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Australian and New Zealand Society for Geriatric Medicine position statement 13. Delirium in older people Australian and New Zealand Society for Geriatric Medicine Position Statement 13 Delirium in Older People Revised 2012 1. Delirium is a syndrome characterized by the rapid onset of impaired attention that fluctuates, together with impaired cognition and / or altered consciousness, perceptual disturbances and behaviour. It may be the only sign of serious medical illness in an older person (...) and should be urgently assessed. Misdiagnosis of delirium may have dire consequences. 2. Better prevention and treatment is needed to avoid the poor outcomes that result from delirium, especially increased rates of cognitive and functional decline, prolonged hospital stay, institutionalisation and mortality. 3. All older persons should be assessed for risk factors for delirium on admission to hospital. These include dementia, polypharmacy, visual and hearing impairment, dehydration, functional disability
The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Drug therapy for delirium in terminally ill adult patients. Delirium is a syndrome characterised by a disturbance of consciousness (often fluctuating), cognition and perception. In terminally ill patients it is one of the most common causes of admission to clinical care. Delirium may arise from any number of causes and treatment should be directed at addressing these causes rather than the symptom cluster. In cases where this is not possible, or treatment does not prove successful, the use (...) of drug therapy to manage the symptoms may become necessary. This is an update of the review published on 'Drug therapy for delirium in terminally ill adult patients' in The Cochrane Library 2004, Issue 2 ( Jackson 2004).To evaluate the effectiveness of drug therapies to treat delirium in adult patients in the terminal phase of a disease.We searched the following sources: CENTRAL (The Cochrane Library 2012, Issue 7), MEDLINE (1966 to 2012), EMBASE (1980 to 2012), CINAHL (1982 to 2012) and PSYCINFO
Cognitive trajectories after postoperative delirium. Delirium is common after cardiac surgery and may be associated with long-term changes in cognitive function. We examined postoperative delirium and the cognitive trajectory during the first year after cardiac surgery.We enrolled 225 patients 60 years of age or older who were planning to undergo coronary-artery bypass grafting or valve replacement. Patients were assessed preoperatively, daily during hospitalization beginning on postoperative (...) day 2, and at 1, 6, and 12 months after surgery. Cognitive function was assessed with the use of the Mini-Mental State Examination (MMSE; score range, 0 to 30, with lower scores indicating poorer performance). Delirium was diagnosed with the use of the Confusion Assessment Method. We examined performance on the MMSE in the first year after surgery, controlling for demographic characteristics, coexisting conditions, hospital, and surgery type.The 103 participants (46%) in whom delirium developed
Delirium screening in critically ill patients: A systematic review and meta-analysis Despite its frequency and impact, delirium in critically ill patients is poorly recognized. Our aim was to systematically review the accuracy of delirium screening instruments in critically ill patients.Systematic review and meta-analysis of publications between 1966 and 2011. The Medline and Embase databases were searched for studies on delirium in critically ill patients.The meta-analysis was limited (...) to studies in critically ill patients in intensive care units, surgical wards, or emergency rooms. The delirium screening tool had to be feasible in a clinical setting for use by a nonexpert. As the gold standard, delirium had to be diagnosed based on appropriate criteria by a delirium expert.The outcomes assessed were sensitivity, specificity, likelihood ratios, and summary receiver operating characteristics curves.Sixteen studies covering 1,523 participants and five screening tools were included
Adverse outcomes after hospitalization and delirium in persons with Alzheimer disease. Hospitalization, frequently complicated by delirium, can be a life-changing event for patients with Alzheimer disease (AD).To determine risks for institutionalization, cognitive decline, or death associated with hospitalization and delirium in patients with AD.Prospective cohort enrolled between 1991 and 2006 into the Massachusetts Alzheimer's Disease Research Center (MADRC) patient registry.Community-based (...) .771 persons aged 65 years or older with a clinical diagnosis of AD.Hospitalization, delirium, death, and institutionalization were identified through administrative databases. Cognitive decline was defined as a decrease of 4 or more points on the Blessed Information-Memory-Concentration test score. Multivariate analysis was used to calculate adjusted relative risks (RRs).Of 771 participants with AD, 367 (48%) were hospitalized and 194 (25%) developed delirium. Hospitalized patients who did
Preventing delirium in an acute hospital using a non-pharmacological intervention delirium is a clinical syndrome associated with multiple short and long-term complications and therefore prevention is an essential part of its management. This study was designed to assess the efficacy of multicomponent intervention in delirium prevention.a total of 287 hospitalised patients at intermediate or high risk of developing delirium were randomised to receive a non-pharmacological intervention delivered (...) by family members (144 patients) or standard management (143 patients). The primary efficacy outcome was the occurrence of delirium at any time during the course of hospitalisation. Three validated observers performed the event adjudication by using the confusion assessment method screening instrument.there were no significant differences in the baseline characteristics between the two groups. The primary outcome occurred in 5.6% of the patients in the intervention group and in 13.3% of the patients
Tools to detect delirium superimposed on dementia: a systematic review Tools to detect delirium superimposed on dementia: a systematic review Tools to detect delirium superimposed on dementia: a systematic review Morandi A, McCurley J, Vasilevskis EE, Fick DM, Bellelli G, Lee P, Jackson JC, Shenkin SD, Trabucchi M, Schnelle J, Inouye SK, Ely EW, MacLullich A CRD summary This review concluded that the evidence on tools for detection of delirium superimposed on dementia was limited (...) , but it supported the Confusion Assessment Method, its adaptation for the intensive care unit, and electroencephalography. Given the paucity of the evidence, the authors' conclusions and recommendations for further research seem reasonable. Authors' objectives To assess validated tools to diagnose delirium superimposed on dementia. Searching PubMed, EMBASE, and Web of Science were searched for studies published in English, between 1960 and January 2012; search terms were reported. Reference lists were scanned
Subsyndromal delirium in older long-term care residents: incidence, risk factors, and outcomes To determine the incidence of, risk factors for, and outcomes of subsyndromal delirium (SSD) in older long-term care (LTC) residents and, secondarily, to explore the use of a more-restrictive definition of SSD.Cohort study with repeated weekly assessments for up to 6 months.Seven LTC facilities in Montreal and Quebec City, Canada.One hundred four LTC residents aged 65 and older and free of delirium (...) core symptoms at baseline.The Mini-Mental State Examination (MMSE), Confusion Assessment Method (CAM), Delirium Index (DI), Hierarchic Dementia Scale (HDS), and Barthel Index (BI) were completed at baseline. The MMSE, CAM, and DI were repeated weekly for 6 months. SSD1 required one or more CAM core symptoms; SSD2, a more-restrictive definition, required two or more CAM core symptoms. Outcomes at 6 months were decline on the MMSE, HDS, and BI; mortality; and a composite outcome.Sixty-eight of 104
Review: Insufficient evidence exists about which drugs are associated with delirium; benzodiazepines may increase risk 21690588 2011 08 19 2018 11 13 1539-3704 154 12 2011 Jun 21 Annals of internal medicine Ann. Intern. Med. ACP Journal Club. Review: Insufficient evidence exists about which drugs are associated with delirium; benzodiazepines may increase risk. JC6-10 10.7326/0003-4819-154-12-201106210-02010 Carpenter Christopher R CR Washington University, St. Louis, MO, USA. eng KM1 CA156708
Delirium. This issue provides a clinical overview of delirium focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. Only ACP members and individual subscribers can access the electronic features of In the Clinic. Non-subscribers who wish to access this issue of In the Clinic can elect "Pay for View." Subscribers can receive 1.5 category 1 CME credits by completing the CME quiz that accompanies
Synopsis of the National Institute for Health and Clinical Excellence Guideline for Prevention of Delirium. Delirium is common, is often underrecognized, and is associated with poor outcomes and high costs. In July 2010, the National Institute for Health and Clinical Excellence released a guideline that addressed diagnosis, prevention, and management of delirium. This synopsis focuses on the main recommendations about prevention of delirium.The National Clinical Guideline Centre developed (...) and public comment informed guideline development and modifications.Considering prevention a feasible and cost-effective health strategy, the guideline development group made 13 specific recommendations that addressed the stability of the care environment (both the care team and location) and the provision of a multicomponent intervention package tailored for persons at risk for delirium. The multicomponent intervention package included assessment and modification of key clinical factors that may
Which medications to avoid in people at risk of delirium: a systematic review delirium is a common clinical problem and is associated with adverse health outcomes. Many medications have been associated with the development of delirium, but the strength of the associations is uncertain and it is unclear which medications should be avoided in people at risk of delirium.we conducted a systematic review to identify prospective studies that investigated the association between medications and risk (...) of delirium. A sensitivity analysis was performed to construct an evidence hierarchy for the risk of delirium with individual agents.a total of 18,767 studies were identified by the search strategy. Fourteen studies met the inclusion criteria. Delirium risk appears to be increased with opioids (odds ratio [OR] 2.5, 95% CI 1.2-5.2), benzodiazepines (3.0, 1.3-6.8), dihydropyridines (2.4, 1.0-5.8) and possibly antihistamines (1.8, 0.7-4.5). There appears to be no increased risk with neuroleptics (0.9, 0.6
Diagnosing delirium in critically ill children: Validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit To validate a diagnostic instrument for pediatric delirium in critically ill children, both ventilated and nonventilated, that uses standardized, developmentally appropriate measurements.A prospective observational cohort study investigating the Pediatric Confusion Assessment Method for Intensive Care Unit (pCAM-ICU) patients in the pediatric medical (...) , surgical, and cardiac intensive care unit of a university-based medical center.A total of 68 pediatric critically ill patients, at least 5 years of age, were enrolled from July 1, 2008, to March 30, 2009.None.Criterion validity including sensitivity and specificity and interrater reliability were determined using daily delirium assessments with the pCAM-ICU by two critical care clinicians compared with delirium diagnosis by pediatric psychiatrists using Diagnostic and Statistical Manual, 4th Edition
Which Medications are Associated With Incident Delirium? SystematicReviewSnapshot ClinicalSynopsis TAKE-HOME MESSAGE According to limited evidence, emergency physicians should avoid meperidine and consider prescribing oxycodone to elderly patients when narcotics are indicated for pain control. METHODS DATA SOURCES MEDLINE, EMBASE, PsychInfo, and Allied & Complementary Medicine from 1966 through October 2009 were used; bibli- ographies of selected studies were re- viewed for additional relevant (...) articles. STUDY SELECTION Randomized controlled trials, prospective cohort studies, and case-control studies that reported on medications and delir- ium in hospitalized patients or long-term care residents were included. Delirium was de?ned by the Diagnostic and Statisti- cal Manual for Mental Disorders (DSM), International Classi?cation of Diseases, 10th Revision (ICD-10), or a diagnostic tool vali- dated against the DSM, Third Edition; DSM, Third Edition, Revised; DSM, Fourth Edition; or ICD-10. DATA
Delirium: Screening, Prevention and Diagnosis Management Briefs Enter search terms Button to search HSRD ® Inside VA Budget and Performance Inside the News Room National Observances Special Events » » » » » Management Briefs Health Services Research & Development Management Briefs Management eBriefs: Provide VA senior managers with results from VA Health Services Research in a concise and timely manner. , April 2019, Issue 152 , March 2019, Issue 151 , March 2019, Issue 150 , March 2019, Issue
Delirium: Screening, Prevention, and Diagnosis ? A Systematic Review of the Evidence Evidence-based Synthesis Program Department of Veterans Affairs Health Services Research & Development Service Evidence-based Synthesis Program Delirium: Screening, Prevention, and Diagnosis – A Systematic Review of the Evidence Department of Veterans Affairs Health Services Research & Development Service September 2011 Prepared for: Department of Veterans Affairs Veterans Health Administration Health Services (...) Research & Development Service Washington, DC 20420 Prepared by: Evidence-based Synthesis Program (ESP) Center Minneapolis VA Medical Center Minneapolis, MN Timothy J. Wilt, MD, MPH, Director Investigators: Principal Investigator: Rebecca Rossom, MD, MSCR Co-Investigators: Pauline Anderson, RN Nancy Greer, PhD Research Associates: Roderick MacDonald, MS Indulis Rutks, BS James Tacklind, BSi Delirium: Screening, Prevention, and Diagnosis – A Systematic Review of the Evidence Evidence-based Synthesis