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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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: 3042

  • Evaluation of a Multidisciplinary Pain, Agitation, and Delirium Guideline in Mechanically Ventilated Critically Ill Adults. 2019 Heim, M. Draheim, R. Krupp, A. Breihan, P. O'Rourke, A. Wells, J. Fish, J.. Hosp Pharm, 54:2 (119-124)
    • Title

      Evaluation of a Multidisciplinary Pain, Agitation, and Delirium Guideline in Mechanically Ventilated Critically Ill Adults.

    • Authors
      Heim, M. Draheim, R. Krupp, A. Breihan, P. O'Rourke, A. Wells, J. Fish, J.
    • Year
      2019
    • Journal
      Hosp Pharm
    • URL
    • Abstract
      Background: A multidisciplinary team updated an institution-specific pain, agitation, and delirium (PAD) guideline based on the recommendations from the Society of Critical Care Medicine (SCCM) PAD guidelines. This institution-specific guideline emphasized protocolized sedation with increased as needed boluses, and nonbenzodiazepine infusions, daily sedation interruption, and pairing of spontaneous awakening (SAT) and breathing trials (SBT). Objective: The purpose of this study was to evaluate the impact of implementation of a PAD guideline on clinical outcomes and medication utilization in an academic medical center intensive care unit (ICU). It was hypothesized that implementation of an updated guideline would improve clinical outcomes and decrease usage of benzodiazepine infusions. Methods: Pre-post retrospective chart review of 2417 (1147 pre, 1270 post) critically ill, mechanically ventilated adults in a medical/surgical ICU over a 2-year period (1 year pre and post guideline implementation). Results: After guideline implementation, average ventilation days was reduced (3.98 vs 3.43 days, P = .0021), as well as ICU and hospital length of stay (LOS) (4.79 vs 4.34 days, P = .048 and 13.96 vs 12.97 days, P = .045, respectively). Hospital mortality (19 vs 19%, P = .96) and acute physiology and chronic health evaluation (APACHE) IV scores (77.28 vs 78.75, P = .27) were similar. After guideline implementation, the percentage of patients receiving midazolam infusions decreased (422/1147 [37%] vs 363/1270 patients [29%], P = .0001). The percentage of patients receiving continuous infusion propofol (679/1147 [59%] vs 896/1270 [70%], P = .0001) and dexmedetomidine (78/1147 [7%] vs 147/1270 [12%], P = .0001) increased. Conclusions: Implementing a multidisciplinary PAD guideline utilizing protocolized sedation and daily sedation interruption decreased ventilation days and ICU and hospital LOS while decreasing midazolam drip usage.
    • PubMed ID
  • Risk factors for postoperative delirium in patients undergoing microvascular decompression. 2019 He, Z. Cheng, H. Wu, H. Sun, G. Yuan, J.. PLoS One, 14:4 (e0215374)
    • Title

      Risk factors for postoperative delirium in patients undergoing microvascular decompression.

    • Authors
      He, Z. Cheng, H. Wu, H. Sun, G. Yuan, J.
    • Year
      2019
    • Journal
      PLoS One
    • URL
    • Abstract
      This study is to identify the risk factors for postoperative delirium (PODE) in patients undergoing microvascular decompression (MVD) for the treatment of primary cranial nerve disorders. We retrospectively reviewed the data of 912 patients (354 men, 558 women) with primary cranial nerve disorders (trigeminal neuralgia, 602 patients; hemifacial spasm, 296 patients; glossopharyngeal neuralgia, 14 patients) who underwent MVD in the Neurosurgery Department of Lanzhou University Second Hospital between July 2007 and June 2018. Potential risk factors for PODE were identified using univariate and multivariate stepwise logistic regression analysis.Of the 912 patients, 221 (24.2%) patients developed PODE. Patients with PODE were significantly older and significantly more likely to be male than patients without PODE. A history of hypertension, preoperative carbamazepine therapy, and postoperative sleep disturbance and tension pneumocephalus were independently associated with PODE. Variables such as body-mass index, smoking and drinking habits, cardiac disease, diabetes mellitus, cerebrovascular disease, mean operative time, affected vessel, mean blood loss, postoperative intensive care unit stay, postoperative fever (>38 degrees C), and routine laboratory results were not associated with PODE in our patients.PODE is a common complication after MVD, and is associated with multiple risk factors, including old age, male sex, hypertension, preoperative carbamazepine use, postoperative sleep disturbance, and tension pneumocephalus.
    • PubMed ID
  • Preliminary investigation of predictors of distress in informal caregivers of patients with delirium superimposed on dementia. 2019 Grossi, E. Lucchi, E. Gentile, S. Trabucchi, M. Bellelli, G. Morandi, A.. Aging Clin Exp Res,
    • Title

      Preliminary investigation of predictors of distress in informal caregivers of patients with delirium superimposed on dementia.

    • Authors
      Grossi, E. Lucchi, E. Gentile, S. Trabucchi, M. Bellelli, G. Morandi, A.
    • Year
      2019
    • Journal
      Aging Clin Exp Res
    • URL
    • Abstract
      OBJECTIVE: Delirium superimposed on dementia (DSD) is common and associated with adverse outcomes. Current evidence indicates that some patients with dementia may recall delirium with distress for them and their caregivers. The aim of this study is to identify predictors of distress in informal caregivers of older patient with DSD. METHODS: A total of 33 caregivers of 33 patients with DSD were interviewed 3 days after the resolution of delirium (T0) and at 1-month follow-up (T1) to describe their level of distress related to the delirium episode. A linear regression was used to identify predictors of caregivers' distress at T0 and T1 defined a priori: age, sex, level of education, employment status, delirium subtypes, delirium severity, type and severity of dementia, and the time spent with the patient during the delirium episode. RESULTS: Caregivers were mostly female (81%), 59 (+/- 13.0) years old on average. The predictors of distress at T0 were the patient's severity of both dementia and delirium. Moderate dementia was associated with lower distress, whereas higher delirium severity was associated with greater distress. At 1-month follow-up, the predictors of distress were the age of caregiver and time spent in care; the distress level was higher when caregivers were older, and they spent less time with their loved one. CONCLUSIONS: These preliminary findings underline the importance of providing continuous training and support for the caregivers, especially in coping strategies, in order to improve the care of DSD patients and prevent the caregivers' distress in long time period.
    • PubMed ID
  • Use of the confusion assessment method in multicentre delirium trials: training and standardisation. 2019 Green, J. R. Smith, J. Teale, E. Collinson, M. Avidan, M. S. Schmitt, E. M. Inouye, S. K. Young, J.. BMC Geriatr, 19:1 (107)
    • Title

      Use of the confusion assessment method in multicentre delirium trials: training and standardisation.

    • Authors
      Green, J. R. Smith, J. Teale, E. Collinson, M. Avidan, M. S. Schmitt, E. M. Inouye, S. K. Young, J.
    • Year
      2019
    • Journal
      BMC Geriatr
    • URL
    • Abstract
      BACKGROUND: Delirium occurs commonly in older adults and is associated with adverse outcomes. Multicentre clinical trials evaluating interventions to prevent delirium are needed. The Confusion Assessment Method (CAM) is a validated instrument for delirium detection. We hypothesised it would be possible for a large feasibility study to train a large number of research assistants, with varying experience levels, to conduct CAM assessments reliably in multiple hospital sites. METHODS: A standardised training programme was followed, incorporating structured training at a central location and at study sites. CAM practice sessions on both delirious and non-delirious patients by research assistants were conducted and, thereafter, there was ongoing inter-rater reliability assessment on the CAM between research assistant pairs at study sites. The setting was eight acute care hospitals in England and Wales. Participants were research assistants working on a multicentre feasibility study of delirium prevention. The measurement used was the Confusion Assessment Method. RESULTS: Thirty-seven research assistants were trained in CAM assessment and 33 returned training logs. The logs showed there was 100% overall agreement between research assistant pairs on 295 CAM assessments, of which 263 (89.2%) were negative for delirium and 32 (10.8%) were positive. In the course of the feasibility study, research assistants successfully completed 5065 (89.7%) of the 5645 expected CAM assessments, with minimal missing data. CONCLUSION: Using the training methods described in this study, it is possible to achieve high quality delirium assessments for large numbers of patients with little missing data across geographically dispersed sites in multicentre studies. The standardisation of multisite delirium assessments is an important contribution to research methodology, and provides a much-needed advance for the field. TRIAL REGISTRATION: ISRCT ISRCTN01187372 . Registered 13 March 2014.
    • PubMed ID
  • Distinguishing characteristics of delirium in a skilled nursing facility in Spain: Influence of baseline cognitive status. 2019 Franco, J. G. Trzepacz, P. T. Gaviria, A. M. Sepulveda, E. Vinuelas, E. Palma, J. Grau, I. Vilella, E.. Int J Geriatr Psychiatry,
    • Title

      Distinguishing characteristics of delirium in a skilled nursing facility in Spain: Influence of baseline cognitive status.

    • Authors
      Franco, J. G. Trzepacz, P. T. Gaviria, A. M. Sepulveda, E. Vinuelas, E. Palma, J. Grau, I. Vilella, E.
    • Year
      2019
    • Journal
      Int J Geriatr Psychiatry
    • URL
    • Abstract
      OBJECTIVE: Mild cognitive impairment (MCI) and dementia (DEM) are prevalent in skilled nursing facilities (SNF), confounding delirium detection. We report characteristics of delirium in a SNF to ascertain distinguishing features for delirium diagnosis, despite challenges of comorbidity with MCI and DEM. METHODS: Cross-sectional study of 200 consecutive patients from a SNF in Catalunya, Spain; assessed within the first 24-48 admission hours by independent experts with: Spanish-Informant Questionnaire on Cognitive Decline in the Elderly (for MCI-DEM), DSM-5 delirium criteria, and Delirium Rating Scale Revised-98 (DRS-R98) for delirium phenomenology. Delirium characteristics were modeled in successive steps, according to the presence of delirium and MCI-DEM, with ANOVA, receiver operator characteristics analyses, and conditional logistic regression. RESULTS: The final model produced symptoms that represented each of the three delirium core domains (i.e., Cognitive, Higher Order Thinking, and Circadian). The DRS-R98 items rated these symptoms as: moderate-severe attention/vigilance, mild-severe language, and moderate-severe sleep-wake cycle alterations. The delirium discriminant accuracy of the three symptoms together was high: 84.6% in the MCI-DEM group to 92.8% in the No MCI-DEM group. CONCLUSIONS: Impairments of attention, language and sleep-wake cycle indicate delirium in SNF patients regardless of the underlying MCI-DEM status. Because delirium is under-detected in SNFs, where nursing staff/patient ratios are low, brief simple tools that measures these symptoms could potentially enhance delirium detection.
    • PubMed ID
  • Modifiable Risk Factors for Delirium in Critically Ill Trauma Patients: A Multicenter Prospective Study. 2019 Duceppe, M. A. Williamson, D. R. Elliott, A. Para, M. Poirier, M. C. Delisle, M. S. Deckelbaum, D. Razek, T. Desjardins, M. Bertrand, J. C. Bernard, F. Rico, P. Burry, L. Frenette, A. J. Perreault, M.. J Intensive Care Med, 34:4 (330-6)
    • Title

      Modifiable Risk Factors for Delirium in Critically Ill Trauma Patients: A Multicenter Prospective Study.

    • Authors
      Duceppe, M. A. Williamson, D. R. Elliott, A. Para, M. Poirier, M. C. Delisle, M. S. Deckelbaum, D. Razek, T. Desjardins, M. Bertrand, J. C. Bernard, F. Rico, P. Burry, L. Frenette, A. J. Perreault, M.
    • Year
      2019
    • Journal
      J Intensive Care Med
    • URL
    • Abstract
      OBJECTIVE:: Intensive care unit (ICU)-acquired delirium has been associated with increased morbidity and mortality. Prevention strategies including modification of delirium risk factors are emphasized by practice guidelines. No study has specifically evaluated modifiable delirium risk factors in trauma ICU patients. Our goal was to evaluate modifiable risk factors for delirium among trauma patients admitted to the ICU. DESIGN:: Prospective observational study. SETTING:: Two level 1 trauma ICU centers. PATIENTS:: Patients 18 years of age or older admitted for trauma including mild to moderate traumatic brain injury were eligible for the study. INTERVENTIONS AND MEASUREMENTS:: Delirium was assessed daily using the confusion assessment method for the ICU (CAM-ICU). The effect of modifiable risk factors was assessed using multivariate Cox regression analysis adjusting for severity of illness and significant nonmodifiable risk factors. MAIN RESULTS:: A total of 58 of 150 recruited patients (38.7%; 95% confidence interval [CI] 30.9-46.5) screened positive for delirium during ICU stay. When adjusting for significant nonmodifiable risk factors, physical restraints (hazard ratio [HR]: 2.13; 95% CI: 1.07-4.24) and active infection or sepsis (HR: 2.12; 95% CI: 1.18-3.81) significantly increased the risk of delirium, whereas opioids (HR: 0.35; 95% CI: 0.13-0.98), episodes of hypoxia (HR: 0.55; 95% CI: 0.31-0.95), access to a television/radio in the room (HR: 0.26; 95% CI: 0.11-0.62), and number of hours mobilized per day (HR: 0.77; 95% CI: 0.68-0.88) were associated with significantly less risk of delirium. CONCLUSION:: We have identified modifiable risk factors for delirium. Future studies should aim at implementing strategies to modify these risk factors and evaluate their impact on the risk of delirium.
    • PubMed ID
  • Delirium after hip hemiarthroplasty for proximal femoral fractures in elderly patients: Risk factors and clinical outcomes. 2019 de Jong, L. van Rijckevorsel, V. A. J. I. M. Raats, J. W. Klem, T. M. A. L. Kuijper, T. M. Roukema, G. R.. Clinical Interventions in Aging, (427-435)
    • Title

      Delirium after hip hemiarthroplasty for proximal femoral fractures in elderly patients: Risk factors and clinical outcomes.

    • Authors
      de Jong, L. van Rijckevorsel, V. A. J. I. M. Raats, J. W. Klem, T. M. A. L. Kuijper, T. M. Roukema, G. R.
    • Year
      2019
    • Journal
      Clinical Interventions in Aging
    • URL
    • Abstract
      Background: The primary aim of the present study was to verify the potential risk factors for developing a delirium after hip fracture surgery. The secondary aim of this study was to examine the related clinical outcomes after a delirium developed post-hip fracture surgery. Patients and methods: Data were extracted from a prospective hip fracture database and completed by retrospective review of the hospital records. A total of 463 patients undergoing hip fracture (hip hemiarthroplasty) surgery in a level II trauma teaching hospital between January 2011 and May 2016 were included. Delirium was measured using the Delirium Observation Screening Scale, the confusion assessment method, and an observatory judgment by geriatric medicine specialists. Results: The results showed that 26% of the patients (n=121) developed a delirium during hospital stay with a median duration during admission of 5 days (IQR 3–7). The multivariable model showed that the development of delirium was significantly explained by dementia (OR 2.75, P=0.001), age (OR 1.06, P=0.005), and an infection during admission (pneumonia, deep surgical site infection, or urinary tract infection) (OR 1.23, P=0.046). After 1 year of follow-up, patients who developed delirium after hip fracture surgery were significantly more discharged to (semi-independent) nursing homes (P,0.001) and had a significantly higher mortality rate (P,0.001) compared to patients without delirium after hip fracture surgery. Conclusions: The results showed that 26% of the patients undergoing hip fracture surgery developed a delirium. The risk factors including age, dementia, and infection during admission significantly predicted the development of the delirium. No association was confirmed between delirium and time of admission or time to surgery. The development of delirium after hip fracture surgery was subsequently found to be a significant predictor of admission to a nursing home and mortality after 1 year.
    • PubMed ID
  • Frailty Identification and Care Pathway: An Interdisciplinary Approach to Care for Older Trauma Patients. 2019 Bryant, E. A. Tulebaev, S. Castillo-Angeles, M. Moberg, E. Senglaub, S. S. O'Mara, L. McDonald, M. Salim, A. Cooper, Z.. J Am Coll Surg,
    • Title

      Frailty Identification and Care Pathway: An Interdisciplinary Approach to Care for Older Trauma Patients.

    • Authors
      Bryant, E. A. Tulebaev, S. Castillo-Angeles, M. Moberg, E. Senglaub, S. S. O'Mara, L. McDonald, M. Salim, A. Cooper, Z.
    • Year
      2019
    • Journal
      J Am Coll Surg
    • URL
    • Abstract
      BACKGROUND: Frailty is a well-established marker of poor outcomes in geriatric trauma patients. There are few interventions to improve outcomes in this growing population. Our goal was to determine if an interdisciplinary care pathway for frail trauma patients improved in-hospital mortality, complications, and 30-day readmissions. STUDY DESIGN: This was a retrospective cohort study of frail patients >/=65 years old, admitted to the trauma service at an academic, urban level I trauma center between 2015 and 2017. Patients transferred to other services and those who died within the first 24 hours were excluded. An interdisciplinary protocol for frail trauma patients, including early ambulation, bowel/pain regimens, nonpharmacologic delirium prevention, nutrition/physical therapy consults, and geriatrics assessments, was implemented in 2016. Our main outcomes were delirium, complications, in-hospital mortality, and 30-day readmission, which were compared with these outcomes in patients treated the year before the pathway was implemented. Multivariate logistic regression was used to determine the association of being on the pathway with outcomes. RESULTS: There were 125 and 144 frail patients in the pre- and post-intervention cohorts, respectively. There were no significant demographic differences between the 2 groups. Among both groups, the mean age was 83.51 years (SD 7.11 years), 60.59% were female, and median Injury Severity Score was 10 (interquartile range 9 to 14). In univariate analysis, there were no significant differences in complications (28.0% vs 28.5%, respectively, p = 0.93); however, there was a significant decrease in delirium (21.6% to 12.5%, respectively, p = 0.04) and 30-day readmission (9.6% to 2.7%, respectively, p = 0.01). After adjusting for patient characteristics, patients on the pathway had lower delirium (odds ratio [OR] 0.44, 95% CI 0.22 to 0.88, p = 0.02) and 30-day readmission rates (OR 0.25, 95% CI 0.07 to 0.84, p = 0.02), than pre-pathway patients. CONCLUSIONS: An interdisciplinary care protocol for frail geriatric trauma patients significantly decreases their delirium and 30-day readmission risk. Implementing pathways standardizing care for these vulnerable patients could improve their outcomes after trauma.
    • PubMed ID
  • Validation of the O3DY French Version (O3DY-F) for the Screening of Cognitive Impairment in Community Seniors in the Emergency Department. 2019 Bedard, C. Boucher, V. Voyer, P. Yadav, K. Eagles, D. Nadeau, A. Carmichael, P. H. Pelletier, M. Gouin, E. Berthelot, S. Daoust, R. Lague, A. Gagne, A. J. Emond, M.. J Emerg Med,
    • Title

      Validation of the O3DY French Version (O3DY-F) for the Screening of Cognitive Impairment in Community Seniors in the Emergency Department.

    • Authors
      Bedard, C. Boucher, V. Voyer, P. Yadav, K. Eagles, D. Nadeau, A. Carmichael, P. H. Pelletier, M. Gouin, E. Berthelot, S. Daoust, R. Lague, A. Gagne, A. J. Emond, M.
    • Year
      2019
    • Journal
      J Emerg Med
    • URL
    • Abstract
      BACKGROUND: It is recommended that older patients undergo systematic mental status screening when presenting to the emergency department (ED). However, the tools available are not necessarily adapted to the ED environment, therefore, quicker and easier tools are needed. OBJECTIVES: The purpose of this study is to validate the Ottawa 3DY-French (O3DY-F) Scale as a screening tool for delirium and cognitive impairment in a French-speaking cohort. METHOD: This multicenter prospective study was conducted in four hospitals across the province of Quebec. Inclusion criteria were: age >/= 65 years, ED stay >/= 8 h, awaiting admission to a care unit, and independent or semi-independent in their daily living activities. Cognitive status was assessed during the initial interview using the Telephone Interview for Cognitive Screening-modified (TICS-m) and the O3DY-F scale. Comparisons were made between the O3DY-F and the TICS-m and Confusion Assessment Method (CAM) to assess the sensitivity and specificity of the O3DY-F for the detection of cognitive impairment and delirium. RESULTS: A total of 313 patients were included in this study, 139 of which had a positive O3DY-F. When compared with the CAM, the O3DY-F had a sensitivity of 84.2% (95% confidence interval [CI] 60.4-96.6) and a specificity of 58.2% (95% CI 52.3-63.9) for the detection of prevalent delirium. The O3DY-F had a sensitivity of 76.2% (95% CI 66.7-84.8) and a specificity of 67.6% (95% CI 61.0-73.6) for cognitive impairment (defined as a TICS-m < 27). CONCLUSION: The O3DY-F is a useful and effective tool to screen for delirium and undetected cognitive impairment among a French-speaking cohort in the ED.
    • PubMed ID
  • Identification of delirium and subsyndromal delirium in intensive care patients. 2019 Bastos, A. S. Beccaria, L. M. Silva, D. C. D. Barbosa, T. P.. Rev Bras Enferm, 72:2 (463-7)
    • Title

      Identification of delirium and subsyndromal delirium in intensive care patients.

    • Authors
      Bastos, A. S. Beccaria, L. M. Silva, D. C. D. Barbosa, T. P.
    • Year
      2019
    • Journal
      Rev Bras Enferm
    • URL
    • Abstract
      OBJECTIVE: identify delirium and subsyndromal delirium in intensive care patients; age, hospitalization time, and mortality. METHOD: a retrospective, quantitative study conducted in the Intensive Care Unit, using the Richmond Agitation-Sedation Scale to evaluate sedation and the Intensive Care Delirium Screening Checklist for the identification of delirium, with the participation of 157 patients. For statistical analysis, the t-test and the Chi-square test was carried out. RESULTS: the majority presented subsyndromal delirium (49.7%). Mortality was 21.7%. The relationship between delirium and its subsyndromal with hospitalization time was statistically significant for both (p=0.035 and p <0.001), while age was significant only in the subsyndromal delirium (p=0.009). CONCLUSION: the majority of the patients presented subsyndromal delirium. The length of hospital stay was statistically significant in delirium and subsyndroma delirium. Age was significant only in subsyndromal delirium. The mortality of patients with delirium was higher than the others.
    • PubMed ID
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