General Medical Aspects of Confusional States in Elderly People

Bedford, P.D.

doi:10.1136/bmj.2.5145.185

Cited by 36 publications

(13 citation statements)

References 6 publications

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“…Our prevalence of delirium on admission 13.5% is similar to prevalence rates from previous studies— that is, 10% on medical wards, 1 , 2 16% of patients greater than 70 years of age on medical wards, 3 , 4 40% on neurologic wards, 5 8% to 12% on psychiatric wards 6‐7 and 35% to 80% on geriatric wards 8–10 . Prevalence rates of 8% to 80% have been obtained only when clinicians assessed all patients for delirium.…”

Section: Discussionsupporting

confidence: 86%

“…Although 10% to 15% of patients admitted to acute care hospitals are in a state of delirium, 1–14 few patients are given this diagnosis by their clinicians 15–17 . Clinicians often have trouble making the diagnosis because of difficulties in administering cognitive tests and in interpreting cognitive deficits 18 , 19 .…”

Section: Diagnostic and Statistical Manual III Criteria For Delirium20mentioning

confidence: 99%

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Delirium: A Test of the Diagnostic and Statistical Manual III Criteria on Medical Inpatients

Cameron¹,

Thomas²,

Mulvihill³

et al. 1987

J American Geriatrics Society

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Although 10% to 15% of patients admitted to acute care hospitals are in a state of delirium, few patients are given this diagnosis by their clinician. We field-tested the Diagnostic and Statistical Manual III (DSM-III) criteria for diagnosing delirium on 133 consecutively admitted patients to an acute medical ward. Twenty patients were delirious using DSM-III criteria, 19 more patients than were reported by the primary clinician. Seven delirious patients were less than 65 years of age (range, 32 to 64 years). Sixty-five percent of patients with delirium died, whereas significantly fewer (3.3%) of patients without delirium died (P less than .0001). We found that delirium could be readily and reliably detected (kappa coefficient of agreement = 0.62 for interrater reliability) using the DSM-III criteria. Clinicians should routinely screen hospitalized patients of all ages using DSM-III criteria to identify delirious patients for an immediate evaluation and treatment.

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Section: Discussionsupporting

confidence: 86%

Section: Diagnostic and Statistical Manual III Criteria For Delirium20mentioning

confidence: 99%

Delirium: A Test of the Diagnostic and Statistical Manual III Criteria on Medical Inpatients

Cameron¹,

Thomas²,

Mulvihill³

et al. 1987

J American Geriatrics Society

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“…It must also be observed that in this series a change in the mental state is often the first, and sometimes the only, sign of physical disease in elderly people. That a diagnosis could be established with reasonable certainty in 22 of the 24 cases of confusion in this series echoes strongly the argument of earlier writers 37,38 that the acute confusional state merits aggressive investigation and treatment. Formal mental status testing of all elderly people admitted to hospital is desirable.…”

Section: Discussionsupporting

confidence: 79%

Acute Confusion in Elderly Medical Patients

Rockwood¹

1989

J American Geriatrics Society

218

133

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The acute confusional state (delirium) is a common presentation for a wide variety of medical conditions in the elderly. This paper reports a prospective study of acute confusion in elderly people admitted to general medical services in two acute care hospitals in Edmonton, Alberta. Eighty patients were studied, ranging in age from 65-91. Acute confusion was seen in one-fourth of these patients, who tended to be older, more ill, more likely to have chronic cognitive impairment and a higher mortality rate. In patients admitted with confusion, infection and congestive heart failure predominated. In those who developed confusion after hospitalization, iatrogenic disease was more common. Confusion was a sensitive sign of physical illness, and its resolution accompanied recovery. A diagnosis of the cause of the confusion state could be made in 22 of 24 cases. These findings support the aggressive investigation and treatment of acute confusion in the elderly.

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“…However, in view of the small number of patients who died, we cannot exclude a type 2 error. Early studies of delirious patients in acute medical wards reported mortality rates of 20 to 40%; 4, 28 the lower rate of mortality in this and other prospective studies is probably attributable to increased detection of milder forms of delirium.…”

Section: Discussionsupporting

confidence: 37%