Delirium Risk Factors in Hospitalized Patient: a Comprehensive Evaluation of Underlying Diseases and Medications in Different Wards of a Large Urban Hospital Center in Iran

Abstract

Background: Delirium is a neurobehavioral syndrome, which is characterized by fluctuation of mental status, disorientation, confusion and inappropriate behavior and it is prevalent among hospitalized patients. Recognizing modifiable risk factors of delirium is the key point for improving our preventive strategies and restraining its devastating consequences. The present study investigated a wide range of possible predisposing factors of delirium, mainly focused on underlying diseases and mediations, of hospitalized patients in the different wards of a general hospital.Method: In a prospective, observational trial, we investigated 220 patients who had been admitted to the internal, emergency, surgery and hematology-oncology departments. We employed the Confusion Assessment Method (CAM) questionnaire, The Richmond Agitation Sedation Scale (RASS), the General Practitioner Assessment of Cognition (GPCOG), demographic questionnaire, patient interviews and medical records. Multivariate logistic regression models were used to analyze predictive value of medications and underlying diseases for daily transition to delirium.; demographics were analyzed using univariate analysis to identify those independently associated with delirium.Results: 220 patients were enrolled; the emergency department had the most incident delirium (%31.3) and the surgery section had the least (%2.4); delirium was significantly correlated with older ages and sleep disturbance. Among multiple underlying diseases and the medications evaluated in this study, we found that history of dementia, neurological diseases and malignancies increase the odds of transition to delirium and the use of anticoagulants decreases the incident delirium.Conclusion: Approximately, 1 out of 10 overall patients developed delirium; Considering underlying diseases and the medications as the predisposing factors of delirium would help to better predict those at risk.

Potentially inappropriate medications with older people in intensive care and associated factors: a historic cohort study

“…This therapeutic class reduces excessive dopaminergic activity, a major contributing factor in delirium, which favors its prescription in critical care situations. 39,40 Studies have shown that delirium affects a significant proportion of older people in ICUs and that haloperidol, the predominant antipsychotic in the study sample, prevents delirium. 39,40 In patients receiving mechanical ventilation, agitation, which often results from delirium, increases the risk of extubation.…”

“…39,40 Studies have shown that delirium affects a significant proportion of older people in ICUs and that haloperidol, the predominant antipsychotic in the study sample, prevents delirium. 39,40 In patients receiving mechanical ventilation, agitation, which often results from delirium, increases the risk of extubation. Among older adults with nasoenteral tubes, confusion, which is also associated with delirium, can lead to accidental tube removal.…”