Delirium Predisposing and Triggering Factors in Nursing Home Residents: A Cohort Trial-Nested Case-Control Study

Abstract

Background: Delirium is a common geriatric syndrome, with a prevalence of between 15-70% among older long-term care residents. It is associated with adverse outcomes, and its onset may prove imperceptible to health professionals. Few studies in institutionalized older people have analyzed the predictors of delirium. Objective: The aim of the present study was to identify delirium predisposing and triggering factors, and develop a predictive model. Methods: A cohort trial-nested case-control study covering a period of 12 consecutive months (April 2015 -March 2016) was carried out. Predisposing and triggering episodes of delirium were recorded. Results: A total of 443 older persons were recruited, with a mean age of 85.73 (6.72) years and female predominance (78.3%; n = 374). The incidence of older people with delirium was 18.7% (n = 83). Dementia was the predisposing factor with the highest predictive capacity (OR = 2.74 [1.49-5.04]). In the presence of dementia, falls (OR = 2.45 [1.49-3.69]), neuroleptics ) and anticholinergic drug use ) were identified as triggering factors. The area under the curve (AUC) was 0.72 (95%CI: 0.66-0.78). Conclusions: Our findings suggest that interventions targeted to potentially preventable triggering factors could avoid the onset of delirium in older people with dementia. Knowledge of the predictive factors of delirium facilitates the screening of older people at increased risk, thereby allowing mental health service providers to prevent and identify the onset of a delirium episode. The decrease in delirium predictive factors should lead to a direct reduction in the occurrence of delirium and its consequences.

Delirium in Nursing Home Residents: A Narrative Review

“…From our review, we identified 28 [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ] articles with relevant data regarding the prevalence of delirium, and eight articles [ 11 , 26 , 39 , 40 , 41 , 42 , 43 , 44 ] described the incidence of delirium. Total population mean age ranged from 76.2 years to 88.5 years, and 46.8% to 90.8% of the participants in the studies were female.…”

“…Parkinson’s disease and depression were other comorbidities reported as risk factors. Of interest, diabetes resulted as a protective risk factor, probably because the frequent glycemic control results in closer contact between nurses and older people, which may avoid the development of delirium [ 41 ].…”

Delirium in Older Adults: What a Surgeon Needs to Know

“…Risk factors of developing postoperative delirium could be patient-related, could be different depending on the timing of appearance during hospitalization, and could be medical-or surgery-related factors [47,48]. More generally, the risk of developing postoperative delirium derives from the presence of some predisposing factors in addition to one or more precipitant factors (Table 1) [46][47][48][49][50].…”

Abordagem do Delirium na Comunidade

“…A evicção de fatores de risco de delirium conduz à diminuição direta da ocorrência deste e das suas consequências. 35 Em cerca de 50% dos casos, os quadros de delirium são reversíveis. 25 Assim, os profissionais de saúde, os cuidadores e os familiares dos doentes devem ser treinados para reconhecer atempadamente e alertar para o surgimento de sintomas de delirium.…”