postoperative cognitive dysfunction at 1 month, but this proportion decreased at 2 months (23%, 123 of 536) and 6 months (16%, 85 of 528). At each follow-up, the level of agreement between delirium and postoperative cognitive dysfunction was poor (kappa less than .08) and correlations were small (r less than .16). The relative risk of postoperative cognitive dysfunction was significantly elevated for patients with a history of postoperative delirium at 1 month (relative risk = 1.34; 95% CI, 1.07-1.67), but not 2 months (relative risk = 1.08; 95% CI, 0.72-1.64), or 6 months (relative risk = 1.21; 95% CI, 0.71-2.09). CONCLUSIONS: Delirium significantly increased the risk of postoperative cognitive dysfunction in the first postoperative month; this relationship did not hold in longer-term follow-up. At each evaluation, postoperative cognitive dysfunction was more common among patients without delirium. Postoperative delirium and postoperative cognitive dysfunction may be distinct manifestations of perioperative neurocognitive deficits.
    • PubMed ID
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