Preliminary Derivation of a Nursing Home Confusion Assessment Method Based on Data from the Minimum Data Set

Abstract

The NH-CAM successfully stratified NH residents' risk of mortality and rehospitalization. If validated clinically, the NH-CAM may be useful in care planning and in further research on the determinants and consequences of delirium in the NH.

Subsyndromal Delirium and Institutionalization Among Patients With Critical Illness

“…In addition to considering all days of acute brain dysfunction as having potential importance, our study provides other methodological advancements in the study of SSD during critical illness: 1) While previous investigators have used a variety of dimensional (ie, Delirium Rating Scale Revised-98 [DRS-R98], 11,21,22 Neelon and Champagne [NEECHAM] Confusion Scale, 26 Memorial Delirium Assessment Scale [MDAS] 9 and the Intensive Care Delirium Screening Checklist [ICDSC] 14 ) or categorical delirium screening tools (ie, Confusion Assessment Method 9,10,12,13,15,20,23,26,45 ) to detect SSD, our study is the first to use the CAM-ICU, and 2) In a manner complementing the previous studies of SSD patients with critical illness, 14,43 we considered the presence of delirium symptoms to indicate either delirium (if the CAM-ICU was positive) or SSD (if the CAM-ICU was negative) even in the setting of sedation, since such medications may have important implications in the majority of patients. 46,47 …”

A Point Prevalence Study of Delirium in Italian Nursing Homes

“…Our study confirms these data, showing a delirium prevalence of 53% in subjects with dementia. Larger and generally older studies had previously reported much lower percentages, from 6.5 to 21.9%, but they included fewer severely cognitively impaired patients [23][24][25]. In studies performed in NHs the diagnosis of delirium has been more commonly made using CAM, International Classification of Diseases (ICD)-10, or Diagnostic and Statistical Manual of Mental Disorders (DSM) III or IV.…”

Delirium phenomenology: What can we learn from the symptoms of delirium?

“…Subsyndromal delirium (SSD) was first described by Lipowski [45], and subsequently, it has been defined by the presence of any core delirium symptoms or severity scores on rating scales that are below diagnostic threshold [53][54][55][56][57]. Prevalence rates of 30-50% have been reported in intensive care unit and post-acute nursing home facilities with SSD subjects having intermediate outcomes (in terms of morbidity, mortality, and length of hospital stay) between those with and without delirium [56,57].…”