Delirium in elderly patients hospitalized in internal medicine wards

Abstract

Objectives: to identify reasons for re-hospitalization, assess nutritional status of elderly hospitalized patients using a validated nutritional assessment tool and analyze which factors are associated with readmission within the last year after discharge from index hospitalization for elderly hospitalized patients including nutritional related factors. Methodology: A cross-sectional study design was conducted in the internal medicine wards of Menoufia university hospital. All patients over 65 years of age within the first 72 hours of admission were eligible for the study. 162 patients were recruited with (93.6%) response rate. Data being collected using a structured questionnaire includes patients' sociodemographic, admission characteristics, severity of chronic disease using Cumulative Illness Rating Scale (CIRS) for geriatric. Assessment of nutrition status was performed using Mini Nutritional Assessment (MNA) tool and anthropometric measurements. Results: readmission within one year was found among (46.3%) of elderly participants. Relapse of initial condition was the most common reason (42.7%) followed by complications (24%). Half of readmitted group was malnourished and nearly one third at risk of malnutrition. Logistic regression identified strong association of hospital readmission with advanced old age ,smoking habit , poor dietary compliance , assistance needed feeding pattern ,severity of chronic disease ,comorbidities and lower MNA score Conclusion : Factors associated with readmission in elderly patients are multiple and complex. Malnourished elderly patients with cardiac , respiratory disease or diabetic with complex medical and social needs who are severely ill , with advanced age, smoker , who not compel well with dietary advice ,need assistance with feeding are tend to be readmitted. Recommendations: Re-hospitalized elderly patients should be identified and targeted by follow up and post hospital care to reduce readmissions.

Integrate Literature Review of Delirium on the Elders

“…The mental status of the patient is suddenly changed to be insensitive toward time, places, and individuals [6]. Additionally, delirium is a type of neural disturbance combined with psychiatry, rendering it a reversible acute illness with changes in attention, cognition, mobility, activities, sleep cycles, and conscious confusion [7][8][9]. Furthermore, delirium occurs in a short period accompanied by daily changes in cognitive behavior and psychological symptoms such as inattention, short memory, insomnia, sleep disturbances, irritable behavior, delusion, and illusion [10].…”

“…Demographic and physical factors are age, gender, hospitalized days, institutionalization, trauma history, surgery, heart and lung illness, hypertension, diabetes, chronic kidney failure, gastrointestinal diseases, urinary and genital illness, metabolic disorders, central nervous system illness, peripheral vascular disease, stroke, dementia, malnutrition, fever, low albumin, low oxygen, dehydration, electronic imbalance, azotemia, infection, convulsion, and multiple or pain medications [1,2,4,5,[7][8][9][11][12][13][14][15][16][17][18]. Specifically, 3% to 5% of elderly people who have had hip and knee surgeries would experience acute confusion or delirium for a specific period.…”

“…Therefore, insufficient pre-surgery assessments and post-surgery complications are factors related to elderly delirium [6,19]. The functional, cognitive, psychosocial, and other factors are decreases in energy, activities of daily living and instrumental activities of daily living, and cognition, as well as increases in sleep disturbances, depression, social isolation, long-term bed rests, environmental overstimulus, catheter use, and need for restraint [2,5,[7][8][9][10]14,16,17].…”

“…The assessment scales [1,2,4,5,[7][8][9][10][11][12][14][15][16] used to measure elderly delirium include medical diagnosis systems such as DSM-III-R, DSM-IV, and DSM-IV-TR, as well as cognitive assessment scales such as the short portable mental status questionnaire (SPMSQ) [20], the minimental status examination (MMSE) [21], the confusion assessment method-ICU (CAM-ICU) [22,23], the Groningen Frailty Indicator (GFI) [24] and Hasegawa's Dementia Scale-Revised (HDS-R) [25].…”

“…Moreover, delaying the time of delirium might increase the incidence of illness, patients' dependence, the needs of nursing homes, and death rates because of the heavy burden on the health care system and society [1,4,5,7,9,10,14,16,18,19]. In addition, a study reported that urinary tract infection (UTI) rates in elderly patients with delirium ranged from 25.9% to 32% compared with 13% in those without delirium; in patients with UTI, delirium rates ranged from 30% to 35%, compared with 7.7% to 8% in those without UTI [11].…”