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AbstractObjectiveNursing assessments have been recommended for the daily screening for delirium; however, the utility of individual items have not yet been tested. In a first step in establishing the potential of the electronic Patient Assessment-Acute Care (ePA-AC) as such, the impact of delirium on the functional domains was assessed.MethodIn this prospective observational cohort study, 277 patients were assessed and 118 patients were delirious. The impact of delirium on functional domains of the ePA-AC related to self-initiated activity, nutrition, and elimination was determined with simple logistic regressions.ResultsPatients with delirium were older, sicker, were more commonly sedated during the assessment, stayed longer in the intensive care unit (ICU) and floors, and less commonly discharged home. A general pattern was the loss of abilities and full functioning equivalent to global impairment. For self-initiated mobility, in and out of the bed sizable limitations were noted and substantial inability to transfer caused friction and shearing. Similarly, any exhaustion and fatigue were associated with delirium. For self-initiated grooming and dressing, the impairment was greater in the upper body. Within the nutritional domain, delirium affected self-initiated eating and drinking, the amount of food and fluids, energy and nutrient, as well as parenteral nutrition requirement. In delirious patients, the fluid demand was rather increased than decreased, tube feeding more often required and dysphagia occurred. For the elimination domain, urination was not affected — of note, most patients were catheterized, whereas abilities to initiate or control defecation were affected.Significance of resultsDelirium was associated with sizable impairment in the level of functioning. These impairments could guide supportive interventions for delirious patients and perspectively implement nursing instruments for delirium screening.

<b><i>Background:</i></b> Predisposing and precipitating factors for delirium for the elderly, over the age of 65 years, are known, but not for the very old, over 80 years. As the society is getting older and evermore patients will reach &#x3e;80 years, more evidence of the factors and their contribution to delirium is required in this patient group. <b><i>Methods:</i></b> In the course of 1 year, 3,076 patients above 80 years were screened prospectively for delirium based on a Delirium Observation Screening (DOS) scale, Intensive Care Delirium Screening Checklist (ICDSC), and a DSM (Diagnostic and Statistical Manual)-5 nursing instrument (ePA-AC) construct. Relevant predisposing and precipitating factors for delirium were assessed with a multiple regression analysis. <b><i>Results:</i></b> Of 3,076 patients above 80 years, 1,285 (41.8%) developed a delirium, which led to twice prolonged hospitalization (<i>p</i> &#x3c; 0.001), requirement for subsequent assisted living (OR 2.2, CI: 1.73–2.8, <i>p</i> &#x3c; 0.001), and increased mortality (OR 24.88, CI: 13.75–45.03, <i>p</i> &#x3c; 0.001). Relevant predisposing factors were dementia (OR 15.6, CI: 10.17–23.91, <i>p</i> &#x3c; 0.001), pressure sores (OR 4.61, CI: 2.74–7.76, <i>p</i> &#x3c; 0.001), and epilepsy (OR 3.65, CI: 2.12–6.28, <i>p</i> &#x3c; 0.0001). Relevant precipitating factors were acute renal failure (4.96, CI: 2.38–10.3, <i>p</i> &#x3c; 0.001), intracranial hemorrhage (OR 8.7, CI: 4.27–17.7, <i>p</i> &#x3c; 0.001), and pleural effusions (OR 3.25, CI: 1.77–17.8, <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> Compared to the general delirium rate of approximately 20%, the prevalence of delirium doubled above the age of 80 years (41.8%) due to predisposing factors uncommon in younger patients.