Keywords
Elderly
Incidence
Length of stay
Adverse outcomes
How to Cite
Abstract
Introduction: Delirium is a neuropsychiatric syndrome of multifactorial etiology that occurs frequently in hospitalized older adults. There are no studies describing the incidence of delirium in Santander and its associated epidemiological factors. Objective: To assess the incidence of delirium, clinical characteristics according to type, mortality after 30 days of hospitalization and complications associated with delirium, in adult patients over 65 years hospitalized in a department in Colombian northeast. Materials and Methods: We included all hospitalized patients ≥ 65 years. We excluded patients with delirium on admission, those hospitalized in intensive care unit, with orotracheal intubation, Glasgow < 8/15, or with factors limiting the ability to assess delirium. Results: 492 hospitalized patients with an average age of 75 years were analyzed. The cumulative incidence of delirium was 9.3%. Of these patients there was a higher percentage of women (63%) and adults ≥ 85 years (31.5%). The greatest association was related to longer hospital stay (11 0 vs 7.1 days, p <0.05), functional impairment evaluated by Barthel scale, and increased risk of mortality (HR:2.9 IC95%: 2.1-3.4). Male sex, normal cognitive status, Barthel index ≥ 60 and normal nutritional status were protective factors. Conclusions: The incidence of delirium in the population of eastern Colombia was similar to the incidence worldwide. Delirium was associated with longer hospital stay, functional decline, and ortality. Applying cognitive, functional, and nutritional screening scales, it would be possible to identify patients with greater vulnerability to delirium development.
References
Marulanda F, Ocampo JM. Delirium en el paciente anciano. Acta Med Colomb. 2004;29(3):117-129.
Inouye SK. Delirium in Older Persons. N Engl J Med. 2006;354 (11):1157-65.
Saxena S, Lawley D. Delirium in the elderly: a clinical review.Postgrad Med J. 2009;85 (1006):405-413.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th Ed. Arlington (VA): The Association; 2013.
Chae JH, Miller BJ. Beyond Urinary Tract Infections (UTIs) and Delirium: A Systematic Review of UTIs and Neuropsychiatric Disorders. J Psychiatr Pract. 2015;21(6):402-11.
Pieralli F, Vannucchi V, Mancini A, Grazzini M, Paolacci G,Morettini A, et al. Delirium is a predictor of in-hospital mortalityin elderly patients with community acquired pneumonia. Intern Emerg Med. 2014;9(2):195-200.
Ruiz MI, Mateos V, Suárez H, Villaverde P. Guía práctica de diagnóstico y tratamiento del síndrome confusional agudo. Hospital Universitario Central de Asturias; 2006.
McCusker J, Cole M, Abrahamowicz M, Han L, Podoba J, Ramman-Haddad L. Environmental Risk Factors for Delirium in Hospitalized Older People. J Am Geriatr Soc. 2001; 49:1327-34.
Kim H, Chung S, Joo YH, Lee JS. The Major Risk Factors for Delirium clinical setting. Neuropsychiatric Dis Treat. 2016;12:1787-93.
Veiga F, Cruz J. Etiología y Fisiopatología del Delírium. Rev EspGeriatr Gerontol. 2008; 43(3):4-12.
Maldonado JR. Neuropathogenesis of delirium: Review of Current Etiologic Theories and Common Pathways. Am J Geriatr Psychiatry. 2013;21 (12):1190-1222.
Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RJ. Clarifying confusion: the confusion assessment method.A new method for detection of delirium. Ann Intern Med. 1990;113(12):941-8.
González M, De Pablo J, Fuente F, Valdes M, Peri JM, Nomdedeu M,et al. Instrument for Detection of delirium in General Hospitals: adaptation of the confusion assessment method. Psychosomatics.2004; 45(5):426-31.
Perelló C. Valoración del riesgo de delírium en pacientes mayoreshospitalizados. Rev Esp Geriatr Gerontol. 2010; 45(5):285-290.
Tsoi KK, Chan JY, Hirai HW. Cognitive Test to Detect Dementia:A Systematic Review and Meta-analysis. JAMA Intern Med2015;175(9):1450-8.
Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short- Form Mini Nutritional Assessment (MNA-SF). J Gerontol A BiolSci Med Sci. 2001;56(6):M366-72.
Pérez N, García L, Montero B, Cruz AJ. Valoracion del paciente Geriátrico. Medicine. 2014;11(62):3641-58.
O‘Keeffe ST, Lavan JN. Clinical Significance of the Delírium Subtipes in Older People. Age Ageing 1999;28(2):115-19.
Stagno D, Gibson C, Breitbart W. The Delirium subtypes: A Review of Prevalence, Phenomenology, Pathophysiology and Treatment Response. Palliat Support Care 2004;2(2):171-9.
Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people.Lancet 2014; 383 (9920):911-22.
Isfandiaty R, Harimurti K, Setiati S, Roosheroe AG. Incidence and Predictors for Delirium in Hospitalized elderly Patients: a Retrospective Cohort Study. Acta Med Indones 2012;44(4):290-7.
Smith T.O, Cooper A, Peryer G, Griffiths R, Fox C, Cross J. Factors predicting incidence of post-operative delirium in older people following hip fracture surgery: a systematic review and metaanalysis. Int J Geriatr Psychiatry. 2017; 32(4):386-96.
Ilango S, Pulle RC, Bell J, Kuys SS. General versus spinal anaesthesia and postoperative delirium in an orthogeriatric population. Australas J Ageing. 2016;35(1):42-7.
Massie MJ, Holland J, Glass E. Delirium in the terminally ill Cancer Patients. Am J Psychiatry. 1983;140(8):1048-50.
Oh ES, Fong TG, Hshieh TT, Inouye SK. Delirium in Older Persons:Advances in Diagnosis and Treatment. JAMA. 2017;318(12):1161-74.
Pandharipande PP, Ely EW, Arora RC, Balas MC, Boustani MA, La Calle GH, et al. The Intensive Care Delirium Research Agenda: A Multinational, Interprofessional Perspective. Intensive Care Med. 2017;43(9):1329-39.
Ahmed S,Leurent B, Sampson EL. Risk Factors for Incident Delirium Among Older People in Acute Hospital Medical Units: A Systematic Review and meta-analysis. Age Ageing. 2014; 43(3):326-33.
Restrepo D, Cardeño C, Paramo L, Ospina S, Calle J. Delírium: Incidencia y Caracteristicas Clínicas y pidemiológicas en un Hospital Universitario. Rev Colomb Psiquiatr 2009;38(3):471-87.
Oviedo G, Gómez-Restrepo C, García P, López-Porras A, Chavarría R, Pineda C, et al. Incidence of confusional syndrome (delirium) in adult patients hospitalized at a university hospital in Bogota Colombia. J Psychosom Res. 2019; 121: 150.
Van Velthuijsen EL, Zwakhalen SM, Mulder WJ, Verhey FR, Kempen GI. Detection and management of hyperactive and hypoactive delirium in older patients during hospitalization: a retrospective cohort study evaluating daily practice. Int J Geriatr Psychiatria. 2018; 33(11): 1521-9.
Petersen PB, Jorgensen CC, Kehlet H. Delirium after fast-track hip and knee arthroplasty – a cohort study of 6331 elderly patients. Acta Anaesthesiol Scand. 2017;61(7):767-772.
Ocampo-Chaparro JM,Mosquera-Jiménez JI, Davis AS, Reyes Ortiz CA. Deterioro funcional asociado al deterioro cognitivo en el anciano hospitalizado. Rev Esp Geriatr Gerontol.2018; 53 (1); 19-22.
Urrutia A, Sacanella E, Mascaro J, Formiga F. Anemia en el anciano. Rev Esp Geriatr Gerontol. 2010;45(5):291-7.
Chen CC, Li HC, Liang JT, Lai IR, Purnomo JD, Yang YT, et al. Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients UndergoingAbdominal Surgery: A Cluster Randomized Clinical Trial. JAMA Surg.2017;152(9):827-834.
Eamer G, Taheri A, Chen SS, Daviduck Q, Chamber T, Shi X, et al. Comprehensive geriatric assessment for older people admitted to a surgical service. Cochrene Database Syst Rev.2018;31(1):CD012485.
Bo M, Bonetto M, Bottignole G, Porrino P, Coppo E, Tibaldi M, et al. Lenght of Stay in the Emergency Department and Occurrence of Delirium in Older Medical Patients. J Am Geriatr Soc. 2016;64(5):1114-9.
Hughes CG, Boncyk CS, Culley DJ, Fleisher LA, Leung JM, McDonagh DL, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Delirium Prevention. Anesth Analg 2020;130(6):1572-1590.
Liao Y, Flaherty JH, Yue J, Wang Y, Deng C, Chen L. The Incidence of Delirium After Cardiac Surgery in the Elderly: Protocol for a Systematic Review and Meta-analysis. BMJ. 2017;7(3):e014726.
Carrasco M, Accatino-Scagliotti L, Calderon J, Villarroel L, Marin PP, González M. Impacto del Delírium en Pacientes de Edad Avanzada Hospitalizados: un Estudio Prospectivo de Cohortes.Rev Med Chile. 2012;140(7):847-852.
Marulanda F, Restrepo JP, Chacon JA. Delirium en el paciente geriátrico hospitalizado. Rev Asoc Colomb Gerontol Geriatr. 2000; 4:165-175.
Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, Van Gool WA. Delirium in the elderly patients and the Risk of postdischarge mortality, institutionalization, and dementia: ameta-analysis. JAMA. 2010;304(4):443-51.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2021 Médicas UIS