The role of diagnosis in delirium

Bhat, Ravi; Rockwood, Kenneth

doi:10.1017/s1041610216001095

Cited by 8 publications

(8 citation statements)

References 68 publications

(98 reference statements)

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“…Early identification is considered key in the effective management of delirium (Holly et al, 2013), yet delirium recognition is a challenge irrespective of the country of practice or hospital setting (Bhat & Rockwood, 2016;Rice et al, 2011;Ryan et al, 2013). The barriers to effective and timely delirium identification have been studied internationally, and in the practice of doctors and nurses, a lack of awareness of the seriousness of the condition and its prevalence as well as a lack of confidence were found to be responsible for low identification rates (Baker et al, 2015;Davis & MacLullich, 2009;Ettema et al, 2014;Flagg et al, 2010;Schuurmans et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

Identifying and Responding to Delirium in Acute Stroke: Clinical Team Members’ Understandings

et al. 2020

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Delirium is associated with increased mortality, morbidity, and length of hospital stay. In the acute stroke setting, delirium identification is challenging due to the complexity of cognitive screening in this patient group. The aim of this study was to explore how members of interprofessional stroke-unit teams identified and responded to a potential delirium in a patient. Online focus groups and interviews utilizing case vignettes were conducted with 15 participants: nurses, occupational therapists, speech and language therapists, and physiotherapists working in acute stroke services. Participants’ understandings of delirium varied, most participants did not identify the symptoms of a possible hypoactive delirium, and nearly all participants discussed delirium symptoms in tentative terms. Aspects of interprofessional working were discussed through the expression of distinct roles around delirium identification. Although participants demonstrated an ethos of person-focused care, there are ongoing challenges involved in early identification and management of delirium in stroke survivors.

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Section: Introductionmentioning

confidence: 99%

Identifying and Responding to Delirium in Acute Stroke: Clinical Team Members’ Understandings

et al. 2020

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“…Delirium is an acute organic brain dysfunction characterised by disturbances of attention and cognition with a fluctuating course as a direct consequence of an underlying medical condition [ 4 ]. It occurs in different healthcare settings [ 5 ], affecting between 15 and 20% of general hospital patients, and up to 80% of patients in an ICU [ 6 , 7 ]. Delirium has been associated with long-term disability following non-ICU hospitalisations [ 8 – 10 ] and with poor outcomes following ICU admission including prolonged length of stay, cognitive impairment after hospital discharge [ 11 – 14 ], and increased odds of long-term disability in activities of daily living [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Cognitive and psychosocial outcomes of mechanically ventilated intensive care patients with and without delirium

Bulic

Bennett

Georgousopoulou

et al. 2020

Ann. Intensive Care

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Objective: Delirium is common in intensive care patients and is associated with short-and long-term adverse outcomes. We investigated the long-term risk of cognitive impairment and post-traumatic stress disorder (PTSD) in intensive care patients with and without delirium. Methods: This is a prospective cohort study in ICUs in two Australian university-affiliated hospitals. Patients were eligible if they were older than 18 years, mechanically ventilated for more than 24 h and did not meet exclusion criteria. Delirium was assessed using the Confusion Assessment Method for Intensive Care Unit. Variables assessing cognitive function and PTSD symptoms were collected at ICU discharge, after 6 and 12 months: Mini-Mental State Examination, Telephone Interview for Cognitive Status, Impact of Events Scale-Revised and Informant Questionnaire for Cognitive Decline (caregiver). Results: 103 participants were included of which 36% developed delirium in ICU. Patients with delirium were sicker and had longer duration of mechanical ventilation and ICU length of stay. After 12 months, 41/60 (68.3%) evaluable patients were cognitively impaired, with 11.6% representing the presence of symptoms consistent with dementia. When evaluated by the patient's caregiver, the patient's cognitive function was found to be severely impaired in a larger proportion of patients (14/60, 23.3%). Delirium was associated with worse cognitive function at ICU discharge, but not with long-term cognitive function. IES-R scores, measuring PTSD symptoms, were significantly higher in patients who had delirium compared to patients without delirium. In regression analysis, delirium was independently associated with cognitive function at ICU discharge and PTSD symptoms at 12 months. Conclusions: Intensive care survivors have significant rates of long-term cognitive decline and PTSD symptoms. Delirium in ICU was independently associated with short-term but not long-term cognitive function, and with longterm PTSD symptoms.

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“…Although it is widely acknowledged that there are some shortcomings in care that stem from a lack of knowledge, system barriers, or institutional attitudes, these are insufficient to account for the magnitude of the health care gap (Inouye, Schlesinger & Lydon, 1999). These failings transcend disciplines (they affect doctors, nurses, and allied health alike), hierarchies thereof, and systemic processes within hospital settings (Bhat & Rockwood, 2016). However, attempts to redress these deficiencies and improve the care of patients with delirium will be rendered fruitless unless the peculiarities of delirium are considered, and solutions tailored accordingly.…”

Section: Introductionmentioning

confidence: 99%

Delirium Management: Anything’s Possible

et al. 2019

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RÉSUMÉLe délirium est un problème de santé majeur aux conséquences potentiellement graves. Malheureusement, la prise en charge de ce trouble est souvent sous-optimale. Nous considérons que les lacunes dans les soins offerts aux patients avec délirium sont liées aux particularités de cette condition, qui affecte la perception du « soi » de la personne qui en souffre. Cette atteinte entraîne un comportement hors de contrôle chez la personne avec délirium et l’expose à une déshumanisation mécaniste. Une solution consisterait à favoriser une vision élargie du « soi », inspirée de la philosophie et des sciences cognitives récentes, afin d’aider les cliniciens dans la compréhension du comportement pathologique en tant que manifestation de la perturbation de la pensée. Une approche centrée sur l’éthique des soins, intégrant un nouveau cadre pour la relation patient-soignant, est proposée. Considérées dans leur ensemble, les propositions novatrices émises pourraient faciliter l’élaboration d’un cadre de pratiques et de relations plus attentionnées et plus efficaces pour le traitement du délirium.

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The role of diagnosis in delirium

Cited by 8 publications

References 68 publications

Identifying and Responding to Delirium in Acute Stroke: Clinical Team Members’ Understandings

Identifying and Responding to Delirium in Acute Stroke: Clinical Team Members’ Understandings

Cognitive and psychosocial outcomes of mechanically ventilated intensive care patients with and without delirium

Delirium Management: Anything’s Possible

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