Experience in Delirium: Is It Distressing?

Grover, Sandeep; Ghosh, Abhishek; Ghormode, Deepak

doi:10.1176/appi.neuropsych.13110329

Cited by 50 publications

(41 citation statements)

References 24 publications

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“…7,25 Established approaches of caregiver coping may be inadequate or less defined in an unfamiliar situation, 26 leaving the delirium caregiver feeling loss of control, shock, fear, and distress. 6,27 Delirium did not increase DEL-B-P scores in del+/ADRD+ patients. This may be due to lack of awareness, anosognosia, insouciance (lack of concern), or poor recollection of distress by ADRD+ persons.…”

Section: Discussionmentioning

confidence: 90%

“…The unpredictability, rapid onset, and potentially ominous effect on recovery and rehabilitation associated with delirium may create stressors distinct from the more familiar ADRD burden model of slower, more predictable, cognitive decline and loss of function . Established approaches of caregiver coping may be inadequate or less defined in an unfamiliar situation, leaving the delirium caregiver feeling loss of control, shock, fear, and distress . Delirium did not increase DEL‐B‐P scores in del+/ADRD+ patients.…”

Section: Discussionmentioning

confidence: 97%

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The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders

Fong

Racine

Fick

et al. 2019

J American Geriatrics Society

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Objectives: To measure the burden of delirium in older adults with or without Alzheimer disease or related disorders (ADRD) Design: Prospective, observational cohort Setting: Inpatient hospital, study participants’ homes Participants: A subset (n=267) of older medical and surgical patients and their caregivers enrolled in the Better Assessment of Illness (BASIL) study Measurements: Delirium burden was measured using the DEL-B instrument (range 0-40, higher scores indicate greater burden) in caregivers (DEL-B-C) and patients (DEL-B-P) one-month after hospitalization. Severity of cognitive impairment (Montreal Cognitive Assessment, MoCA), delirium presence (Confusion Assessment Method, CAM) and delirium severity (CAM-Severity, CAM-S) were measured during hospitalization and at one-month followup. ADRD diagnosis was determined by a clinical consensus process. Results: For patients with (n=56) and without (n=211) ADRD, both DEL-B instruments had good internal consistency. DEL-B-C scores had a median (interquartile range, IQR) among caregivers of patients with and without ADRD of 9 (5-15) and 5 (1-11), respectively (p<0.05). If the patient developed delirium, caregivers experienced greater burden (β[delirium×ADRD]=−0.29, p=.42), regardless of ADRD status. Further, caregiver burden was modestly correlated with patient MoCA scores (Spearman correlation coefficient, rho=−.18, p=.01). Patients with ADRD who developed delirium self-reported less burden than those without ADRD (β[delirium×ADRD]=−0.67, p=.044). As with caregivers, delirium burden was modestly correlated with patient MoCA score (rho=−.18, p=.005) and correlated with the CAM-S in patients without ADRD (rho=.38, p<.001) but not for patients with ADRD (rho=−.07, p=.61). Conclusions: Delirium resulted in the same degree of increased caregiver burden regardless of whether or not a patient had ADRD, signifying delirium is equally stressful to caregivers, even among those with experience caring for someone with a chronic cognitive disorder. Delirium burden is only modestly associated with degree of cognitive impairment, suggesting that other aspects of delirium contribute to burden.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 97%

The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders

Fong

Racine

Fick

et al. 2019

J American Geriatrics Society

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“…Previous studies ranged from describing the majority of patients having no recall of delirium 28 to reporting a recall of delirium in more than half of the patients. 10, 11, 29, 30, 32, 34 The ability to recall a delirium episode has been associated with delirium severity, perceptual disturbances and dementia in patients hospitalized with cancer. 10 In particular, patients with dementiahaving more severe delirium and hallucinations were less likely to remember the delirium episodes.…”

Section: Discussionmentioning

confidence: 99%

Delirium superimposed on dementia: A quantitative and qualitative evaluation of patient experience

Morandi

Lucchi

Turco

et al. 2015

Journal of Psychosomatic Research

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Objective Delirium superimposed on dementia is common and is associated with adverse outcomes. Yet little is known about the patients’ personal delirium experiences. We used quantitative and qualitative methods to assess the delirium superimposed on dementia experience among older patients. Methods We conducted a prospective cohort study among patients with delirium superimposed on dementia who were admitted to a rehabilitation ward. Delirium was diagnosed using DSM-IV-TR criteria. Delirium severity and symptoms were evaluated with the Delirium-O-Meter (D-O-M). The experience of delirium was assessed after delirium resolution (T0) and one month later (T1) with a standardized questionnaire and a qualitative interview. Level of distress was measured with the Delirium Experience Questionnaire. Results Of the 30 patients included in the study, 50% had mild dementia; 33% and 17% had moderate and severe dementia. Half of the patients had evidence of the full range of D-O-M delirium symptoms. We evaluated 30 patients at T0 and 20 at T1. At T0, half of the patients remembered being confused as part of the delirium episode, and reported an overall moderate level of related distress. Patients reported high distress related to memories of anxiety/fear, delusions, restlessness, hypokinesia, and impaired orientation. Qualitative interviews revealed six main aspects of patients delirium experiences: Emotions; Cognitive Impairment; Psychosis; Memories; Awareness of Change; and Physical Symptoms. Conclusions The study provides novel information on the delirium experience in patients with dementia. These findings are key for health care providers to improve the everyday care of this important group of frail older patients.

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“…The overwhelming emotions related to delirium are fear and anxiety (Grover et al . ; Van Rompaey et al . ) while recall of an episode of delirium has been associated with distress (Breitbart et al .…”

Section: Introductionmentioning

confidence: 99%

“…The overwhelming emotions related to delirium are fear and anxiety (Grover et al 2015;Van Rompaey et al 2016) while recall of an episode of delirium has been associated with distress (Breitbart et al 2002;Grover et al 2015) and anxiety (Lingehall et al 2015). Even those who do not recall the delirium do report persisting distress (Bruera et al 2009).…”

Section: Introductionmentioning

confidence: 99%

Don't go there – It's not a nice place: Older adults’ experiences of delirium

Weir

O’Brien

2018

Int J Mental Health Nurs

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Delirium is a common neuropsychiatric disorder that causes fluctuations in consciousness and attention, impairments in cognitive functioning and information processing, and changes in how individuals perceive what is going on around them. Delirium is associated with increased mortality, ongoing impairment in cognitive functioning, and a high possibility of discharge to residential care. The experience of delirium may be distressing for the patient and their family. Despite the frequency of delirium in hospitalized elderly patients, there is a dearth of literature that examines their experience of this phenomenon, and how it affects individuals as they continue their lives. This study uses descriptive qualitative methodology to explore the question: ‘What is the experience of delirium for older adults during hospitalisation?’ Data were collected from older adults who had received hospital care in a tertiary general hospital setting. Seven participants were recruited between January and June 2017. Semi‐structured individual interviews were used to gather data which was analysed using content analysis. Four themes were identified. These were sense of confusion, disrupted sense of autonomy, perceptual disturbances, and emotional response. Participants exercised agency in the way they responded to these experiences. The study highlighted the need for delirium prevention, and education to improve nurses’ recognition, understanding, and management of delirium. In particular, there is a need for nurses to attend to the psychological and emotional experience of delirium.

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Experience in Delirium: Is It Distressing?

Cited by 50 publications

References 24 publications

The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders

The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders

Delirium superimposed on dementia: A quantitative and qualitative evaluation of patient experience

Don't go there – It's not a nice place: Older adults’ experiences of delirium

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