The utility of nursing instruments for daily screening for delirium: Delirium causes substantial functional impairment

Bode, Leonie; Isler, Florian; Fuchs, Simon; Marquetand, Justus; Petry, Heidi; Ernst, Jutta; Schubert, Maria; Nuñez, David Garcia; Känel, Roland von; Böettger, Soenke

doi:10.1017/s1478951519001019

Cited by 12 publications

(15 citation statements)

References 20 publications

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“…This study complements the previously reported usefulness of the functional domains of the ePA-AC (Bode et al, 2020) by the missing and equally useful domains related to cognition and consciousness, communication and interaction, sleep, respiration, pain, and wounds.…”

Section: Discussionsupporting

confidence: 86%

“…The statistical procedures were previously described in a paper evaluating the functional domains of the ePA-AC (Bode et al, 2020) using the Statistical Package for Social Sciences (SPSS) version 25. Sociodemographic and clinical variables are described with means and standard deviations or medians and interquartile ranges, depending on parametric properties, as well as percentages for categorical variables.…”

Section: Methodsmentioning

confidence: 99%

“…This prospective case–control study following the assessment of the functional parameters (Bode et al, 2020) investigates the potential use of the ePA-AC as the routine assessment to identify delirium risk factors and possible delirium risk constellations. The integration of validated continuous delirium assessment tools into clinical practice may improve patient care in the critically ill.…”

Section: Introductionmentioning

confidence: 99%

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Assessing delirium with nursing care instruments: Evaluation of the cognitive and associated domains

et al. 2020

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Objective Nursing instruments have the potential for daily screening of delirium; however, they have not yet been evaluated. Therefore, after assessing the functional domains of the electronic Patient Assessment — Acute Care (ePA-AC), this study evaluates the cognitive and associated domains. Methods In this prospective cohort study in the intensive care unit, 277 patients were assessed and 118 patients were delirious. The impacts of delirium on the cognitive domains, consciousness and cognition, communication and interaction, in addition to respiration, pain, and wounds were determined with simple logistic regressions and their respective odds ratios (ORs). Results Delirium was associated with substantial impairment throughout the evaluated domains. Delirious patients were somnolent (OR 6), their orientation (OR 8.2–10.6) and ability to acquire knowledge (OR 5.5–11.6) were substantially impaired, they lost the competence to manage daily routines (OR 8.2–22.4), and their attention was compromised (OR 12.8). In addition, these patients received psychotropics (OR 3.8), were visually impaired (OR 1.8), unable to communicate their needs (OR 5.6–7.6), displayed reduced self-initiated activities (OR 6.5–6.9) and challenging behaviors (OR 6.2), as well as sleep–wake disturbances (OR 2.2–5), Furthermore, delirium was associated with mechanical ventilation, abdominal/thoracic injuries or operations (OR 4.2–4.4), and sensory perception impairment (OR 3.9–5.8). Significance of results Delirium caused substantial impairment in cognitive and associated domains. In addition to the previously described functional impairments, these findings will aid the implementation of nursing instruments in delirium screening.

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Section: Discussionsupporting

confidence: 86%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessing delirium with nursing care instruments: Evaluation of the cognitive and associated domains

et al. 2020

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“…3) a nursing instrument most recently validated by our group for the diagnosis of delirium, the Ergebnisorientiertes PflegeAssessment Acute-Care (ePA-AC) ( 17 , 18 ) DSM-5-criteria ( 1 ), see also below.…”

Section: Methodsmentioning

confidence: 99%

“…The maximum score is eight; scores of more than three indicate the presence of delirium. Each item is rated on the patient's behavior over the previous eight ( 15 , 18 ).…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for Delirium Are Different in the Very Old: A Comparative One-Year Prospective Cohort Study of 5,831 Patients

et al. 2021

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Background: In an ever-aging society, health care systems will be confronted with an increasing number of patients over 80 years (“the very old”). Currently, knowledge about and recommendations for delirium management are often based on studies in patients aged 60 to 65 years. It is not clear whether these findings apply to patients ≥80 years.Aim: Comparison of younger and older patients with delirium, especially regarding risk factors.Methods: In this prospective cohort study, within 1-year, 5,831 patients (18–80 years: n = 4,730; ≥80: n = 1,101) with delirium were enrolled. The diagnosis of delirium was based on the Delirium Observation screening scale (DOS), Intensive Care Delirium Screening Checklist (ICDSC) and a DSM (Diagnostic and Statistical Manual)-5 construct of nursing instrument. Sociodemographic trajectories, as well as the relevant predisposing and precipitating factors for delirium, were assessed via a multiple regression analysis.Results: The very old were more commonly admitted as emergencies (OR 1.42), had a greater mortality risk (OR 1.56) and displayed fewer precipitating risk factors for the development of a delirium, although the number of diagnoses were not different (p = 0.325). Predisposing factors were sufficient almost alone for the development of delirium in patients ≥ 80 years of age; in 18–80 years of age, additional precipitating factors had to occur to make a delirium possible.Conclusion: When relevant predisposing factors for delirium are apparent, patients over 80 years of age require comparatively few or no precipitating factors to develop delirium. This finding should be taken into account at hospitalization and may allow better treatment of delirium in the future.

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Consciousness, Memory, and Intelligence

Gill

McIntyre

2023

Tasman’s Psychiatry

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The utility of nursing instruments for daily screening for delirium: Delirium causes substantial functional impairment

Cited by 12 publications

References 20 publications

Assessing delirium with nursing care instruments: Evaluation of the cognitive and associated domains

Assessing delirium with nursing care instruments: Evaluation of the cognitive and associated domains

Risk Factors for Delirium Are Different in the Very Old: A Comparative One-Year Prospective Cohort Study of 5,831 Patients

Consciousness, Memory, and Intelligence

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