Predicting Delirium in Elderly Patients: Development and Validation of a Risk-stratification Model

Abstract

Delirium is a common and serious complication of acute illness in elderly patients. The aim of this study was to develop and validate a model for predicting development of delirium in elderly medical inpatients who did not have delirium on admission. Consecutive admissions to an acute geriatric unit underwent standardized cognitive assessment every 48 hours. Delirium was diagnosed according to DSM-3 criteria. Independent predictors of delirium in a derivation group of 100 patients were determined using stepwise logistic regression analysis; the predictive model comprised dementia, severe illness and elevated serum urea. This model performed well in a validation group of 84 patients. We conclude that elderly medical patients can be stratified according to their risk for developing delirium using a simple clinical model.

Risk Factors for Delirium in Older Medical Inpatients in Tanzania

“…Raised serum urea or urea to creatinine ratio (used as a proxy for dehydration) was found to be significantly predictive of incident delirium, and authors have argued that these could form part of a simple screening tool [26,27]. Due to study resource constraints, we were only able to assess blood results for the admissions with delirium.…”

“…Illness severity has frequently been found to be a significant risk factor across many settings including ICU, and acute medical wards [27,32,33]. Yet, there is significant heterogeneity in measurement, with some studies preferring a physician or nurse's subjective opinion over measurements of physiological parameters [27,34].…”

“…Yet, there is significant heterogeneity in measurement, with some studies preferring a physician or nurse's subjective opinion over measurements of physiological parameters [27,34]. Where physiological parameters have been used, the most commonly employed tool is the Acute Physiology and Chronic Health Evaluation II (APACHE II) [4,5], originally devised and developed for use in critical care settings [35].…”

Riesgo de delirium durante la hospitalización en personas mayores: desarrollo y validación de un modelo de predicción clínica

“…Sin embargo, estos modelos no han logrado traspasarse a la práctica clínica habitual 17,19,20 , posiblemente ha influido que estas evaluaciones requieren personal entrenado y un tiempo no menor de aplicación, siendo ambos recursos escasos en el momento del ingreso a los hospitales generales. Además, estos modelos buscan detectar sólo el delirium incidente, por lo que están diseñados para ser aplicados en pacientes sin delirium.…”

“…Otros modelos, como el de Pompey, emplean características demográficas, depresión, cognición, funcionalidad y alcoholismo 19 . O'Keeffe incluye demencia, severidad de la enfermedad y niveles de urea elevados 20 . Los modelos previos han aportado información relevante en relación a los factores de riesgo y precipitantes para delirium y han sido validados en diferentes cohortes, sin embargo, ellos excluyeron pacientes que ingresaban con delirium o demencia al hospital.…”