Delirium point prevalence studies in inpatient settings: A systematic review and meta‐analysis

Abstract

Aims To examine the delirium point prevalence studies conducted in different inpatient settings and to discuss the implication of the findings for delirium screening, assessment, prevention and management. Background Delirium—a common and distressing condition manifesting as an acute decline of attention and cognition—is frequently overlooked, misdiagnosed or treated inappropriately. This neuropsychiatric syndrome manifests as changes in attention, cognition and awareness, with resultant impact on behaviour, function and emotions. Delirium is recognised as a patient management challenge in the inpatient setting, and there is a need to understand the current point prevalence and assessment practices of delirium. Design A systematic review and meta‐analysis. Methods A systematic review of published delirium prevalence studies in inpatient settings was conducted and the implications of findings for delirium screening, assessment, prevention and management identified. The random‐effects meta‐analysis was conducted among studies measuring delirium point prevalence. The PRISMA statement was used to report systematic review and meta‐analysis. Results Nine studies were included in the review, with sample sizes ranging from 47–1867. Delirium point prevalence ranged from 9%–32%. Hypoactive delirium was the most common subtype, ranging from 23%–78%. Fifteen delirium screening tools or assessment or diagnostic methods were used. Comorbid dementia was present in up to 50% of inpatients. Conclusions Gaining a consensus on effective delirium instruments, the time windows for assessment and measurement will be crucial in driving benchmarking and quality improvement studies. Relevance to clinical practice Consistent identification of high‐risk patients and treatment settings with elevated risk, accompanied by the implementation of effective preventive and management strategies, are critical to addressing delirium—a frequent and burdensome condition, that adversely affects patient outcomes.

First delirium episode in Parkinson’s disease and parkinsonism: incidence, predictors, and outcomes

“…Several other studies found delirium to be common in specific settings including nursing homes 10 and after DBS 6 . By comparison, the delirium point-prevalence across different inpatient settings in general (non-parkinsonian) populations ranges from 9-32% 11 .…”

Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis

“…Delirium is common in hospitalised older adults, with a recent meta-analysis of 33 studies of medical inpatients finding an overall delirium occurrence of 23% (95% CI 19–26%) [ 2 ]. It is also common in surgical patients, in care homes and palliative care settings [ 3 ]. Delirium is associated with significant adverse outcomes including functional decline and mortality, and patient and carer distress [4, 5].…”

Unplanned nursing home admission among discharged polymedicated older inpatients: a single-centre, registry-based study in Switzerland

“… 12 Such events can lengthen hospitalisation, produce cognitive changes and lessen the ability to perform the ADL, all potentially leading to unplanned nursing home admission. 12 Indeed, hospitalisation causes an increased risk of the onset of acute cognitive decline in the form of delirium, with a prevalence of up to 60% on some surgical wards, 13 often leading to unplanned nursing home admission. 14 Dementia, Parkinson’s disease and its associated risk of falls, and behavioural changes are common reasons for deciding to transfer inpatients from hospital to long-term care.…”