Dysphagia in older patients admitted to a rehabilitation setting after an acute hospitalization: the role of delirium

Grossi, Eleonora; Rocco, Chiara; Stilo, Leone; Guarneri, Barbara; Inzitari, Marco; Bellelli, Giuseppe; Gentile, Simona; Morandi, Alessandro

doi:10.1007/s41999-023-00773-2

Cited by 6 publications

(2 citation statements)

References 41 publications

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“…In geriatric syndromes, delirium was found to be a risk factor for dysphagia, effectively doubling the likelihood of developing swallowing difficulties [ 12 ]. In one study, the prevalence of concurrent delirium after dysphagia in elderly patients ranged from 22 to 59.4% [ 13 ]. However, these findings showed considerable variability due to factors such as heterogeneity within the study population, variations in screening and diagnosis of dysphagia, sample size, and other confounding factors.…”

Section: Introductionmentioning

confidence: 99%

Does ICU admission dysphagia independently contribute to delirium risk in ischemic stroke patients? Results from a cohort study

Cheng,

Song,

Tang

et al. 2024

BMC Psychiatry

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Background Delirium is prevalent in ischemic stroke patients, particularly those in the intensive care unit (ICU), and it poses a significant burden on patients and caregivers, leading to increased mortality rates, prolonged hospital stays, and impaired cognitive function. Dysphagia, a common symptom in critically ill patients with ischemic stroke, further complicates their condition. However, the association between dysphagia and delirium in this context remains unclear. The objective of this study was to investigate the correlation between dysphagia and delirium in ICU patients with ischemic stroke. Methods A retrospective analysis was conducted on adult patients diagnosed with ischemic stroke at a medical center in Boston. Ischemic stroke cases were identified using the ninth and tenth revisions of the International Classification of Diseases. Dysphagia was defined as a positive bedside swallowing screen performed by medical staff on the day of ICU admission, while delirium was assessed using the ICU Confusion Assessment Method and review of nursing notes. Logistic regression models were used to explore the association between dysphagia and delirium. Causal mediation analysis was employed to identify potential mediating variables. Results The study comprised 1838 participants, with a median age of approximately 70 years, and 50.5% were female. Among the total study population, the prevalence of delirium was 43.4%, with a higher prevalence observed in the dysphagia group (60.7% vs. 40.8%, p < 0.001) compared to the non-dysphagia group. After adjusting for confounding factors including age, sex, race, dementia, depression, sedative medications, history of falls, visual or hearing deficit, sequential organ failure score, and Glasgow coma score, multifactorial logistic regression analysis demonstrated a significant association between dysphagia and an increased likelihood of delirium (odds ratio [OR]: 1.48; 95% confidence interval [CI]: 1.07–2.05; p = 0.018; E-value = 1.73). Causal mediation analysis revealed that serum albumin levels partially mediated the association between dysphagia and delirium in critically ill patients with ischemic stroke (average causal mediated effect [ACME]: 0.02, 95% CI: 0.01 to 0.03; p < 0.001). Conclusion ICU admission dysphagia may independently contribute to the risk of delirium in patients with ischemic stroke. Early identification and intervention in ischemic stroke patients with dysphagia may help mitigate the risk of delirium and improve patient prognosis.

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Section: Introductionmentioning

confidence: 99%

Does ICU admission dysphagia independently contribute to delirium risk in ischemic stroke patients? Results from a cohort study

Cheng,

Song,

Tang

et al. 2024

BMC Psychiatry

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“…The occurrence of delirium in frail patients is also predictive of worse clinical outcomes. Although according to some studies, delirium-associated mortality tended to be higher in fit than in frail individuals [ 37 ], in geriatric settings such as postoperative care after hip fracture, the co-occurrence of frailty and delirium resulted in poorer functional status at discharge [ 38 ] and higher risk of dysphagia [ 39 ]. In this regard, delirium itself can be considered as a marker of frailty [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with delirium in a real-world acute-care setting: analysis considering the interdependence of clinical variables with the frailty syndrome

Ticinesi,

Parise,

Delmonte

et al. 2024

Eur Geriatr Med

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Purpose Delirium risk assessment in the acute-care setting generally does not account for frailty. The objective of this retrospective study was to identify factors associated with delirium, considering the interdependency of clinical variables with frailty syndrome in complex older patients. Methods The clinical records of 587 participants (248 M, median age 84) were reviewed, collecting clinical, anamnestic and pharmacological data. Frailty syndrome was assessed with the Clinical Frailty Scale (CFS). Delirium was the main study endpoint. The correlations of the considered anamnestic and clinical variables with delirium and its subtypes were investigated selecting only those variables not showing a high overlap with frailty. Correlations associated with a 25% excess of frequency of delirium in comparison with the average of the population were considered as statistically significant. Results Delirium was detected in 117 (20%) participants. The presence of one among age > 85 years old, CFS > 4 and invasive devices explained 95% of delirium cases. The main factors maximizing delirium incidence at the individual level were dementia, other psychiatric illness, chronic antipsychotic treatment, and invasive devices. The coexistence of three of these parameters was associated with a peak frequency of delirium, ranging from 57 to 61%, mostly hypoactive forms. Conclusions In acute-care wards, frailty exhibited a strong association with delirium during hospitalization, while at the individual level, dementia and the use of antipsychotics remained important risk factors. Modern clinical prediction tools for delirium should account for frailty syndrome.

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Screening for Dysphagia: Time Is Now!

Fedecostante

Dell’Aquila

Cherubini

2023

The Journal of nutrition, health and aging

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Dysphagia in older patients admitted to a rehabilitation setting after an acute hospitalization: the role of delirium

Cited by 6 publications

References 41 publications

Does ICU admission dysphagia independently contribute to delirium risk in ischemic stroke patients? Results from a cohort study

Does ICU admission dysphagia independently contribute to delirium risk in ischemic stroke patients? Results from a cohort study

Factors associated with delirium in a real-world acute-care setting: analysis considering the interdependence of clinical variables with the frailty syndrome

Screening for Dysphagia: Time Is Now!

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