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Query: UMLS:C0011206 (delirium)
 5,996 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case-control study was conducted to examine factors relating to discontinuation of domiciliary care for the bedridden elderly in Shinagawa-ku, Tokyo. Cases were bedridden residents aged 65 years and over who had abandoned home care and applied for admission to live in a special nursing home for the aged between April and September in 1990 after being recipients of welfare allowances for disabled elderly. Controls were bedridden residents who continued to be given home care and matched to cases by sex, age and beginning month of the receiving of allowances. Among 50 cases and 94 controls interviewed, we obtained responses from 31 cases (62%) and 60 controls (64%). The main results were as follows: 1. During the home-care period, ADL (activities of daily living) of cases, especially walking ability, deteriorated more severely than in controls. Night delirium also appeared more frequently in cases. 2. The primary caregivers of cases were older than those of controls. Remarkable differences between cases and controls were observed in the family structure, the number of family members and the number of sub-caregivers. Cases tended to live alone or live with a spouse only, and with smaller number of family members and caregivers. 3. Case lived more frequently in houses with small numbers of rooms and without rooms of their own. 4. As regards utilization of domiciliary care services, cases used dispatch of home helpers more frequently and used day services less frequently.
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PMID:[A case-control study on factors relating to discontinuation of domiciliary care for the bedridden elderly in a metropolitan area]. 129 43

We have studied 97 patients with dementia who have been discharged from our hospital and 106 inpatients with dementia who have been admitted during last two years in our hospital. The diagnosis of dementia was done according to the criteria of DSM-III. Based on their clinical course, neurological signs, Hachinski's ischemic score and neuroradiological findings, we divided patients into 4 groups, [senile dementia of the Alzheimer type (SDAT), vascular dementia (VD), unclassified dementia and other dementias which includes dementia with Parkinson's disease or motor neuron disease, etc.]. Concerning 70 demented patients who died during hospitalization, the average age of onset and the duration of illness of SDAT were 80.5 years old and 4.6 years respectively and those of VD were 77.6 years old and 2.7 years respectively. The common causes of death were pneumonia (50%) and cardiac failure (24%). Recurrence of cerebral vascular accident (CVA) was also another frequent cause of death in VD. The most common behavioral problems causing admission in patients of SDAT were aimless wandering, nocturnal delirium, illusion and hallucination. In VD, nocturnal delirium, aimless wandering, violence and abnormal monologue were most common causes of admission. The important causes degrading ADL of inpatients were fracture, especially fracture of the hip joint, pneumonia, intestinal bleeding and CVA. Concerning the increase of the population of over 75 years old, it will be suggested that the care and treatment of demented patients in this age group will become a major social problem.
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PMID:[Clinical and epidemiological studies on inpatients with dementia]. 238 92

Strokes can be due to ischemic or hemorrhagic vascular disorders. Ischemic strokes outnumber hemorrhagic strokes approximately 4:1. Although the mode of presentation and pathophysiology are different in the two conditions, the outcome is really dependent on the extent and location of brain injury. A CT scan helps in this regard and reveals surgically correctable lesions such as a subdural hematoma or normal pressure hydrocephalus. Effective rehabilitation of the stroke patient is dependent on motivation and cognitive ability even more than on remaining motor or sensory function. A team approach to assessment provides the opportunity to make an accurate appraisal of a patient's current level of functioning and an estimate of premorbid capabilities. A thorough review of the history, complete neurologic examination, mental status testing, and laboratory and radiographic data should be obtained by the treating physician. Neuropsychologic testing, speech and language evaluation, ADL assessment, nursing observations, and psychiatric consultation round off the attempts to fully learn the limitations and strengths that characterize the patient. The value in assessing cognitive abilities after a stroke should be obvious. Not only is motivation necessary, but the patient must comprehend the purpose of the rehabilitation process. Goal-setting is a combined effort of the patient and the rehabilitation team. If a patient has limited understanding and faulty memory, the efforts may be wasted. The presence of acute confusion or delirium may delay rehabilitation efforts, but the etiology may be readily treatable. When there is strong suspicion of a degenerative dementia such as Alzheimer's disease, the expectations are lowered. Occasionally, the problem is a mixed dementia in which instance the prognosis is poor. When there is evidence for multi-infarct dementia, there is a possibility for cognitive improvement when medical problems such as hypertension and embolization are treated. Much can be done for one who has limited and focal cerebral damage provided there is adequate comprehension and ability to compensate for disability.
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PMID:Dementia following stroke. 306 59

Psychotic symptoms develop in 20-30% of patients with Parkinson's disease (PD) receiving chronic anti-PD medications, and visual hallucinations with or without delirium and paranoid delusions are the most frequent symptoms. Psychotic symptoms disturb ADL and QOL of PD patients and tax caregivers far more than the motor disabilities do, and good management of drug-induced psychotic symptoms is potentially important. Withdrawal of anti-PD drugs relieves the patients from psychotic side effects, but worsens the parkinsonian motor symptoms. The first step of treatment is to eliminate triggering factors other than anti-PD drugs, such as infections, metabolic disorders, subdural hematoma, and hallucinogenic drugs. The second step is to eliminate anti-PD drugs in the following order; first anticholinergics, amantadine and selegiline, second dopamine agonists, and finally levodopa/carbidopa. Anti-PD medications should be reduced to the point of improving psychotic side effects without drastically worsening parkinsonian motor symptoms. When the above adjustments fail to sufficiently alleviate psychotic side effects, the third step is consideration of antipsychotic drugs although they have potential capacity to antagonize dopamine D2 receptors and worsen parkinsonism. Atypical antipsychotics such as clozapine and olanzapine are recommended, though the former is not available in Japan.
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PMID:Drug-induced psychotic symptoms in Parkinson's disease. Problems, management and dilemma. 1169 85

Aim of the study was to create an instrument (DISCO Index) to evaluate cognitive-behavioural disturbances in elderly people. We considered n. 192 elderly people living in Torino's nursing homes, n. 76 people screened by the Geriatric Evaluation Unit (GEU) of S. Giovanni Battista Hospital in Torino and n. 136 subjects evaluated by a Torino's District GEU. Mean age was 81.8 +/- 8.3 years. By evaluating cognitive status and behavioural disturbances we obtained a list of conditions referring to three different degrees of severity depending on care needs. The three categories have been defined as: group A: absent or light cognitive and behavioural disturbances; group B: significant impairment of space-timing orientation, hallucinations and delirium, frequent verbal abuse (outrage, menace), feeding alteration; group C: total disturbance of sleep--awakeness rhythm, frequent real or threatened physical assault, wandering or escape attempts, suicidal ideas or suicidal trials, sever feeding alterations. Functional status was also considered by ADL. 41.1% of the study population belongs to group A, 50.5% to group B and 8.4% to group C. Functional status in the sample was seriously impaired in 64.4% (autonomy loss in more then three functions) while only 9.4% of the subjects was autonomous. The totally of people belonging to the group C was found to be dependent in ADLs.
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PMID:[An index for evaluation of cognitive-behavioral disorders in elderly people living in nursing homes]. 1263 93

This prospective study investigated risk factors for delirium in elderly hip fracture patients that could be recognized by nurses. Data were collected on predisposing and precipitating factors for delirium from 92 elderly patients with a hip fracture. Predisposing factors included age, gender, sensory impairments, functional impairment before the hip fracture, residency before admission, pre-existing cognitive impairment, comorbidities, and medication use. Precipitating factors included factors related to surgery and to the postoperative period. Factors related to surgery included time between admission and surgery, type of surgery, type of anesthesia, duration of surgery and anesthesia, and complications during surgery. Factors studied in the postoperative period were slow recovery, malnutrition, dehydration, addition of three or more medications, introduction of bladder catheter, infections, complications and falls, and use of morphine. Eighteen patients developed delirium, as diagnosed by a geriatrician by using the Diagnostic Statistical Manual-IV criteria. Data on delirious patients were compared with the data on non-delirious patients. The findings confirm that elderly hip fracture patients with premorbid ADL dependency, psychiatric comorbidities (including dementia), and a high number of other comorbid problems are at risk for the development of delirium. Based on these findings, it is recommended that nurses should assess patients' pre-fracture functional and cognitive capacities in an early stage of the hospital stay. Nurses should also be alert to postoperative delirium in "healthy elderly" patients. Monitoring of symptoms postoperatively in all elderly patients is advised.
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PMID:Elderly patients with a hip fracture: the risk for delirium. 1276 18

The purpose of this study was to address one component of the complex topic "elder abuse". A prospective observational study in the psychogeriatric unit of an acute psychiatric hospital demonstrated that 30% (n=37) of all included patients (n=122) were physically restrained. The highest incidence (48%) was found in elderly patients with severe cognitive impairments (diagnosis of dementia and/or delirium) (n=60). The most commonly used devices of physical restraints were bed rails (100%), belts (trunk 93%, limbs 40%) and chair-tables ("gerichair") (41%). Most restraints occurred at the beginning of hospitalization (83%). Physical restraints were continued for many days and on average of many hours a day. Patients with low cognitive status and serious mobility impairments showed a very high risk of being restrained (p=0.015; OR 32.0 [95% CI:2.0-515.1]). Inability to perform ADL activities increased the frequency of restraint use (p=0.035; OR27.7 [95%CI: 1.3-604.1]). As possible co-factors repetitive disruptive behaviors were found. There was no significant difference between the frequency of falls in restrained or unrestrained patients during the observational period, but fall-related fractures (n=2) only occurred in restrained patients. It is possible that restraints increase the use of benzodiazepines and classical neuroleptics. These results confirm that physical restraints remain a common practice in psychogeriatric care. No evidence-based data support the value of restraints in regard to fall prevention and control of behavioral disturbances in elderly people with serious mental illness. In contrast, these devices can have serious adverse effects and mean one of the most severe interventions in fundamental human rights.
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PMID:Factors relating to the use of physical restraints in psychogeriatric care: a paradigm for elder abuse. 1575 82

Delirium is a common event in geriatric hospitalized patients. A prospective study was performed in order to characterize predictors, features and outcome in an acute geriatric care unit in a general hospital in Israel. The tools used to detect delirium were the Confusion Assessment Method (CAM) and the Delirium Rating Scale (DRS), supported by clinical observation by an experienced geriatrician. Results showed an occurrence of 18%; risk factors were polypharmacy and poor nutritional status. Age, education, ethnic origin, pre-morbid cognition and ADL status did not show any statistical correlation with the occurrence of delirium. Delirious patients experienced longer hospital stays, more complications, high mortality rate, cognitive and functional decline. It is very difficult to prove the correlation between reduction of brain reserve and appearance of delirium, but as we have observed in other systems (cardiovascular, renal, etc.), it seems reasonable to presume that the same mechanism is involved in cognitive function. Our conclusions are that the diagnosis of delirium may be misleading by a psychiatric overwhelming presentation, and should be considered not as a transient event, but as a marker for cognitive and functional decline in the future, and therefore these patients should be looked after once discharged.
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PMID:Delirium in an acute geriatric unit: clinical aspects. 1865 2

We aimed to identify fall incidence, predictors and characteristics and to investigate hospitalization outcomes for elderly inpatients. In 340 men and 280 women consecutively admitted to a Acute Geriatric Ward of a University Hospital the following variables were evaluated: demographics, clinical history, main disease responsible for hospitalization, comorbidity (cumulative illness rating scale: CIRS 1 and 2) gait and balance deficit (Tinetti's scales), cognition/function (short portable mental status questionnaire: SPMSQ); activities of daily living: ADL; instrumental activities of daily living: IADL; delirium (confusion assessment method: CAM), drugs administered during hospitalization. Overall 80 falls occurred in 70 patients. The incidence rate of falls was of 6.0 per 1000 patient-days with 2.0 falls per bed/year. Age (relative risk=RR=1.050; 95% confidence interval=CI=1.013-1.087), delirium (RR=3.577; 95% CI 1.096-11.672), diabetes (RR=5.913; 95% CI 1.693-20.644), balance deficit (RR=0.914; 95% CI 0.861-0.970) and polypharmacy (RR=1.226; 95% CI 1.122-1.340) were independently predictive of falling. Fallers had a prolonged length of stay (LOS) (35.5+/-47.8 days vs. 23.2+/-27.2; p=0.01) and more frequent nursing home placements (12.9% vs.5.6%; p<0.005). The knowledge of falling predictors might help in planning specific preventive strategies to improve the patients' global health status and to reduce the costs of medical care.
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PMID:Predictors of falls and hospitalization outcomes in elderly patients admitted to an acute geriatric unit. 1867 24

To identify predictive factors for 2-year mortality in frail elderly patients after acute hospitalisation, and from these to derive and validate a Mortality Risk Index (MRI). A prospective cohort of elderly patients was set up in nine teaching hospitals. This cohort was randomly split up into a derivation cohort (DC) of 870 subjects and a validation cohort (VC) of 436 subjects. Data obtained from a Comprehensive Geriatric Assessment were used in a Cox model to predict 2-year mortality and to identify risk groups for mortality. A ROC analysis was performed to explore the validity of the MRI. Five factors were identified and weighted using hazard ratios to construct the MRI: age 85 or over (1 point), dependence for the ADL (1 point), delirium (2 points), malnutrition risk (2 points), and co-morbidity level (2 points for medium level, 3 points for high level). Three risk groups were identified according to the MRI. Mortality rates increased significantly across risk groups in both cohorts. In the DC, mortality rates were: 20.8% in the low-risk group, 49.6% in the medium-risk group, and 62.1% in the high-risk group. In the VC, mortality rates were respectively 21.7, 48.5, and 65.4%. The area under the ROC curve for overall score was statistically the same in the DC (0.72) as in the VC (0.71). The proposed MRI appears as a simple and easy-to-use tool developed from relevant geriatric variables. Its accuracy is good and the validation procedure gives a good stability of results.
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PMID:Derivation and validation of a mortality-risk index from a cohort of frail elderly patients hospitalised in medical wards via emergencies: the SAFES study. 1894 7


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