Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-25T16:21:02.620Z Has data issue: false hasContentIssue false
  • English
  • Français

Delirium in care homes

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  17 February 2010

Najma Siddiqi ,
Andrew Clegg  and
John Young
Najma Siddiqi*
Affiliation:
Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, University of Leeds
Andrew Clegg
Affiliation:
Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, University of Leeds
John Young
Affiliation:
Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, University of Leeds
*
Address for correspondence: Dr Najma Siddiqi, Meridian House, Bradford Road, Keighley BD21 4AD. Email: n.siddiqi@leeds.ac.uk
Get access Rights & Permissions [Opens in a new window]

Summary

Delirium is a distressing but preventable condition associated with increased morbidity and mortality, and significant financial costs. Most research on delirium has focused on high-risk patients in hospitals. Another group also at high risk are residents in care homes for older people. This report reviews the literature on the occurrence, aetiology, outcomes, prevention and treatment of delirium in long-term care. Delirium appears to be common in this setting, with a median point prevalence estimate of 14.2% in studies comparable to the UK. However, there is a paucity of high-quality studies, likely to reflect the difficulty in conducting research in this population and the particular challenges of investigating delirium. Addressing delirium successfully in care homes presents an opportunity to improve care standards and to reduce inequalities in health and social care. Well-designed prospective cohort studies and robust evaluations of interventions to prevent and treat delirium are needed.

Keywords

Deliriumacute confusionlong-term careolder peopleage
Type
Intermediate Care & Rehabilitation
Information
Reviews in Clinical Gerontology , Volume 19 , Issue 4 , November 2009 , pp. 309 - 316
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Inouye, SK. Delirium in older persons. N Engl J Med 2006; 354: 1157–65.CrossRefGoogle ScholarPubMed
2Leslie, DL, Marcantonio, ER, Zhang, Y, Leo-Summers, L, Inouye, SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med 2008; 168: 27–32.CrossRefGoogle ScholarPubMed
3Inouye, SK. Delirium in hospitalized older patients: recognition and risk factors. J Geriatr Psychiatry Neurol 1998; 11: 118–25; discussion 57–8.CrossRefGoogle ScholarPubMed
4Wittenberg, R. Demand for long-term care for older people in England to 2031. National Statistics Quarterly 2001; 12: 5–16.Google Scholar
5Cacchione, PZ, Cacchione, PZ. Four acute confusion assessment instruments: reliability and validity for use in long-term care facilities. J Gerontol Nursing 2002; 28: 12–19.CrossRefGoogle ScholarPubMed
6Bowman, C, Whistler, J, Ellerby M. A national census of care home residents. Age Ageing 2004; 33: 561–6.CrossRefGoogle ScholarPubMed
7Cunha, UG, Faria, AC, de F Alves, VX, Rigueirinho, SA. Hypocortisolemia and delirium in an older patient. J Am Geriatr Soc 2001; 49: 688–9.CrossRefGoogle Scholar
8Levkoff, SE, Evans, DA, Liptzin, B, Cleary, PD, Lipsitz, LA, Wetle, TT et al. Delirium. The occurrence and persistence of symptoms among elderly hospitalized patients. Arch Intern Med 1992; 152: 334–40.CrossRefGoogle ScholarPubMed
9Marcantonio, ER, Flacker, JM, Michaels M, Resnick NM. Delirium is independently associated with poor functional recovery after hip fracture. J Am Geriatr Soc 2000; 48: 618–24.CrossRefGoogle ScholarPubMed
10Wagner, C, Van Der Wal, G, Groenewegen, PP, de Bakker, DH. The effectiveness of quality systems in nursing homes: a review. Quality in Health Care 2001; 10: 211–17.CrossRefGoogle ScholarPubMed
11Ames, D. Nursing homes. Psychiatry 2005; 4: 79–82.CrossRefGoogle Scholar
12American Psychiatric Association. Task Force on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, 3rd edn.Washington, DC: American Psychiatric Association, 1980.Google Scholar
13American Psychiatric Association. Work Group to Revise DSM-III. Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R, 3rd edn.Washington, DC: American Psychiatric Association, 1987.Google Scholar
14American Psychiatric Association. Task Force on DSM-IV. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th edn.Washington, DC: American Psychiatric Association, 1994.Google Scholar
15World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization, 1992.Google Scholar
16Laurila, JV, Pitkala, KH, Strandberg, TE, Tilvis, RS. The impact of different diagnostic criteria on prevalence rates for delirium. Dement Geriatr Cogn Disord 2003; 16: 156–62.CrossRefGoogle ScholarPubMed
17Inouye, SK, van Dyck, CH, Alessi, CA, Balkin, S, Siegal, AP, Horwitz, RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113: 941–48.CrossRefGoogle Scholar
18Trzepacz, PT, Baker, RW, Greenhouse, J.A symptom rating scale for delirium. Psychiatry Res 1988; 23: 89–97.CrossRefGoogle ScholarPubMed
19Mentes, J, Culp, K, Maas, M, Rantz, M. Acute confusion indicators: risk factors and prevalence using MDS data. Res Nurs Health 1999; 22: 95–105.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
20Godfrey, M, Denby, T. The methodology of systematic reviews. Available at: www.leeds.ac.uk/lihs/hsc/documents/meth_sys_rev.pdf (accessed 23 Dec 2009).Google Scholar
21Wells, GA, Shea, B, O'Connell, D, J, Peterson, Welch, V, LososM, Tugwell P M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomised studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/nos_manual.pdf (accessed 23 Dec 2009).Google Scholar
22Sandberg, O, Gustafson, Y, Brannstrom, B, Bucht, G. Prevalence of dementia, delirium and psychiatric symptoms in various care settings for the elderly. Scand J Soc Med 1998; 26: 56–62.CrossRefGoogle ScholarPubMed
23Pitkala, KH, Laurila, JV, Strandberg, TE, Tilvis, RS. Prognostic significance of delirium in frail older people. Dement Geriatr Cogn Disord 2005; 19: 158–63.CrossRefGoogle ScholarPubMed
24Rovner, BW, German, PS, Broadhead, J, Morriss, RK, Brant, LJ, Blaustein, J et al. The prevalence and management of dementia and other psychiatric disorders in nursing homes. Int Psychogeriatr 1990; 2: 13–24.Google ScholarPubMed
25Cacchione, PZ. Four acute confusion assessment instruments: reliability and validity for use in long-term care facilities. J Gerontol Nurs 2002; 28: 12–19.CrossRefGoogle ScholarPubMed
26Cacchione, PZ, Culp, K, Dyck, MJ, Laing, J. Risk for acute confusion in sensory-impaired, rural, long-term-care elders. Clin Nurs Res 2003; 12: 340–55.CrossRefGoogle ScholarPubMed
27Fries, BE, Mehr, DR, Schneider, D, Foley, WJ, Burke, R. Mental dysfunction and resource use in nursing homes. Med Care 1993; 31: 898–920.CrossRefGoogle ScholarPubMed
28Dosa, D, Intrator, O, McNicoll, L, Cang, Y, Teno, J. Preliminary derivation of a Nursing Home Confusion Assessment Method based on data from the Minimum Data Set. J Am Geriatr Soc 2007; 55: 1099–105.CrossRefGoogle ScholarPubMed
29Andrew, MK, Freter, SH, Rockwood, K. Prevalence and outcomes of delirium in community and non-acute care settings in people without dementia: a report from the Canadian Study of Health and Aging. BMC Med 2006; 4: article 15 (Epub).CrossRefGoogle ScholarPubMed
30Fick, DM, Kolanowski, AM, Waller, JL, Inouye, SK. Delirium superimposed on dementia in a community-dwelling managed care population: a 3-year retrospective study of occurrence, costs, and utilization. J Gerontol A Biol Sci Med Sci 2005; 60: 748–53.CrossRefGoogle Scholar
31Culp, K, Tripp-Reimer, T, Wadle, K, Wakefield, B, Akins, J, Mobily, P et al. Screening for acute confusion in elderly long-term care residents. J Neurosci Nurs 1997; 29: 86–8, 95–100.CrossRefGoogle ScholarPubMed
32Kiely, DK, Bergmann, MA, Murphy, KM, Jones, RN, Orav, EJ, Marcantonio, ER. Delirium among newly admitted postacute facility patients: prevalence, symptoms, and severity. J Gerontol A Biol Sci Med Sci 2003; 58: M441–45.CrossRefGoogle ScholarPubMed
33Marcantonio, ER, Simon, SE, Bergmann, MA, Jones, RN, Murphy, KM, Morris, JN. Delirium symptoms in post-acute care: prevalent, persistent, and associated with poor functional recovery. J Am Geriatr Soc 2003; 51: 4–9.CrossRefGoogle ScholarPubMed
34Kelly, KG, Zisselman, M, Cutillo-Schmitter, T, Reichard, R, Payne, D, Denman, SJ. Severity and course of delirium in medically hospitalized nursing facility residents. Am J Geriatr Psychiatry 2001; 9: 72–77.CrossRefGoogle ScholarPubMed
35Cacchione, PZ, Culp, K, Laing, J, Tripp-Reimer, T. Clinical profile of acute confusion in the long-term care setting. Clin Nurs Res 2003; 12: 145–58.CrossRefGoogle ScholarPubMed
36Laurila, JV, Pitkala, KH, Strandberg, TE, Tilvis, RS. Impact of different diagnostic criteria on prognosis of delirium: a prospective study. Dement Geriatr Cogn Disord 2004; 18: 240–44.CrossRefGoogle ScholarPubMed
37Marcantonio, ER, Kiely, DK, Simon, SE, John Orav, E, Jones, RN, Murphy, KM et al. Outcomes of older people admitted to postacute facilities with delirium. J Am Geriatr Soc 2005; 53: 963–69.CrossRefGoogle ScholarPubMed
38Bergmann, MA, Murphy, KM, Kiely, DK, Jones, RN, Marcantonio, ER. A model for management of delirious postacute care patients. J Am Geriatr Soc 2005; 53: 1817–25.CrossRefGoogle Scholar
39Mentes, JC, Culp, K. Reducing hydration-linked events in nursing home residents. Clin Nurs Res 2003; 12: 210–25; discussion 26–28.CrossRefGoogle ScholarPubMed
40Culp, K, Mentes, J, Wakefield, B. Hydration and acute confusion in long-term care residents. West J Nurs Res 2003; 25: 251–66; discussion 67–73.CrossRefGoogle ScholarPubMed
41Siddiqi, N, Young, J, Cheater, FM, Harding, RA. Educating staff working in long-term care about delirium: the Trojan horse for improving quality of care? J Psychosom Res 2008; 65: 261–66.CrossRefGoogle ScholarPubMed
42Zermansky, AG. Including care home residents in clinical research is fraught. BMJ 2005; 331: 1271–72.CrossRefGoogle ScholarPubMed