Diagnosis and Risk Factors for Delirium in Elderly Patients in the Emergency Rooms and Intensive Care Unit of the National Geriatric Hospital Emergency Department: A Cross-Sectional Observational Study

Abstract

Purpose: To diagnose delirium and identify risk factors for its development in elderly patients in the emergency department (ED) and intensive care units (ICU) at the National Geriatric Hospital (Vietnam). Patients and Methods: A cross-sectional observational study was conducted with a convenience sample of non-surgical patients admitted to ED and ICU at Hanoi National Geriatric Hospital in Vietnam. In total, 163 patients met the selection criteria and were included in the study. Screening involved using the Confusion Assessment Method (CAM) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). The diagnosis was established according to the DSM-5 and ICD-10 codes. Results: Delirium was found in a total of 106 (63.1%) patients. The factors significantly affecting its development were vision impairment (OR, 3.3; 95% CI, 1.5 to 7.4, P=0.003), hearing impairment (OR, 3.6; 95% CI, 1.77 to 7.36, P=0.0001), acute or chronic kidney failure (OR, 7.1; 95% CI, 2.05 to 6.39, P<0.001), respiratory disorders (OR, 2.7; 95% CI, 1.4 to 5.2, P=0.004), and malnutrition (OR, 9.17; 95% CI, 3.43-24.5, P=0.0001). The list also include the fall risk factors (OR, 12.2; 95% CI, 4.1-36.3, P=0.0001), frailty (OR, 8.35; 95% CI, P=0.0001), activities of daily living (OR, 8.35; 95% CI,, P=0.0001), hyponatremia (OR, 2.48; 95% CI, 1.07 to 5.75, P=0.001), hypernatremia (OR, 13.1; 95% CI, 1.67 to 2.5, P=0.001), and treatment interventions. In addition, delirium was linked to the duration of ICU admission (OR, 6.53; 95% CI, 4.5-25.5, P < 0.0001). Conclusion:The CAM/CAM-ICU diagnostic algorithm makes it possible to diagnose delirium successfully. The present study confirmed the role of several premorbid and triggering factors in the occurrence of delirium in elderly patients in ED and ICU. There is a need for further research into risk factors for delirium in elderly patients.

Effect of using eye masks and earplugs in preventing delirium in intensive care patients: A single‐blinded, randomized, controlled trial

“…It has been found that hearing impairment has an effect on the development of delirium. There are studies reporting that hearing impairment is an important risk factor for delirium 40,41 . It was found that, among all ICUs, being hospitalized in the internal ICU had an 11.84 times greater effect on the development of delirium than being treated in the coronary ICU.…”

“…There are studies reporting that hearing impairment is an important risk factor for delirium. 40,41 It was found that, among all ICUs, being hospitalized in the internal ICU had an 11.84 times greater effect on the development of delirium than being treated in the coronary ICU. This may be because of the structure of the coronary ICU in the institution where the study was conducted.…”

Validation to Spanish of nursing assessment scale for early diagnosis of delirium - Nu-DESC

“…2 Its consequences are highly deleterious in patients since it causes more days of mechanical ventilation, longer stay in Intensive Care Units (ICU), higher risk of infections and even higher mortality. 3 , 4 Thus, it is important to prevent delirium, starting with its timely detection, 5 since this is one of the main measures for its prevention and treatment. 6 , 7 The Pain, Agitation and Delirium (PAD) guidelines, 8 the ABCDEF bundle 9 and the Humanizing Intensive Care Units (HU-CI) project 10 confirm that the assessment of delirium using validated scales should be performed frequently so that timely preventive measures can be developed, even from the suspicion or probability of its presence.…”

Non-Pharmacological Nursing Interventions to Prevent Delirium in ICU Patients—An Umbrella Review with Implications for Evidence-Based Practice

“…One of the major determinants of delirium is old age [ 7 ]. In addition, risk factors include severity of illness, previous dementia, malnutrition, emergency surgery or trauma prior to ICU admission, mechanical ventilation, and anxiety [ 8 , 9 , 10 ]. There are also risk factors that are modifiable.…”