Delirium: Comparison of four predictive models in hospitalized critically Ill elderly patients

Eden, Brenda; Foreman, Marquis D.; Sisk, Rebecca

doi:10.1016/s0897-1897(98)80051-7

Cited by 22 publications

(12 citation statements)

References 14 publications

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“…The validity and reliability of the CAM in postoperative patients are well established. 47,48 The instrument has a reported sensitivity of 94% (95% confidence interval, 91%-97%), a specificity of 89% (95% confidence interval, 85%-94%), surgery range from 17% 32,39 to 51%. 19 Because the number of older patients undergoing abdominal surgery, in particular, major colorectal surgery, 41 is increasing, health professionals such as nurses need to understand the potential for postoperative delirium and the associated consequences for patients.…”

Section: Instrumentsmentioning

confidence: 99%

Postoperative Delirium After Colorectal Surgery in Older Patients

Mangnall¹,

Gallagher²,

Stein‐Parbury³

2010

American Journal of Critical Care

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Background Postoperative delirium in older patients results in worse outcomes and increased costs. The prevalence and predictors of postoperative delirium in patients undergoing major colorectal surgery are not clear. Objectives To determine the prevalence and predictors of postoperative delirium in older patients after major colorectal surgery. Methods Patients older than 50 years, without preexisting cognitive impairment, were recruited before surgery. These patients were assessed after surgery for delirium daily for 3 days by using the Confusion Assessment Method. Regression analysis was used to determine independent predictors of postoperative delirium. Results Patients (n = 118) had a mean age of 71.81 years, and approximately half were women (54%). Most participants (64%) were married, and comorbid conditions were common. Delirium developed in 35% of the patients in the 3 days after surgery and in 21% in the first 24 hours. New cases of delirium were identified on each of the 3 days after surgery, and a few patients (7%) had delirium for the entire 3 days. Odds for delirium in the first 24 hours were increased for patients who had early admission (odds ratio [OR] = 4.48; P = .06) and decreased for patients who were married (OR = 0.25; P = .01). Odds for delirium in the first 3 days after surgery were increased for men (OR = 4.27; P = .02), older patients (OR = 1.05; P = .04), and patients who stayed overnight in the critical care unit (OR = 2.97; P = .06). Conclusions Postoperative delirium is common and persistent in older patients in the first 3 days after colorectal surgery.

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Section: Instrumentsmentioning

confidence: 99%

Postoperative Delirium After Colorectal Surgery in Older Patients

Mangnall¹,

Gallagher²,

Stein‐Parbury³

2010

American Journal of Critical Care

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“…Patients with a high vulnerability to delirium may develop delirium with any precipitating factor, even if it is mild, but those with low vulnerability are resistant to the development of delirium even with noxious insults. Several studies have tried to identify predisposing and precipitating factors in older patients (Schor et al ., 1992; Williams‐Russo et al ., 1992; Inouye et al ., 1993; Pompei et al ., 1994; Inouye & Charpentier, 1996; O’Keeffe, 1996; Eden et al ., 1998; Martin et al ., 2000). These studies have concluded that the most powerful risks for developing delirium are present before admission.…”

Section: Risk Factorsmentioning

confidence: 99%

“…Severe illness and dehydration (Inouye et al ., 1993; O’Keeffe, 1996; Eden et al ., 1998) and high age (Schor et al ., 1992; Williams‐Russo et al ., 1992; Eden et al ., 1998; Martin et al ., 2000) also put patients at higher risk for developing delirium. Male gender (Schor et al ., 1992; Williams‐Russo et al ., 1992), alcohol abuse (Pompei et al ., 1994), and comorbidities (Pompei et al ., 1994; Eden et al ., 1998) contributed significantly. Risk factors include a fracture (Schor et al ., 1992), depression (Pompei et al ., 1994) and vision impairment (Inouye et al ., 1993).…”

Section: Risk Factorsmentioning

confidence: 99%

Early recognition of delirium: review of the literature

Schuurmans

Duursma

Shortridge‐Baggett

2001

Journal of Clinical Nursing

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· This review focuses on delirium and early recognition of symptoms by nurses. · Delirium is a transient organic mental syndrome characterized by disturbances in consciousness, thinking and memory. The incidence in older hospitalized patients is about 25%. · The causes of delirium are multi-factorial; risk factors include high age, cognitive impairment and severity of illness.· The consequences of delirium include high morbidity and mortality, lengthened hospital stay and nursing home placement. · Delirium develops in a short period and symptoms¯uctuate, therefore nurses are in a key position to recognize symptoms. · Delirium is often overlooked or misdiagnosed due to lack of knowledge and awareness in nurses and doctors. To improve early recognition of delirium, emphasis should be given to terminology, vision and knowledge regarding health in ageing and delirium as a potential medical emergency, and to instruments for systematic screening of symptoms.

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“…There are several research reports claiming that the delirious patient often goes undetected [7][8][9]. From the research done by one of my doctoral students on an orthopedic ward, those patients who behave in an unexpected manner or do things the staff do not want them to do are the ones who are detected as being delirious.…”

Section: Recognizingmentioning

confidence: 99%

Impact of Delirium on Professionals

Hallberg¹

1999

Dement Geriatr Cogn Disord

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There is a paucity of empirical research on the impact of delirium on professionals’ reactions, interpretations or attitudes to people in a delirious state. This is striking because it stands to reason that it is demanding to take care of a person who is desorientated, perhaps agitated and who may hallucinate and/or act in a manner that calls for interventions involving the use of force or actions that oppose the will of the patient. Apart from some recent intervention studies, there is also little empirical research focusing on the care of delirious patients. Because of the lack of research, deductions will be made from research findings in other areas as well as research findings focusing on the views of patients about what it was like to have been confused, which they narrated afterwards.

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Delirium: Comparison of four predictive models in hospitalized critically Ill elderly patients

Cited by 22 publications

References 14 publications

Postoperative Delirium After Colorectal Surgery in Older Patients

Postoperative Delirium After Colorectal Surgery in Older Patients

Early recognition of delirium: review of the literature

Impact of Delirium on Professionals

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