Detection of delirium in older patients—A point prevalence study in surgical and non‐surgical hospital wards

IF 1.9 4区 医学 Q2 NURSING
Irene Instenes, Leslie S. P. Eide, Hege Andersen, Nina Fålun, Trond Pettersen, Anette H. Ranhoff, James L. Rudolph, Ole Martin Steihaug, Tore Wentzel‐Larsen, Tone M. Norekvål
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Abstract

Aims and ObjectivesTo (i) determine the prevalence of delirium and identify delirium subtypes in surgical and non‐surgical patients aged ≥65 years, (ii) determine whether certain precipitating factors affect the prevalence of delirium and (iii) review patients' medical records for description of delirium symptoms and the presence of International Classification of Diseases (ICD‐10) coding for delirium in discharge summaries.Methodological Design and JustificationsDespite being a robust predictor of morbidity and mortality in older adults, delirium might be inadequately recognised and under‐reported in patients' medical records and discharge summaries. A point prevalence study (24‐h) of patients ≥65 years from surgical and non‐surgical wards was therefore conducted in a tertiary university hospital.Ethical Issues and ApprovalThe study was approved by the Data Protection Officer at the university hospital (2018/3454).Research Methods, Instruments and/or InterventionsPatients were assessed for delirium with 4AT and delirium subtypes with the Delirium Motor Subtype Scale. Information about room transfers, need and use of sensory aids and medical equipment was collected onsite. Patients' medical records were reviewed for description of delirium symptoms and of ICD‐10 codes.ResultsOverall, 123 patients were screened (52% female). Delirium was identified in 27% of them. Prevalence was associated with advanced age (≥85 years). The uncharacterised delirium subtype was most common (36%), followed by hypoactive (30%), hyperactive (24%) and mixed (9%). There were significant associations between positive screening tests and the need and use of sensory aids. Delirium symptoms were described in 58% of the patients who tested positive for delirium and the ICD‐10 code for delirium was registered in 12% of these patients' discharge summaries.ConclusionsThe high prevalence of delirium and limited use of discharge codes highlight the need to improve the identification of delirium in hospital settings and at discharge. Increased awareness and detection of delirium in hospital settings are vital to improve patient care.
老年患者谵妄的检测--在医院外科和非外科病房进行的点流行率研究
目的和目标(i)确定年龄≥65岁的手术和非手术患者中谵妄的发生率并识别谵妄亚型;(ii)确定某些诱发因素是否会影响谵妄的发生率;(iii)审查患者的医疗记录,以了解谵妄症状的描述以及出院摘要中是否存在国际疾病分类(ICD-10)谵妄编码。尽管谵妄是预测老年人发病率和死亡率的可靠指标,但在患者的医疗记录和出院摘要中,对谵妄的认识和报告可能不足。因此,我们在一家三级大学医院对外科和非外科病房中年龄≥65岁的患者进行了一项点流行率研究(24小时)。研究方法、工具和/或干预使用4AT对患者进行谵妄评估,并使用谵妄运动亚型量表对谵妄亚型进行评估。现场收集有关房间转移、感官辅助设备和医疗设备的需求和使用情况的信息。对患者的病历进行了审查,以了解谵妄症状的描述和 ICD-10 编码。其中 27% 的患者被发现患有谵妄。发病率与高龄(≥85 岁)有关。未定性谵妄亚型最常见(36%),其次是低能(30%)、多能(24%)和混合(9%)。筛查测试呈阳性与感官辅助工具的需求和使用之间存在明显关联。58%的谵妄检测呈阳性的患者描述了谵妄症状,12%的患者在出院摘要中登记了谵妄的ICD-10编码。在医院环境中提高对谵妄的认识和检测对于改善患者护理至关重要。
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来源期刊
CiteScore
4.60
自引率
5.30%
发文量
71
期刊介绍: Scandinavian Journal of Caring Sciences is an established quarterly, peer reviewed Journal with an outstanding international reputation. As the official publication of the Nordic College of Caring Science, the Journal shares their mission to contribute to the development and advancement of scientific knowledge on caring related to health, well-being, illness and the alleviation of human suffering. The emphasis is on research that has a patient, family and community focus and which promotes an interdisciplinary team approach. Of special interest are scholarly articles addressing and initiating dialogue on theoretical, empirical and methodological concerns related to critical issues. All articles are expected to demonstrate respect for human dignity and accountability to society. In addition to original research the Journal also publishes reviews, meta-syntheses and meta-analyses.
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