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 a 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. This study aimed to identify and investigate various factors predisposing hospitalized patients to develop delirium, focusing mostly on underlying diseases and medications. 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 the 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 Two hundred twenty 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 a history of dementia, neurological diseases and malignancies increases 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; It is important to evaluate underlying diseases and medications more thoroughly in hospitalized patients to assess the risk of delirium.

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 …”

“… 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 …”

The 4AT scale for rapid detection of delirium in emergency department triage

“…The common characteristic is that they are quick screening scales, generally requiring less than 3 min, suitable to be performed in the ED ( 15 ). Early detection and intervention in people with delirium is a strong indicator of the quality of hospital care for vulnerable patients ( 16 , 17 ). Thus, this study aims to assess the accuracy of the 4AT scale, as administered by ED nurses in triage, and to compare time spent in triage between participants screened with the 4AT and those not screened.…”