Delirium risk factors in elderly hospitalized patients

Abstract

OBJECTIVE: Delirium is frequent in elderly hospitalized patients. Many studies have examined its risk factors, but results have been quite variable. Thus, the goal of this study is to identify through systematic literature review the risk factors associated with the development of delirium in hospitalized geriatric patients. MEASUREMENTS AND MAIN RESULTS:First, MEDLINE / CURRENT CONTENTS databases were screened for relevant articles published from 1966 to December 1995, and from bibliographies of identified articles additional reports were selected. Second, the reports were screened by two different investigators and retained only if meeting the five following criteria: (1) original research in French or English; (2) prospective study; (3) patients over age 50; (4) minimum of one risk factor examined; (5) acceptable definition of delirium. Third, the methodology of each study was graded according to specific criteria for risk factor studies. Fourth, risk factors were identified and tabulated, unadjusted odds ratios (ORs) were computed, and where appropriate a combined OR with the Mantel-Haenszel estimator was calculated. Twenty-seven articles were retained meeting all of the above criteria. Among these studies, 11 were done on medical patients, 9 on surgical patients, 2 on medical and surgical patients, and 5 on psychiatric patients. In total 1,365 subjects with delirium were studied. Sixty-one different risk factors were examined, the five most common being dementia, medication, medical illness, age, and male gender. Mantel-Haenszel estimator was calculated for 10 risk factors, the most strongly associated being dementia (OR 5.2; 95% confidence interval [CI] 4.2, 6.3), medical illness (OR 3.8; 95% CI 2.2, 6.4), alcohol abuse (OR 3.3; 95% CI 1.9, 5.5), and depression (OR 1.9; 95% CI 1.3, 2.6). Methodologic weaknesses were present in many studies.

Opioid medications and longitudinal risk of delirium in hospitalized cancer patients

“…Psychoactive medications, especially opioids, are among the most consistent risk factors for incident delirium. 3,24 We showed previously that opioids were involved in the development of delirium in hospitalized patients. 2 The current study provides convincing evidence that exposure to the latter drug class also strongly influences the course of delirium.…”

Central and Systemic Endotoxin Challenges Exacerbate the Local Inflammatory Response and Increase Neuronal Death during Chronic Neurodegeneration

“…There is already clinical evidence that infections are deleterious in dementia. Delirium is a transient disorder of cognition and attention and is a common consequence of systemic infection in the elderly and demented (Elie et al, 1998). Episodes of delirium significantly increase the risk of dementia (Rockwood et al, 1999), shorten the time to permanent institutionalization (Pitkala et al, 2005), and are associated with long-term functional decline (Murray et al, 1993) and increased mortality (Rockwood et al, 1999).…”

Delirium

“…A intervenção em um ou mais desses fatores é comumente suficiente para a resolução do quadro. 12 Em estudo realizado com o objetivo de desenvolver um modelo preditivo de risco de desenvolvimento de delirium no momento da admissão hospitalar os principais fatores predisponentes independentes foram: gravidade da doença de base, déficit visual, nível cognitivo basal e alta relação BUN/creatinina (usado como índice de desidratação). 13 O mesmo estudo apontou os fatores precipitantes com maior valor preditivo para o desenvolvimento de delirium: uso de restrição físi-ca, desnutrição, adição de mais de 3 medicações no dia anterior (70% eram medicações psicoativas), uso de cateter urinário e qualquer evento iatrogênico.…”