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Aspects and assessment of delirium in old age

First data from a German interdisciplinary emergency department

Besonderheiten und Assessment bei Delir im Alter

Erste Daten einer deutschen interdisziplinären Notaufnahme

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Abstract

Background

The prevalence of delirium in hospitalized patients is high, but delirium is frequently not identified by treating physicians in emergency departments (EDs). Although the number of elderly patients admitted to EDs is increasing, no data on prevalence, identification and outcome of delirious elderly patients in German EDs exist.

Objectives

To evaluate the prevalence and identification of delirium in elderly patients in a German ED and to identify characteristics of delirium in elderly ED patients.

Methods

Evaluation of data from a prospective single-center observational study. The study was conducted in the interdisciplinary ED of an urban university-affiliated hospital receiving approximately 80,000 visits per year. The shortened Confusion Assessment Method (CAM) was used to screen 133 consecutive ED patients, aged 75 years and older, for delirium. Comorbid conditions were ascertained by patient interview and review of medical records. Data concerning patient mortality and current living status were collected 28 days after the ED visit in a structured telephone interview.

Results

A positive CAM result was recorded in 14.3 % of cases; 68.4 % of these CAM-positive patients were not identified as being delirious by the ED physician. The 28-day mortality was higher among patients with delirium. Dependency on external help, polypharmacy, pre-existing cognitive or mobility impairments and the presence of any care level were strongly associated with delirium.

Conclusion

Elderly patients with known risk factors should be routinely assessed for delirium in the ED with a standardized assessment tool such as the CAM.

Zusammenfassung

Hintergrund

Die Prävalenz des Delirs bei hospitalisierten Patienten ist hoch. Allerdings wird ein Delir in der Notaufnahme von den Behandelnden häufig nicht erkannt. Obwohl die Anzahl älterer Patienten in der Notaufnahme stetig steigt, gibt es aus Deutschland noch keine Daten zur Prävalenz, Identifizierungsrate und dem weiteren Verlauf deliranter Patienten in der Notaufnahme.

Ziele der Arbeit

Die Arbeit befasst sich mit der Evaluierung der Prävalenz und der Identifizierungsrate deliranter älterer Patienten in einer deutschen Notaufnahme sowie mit der Identifizierung von Patientencharakteristika älterer Patienten mit Delir in der Notaufnahme.

Methoden

Die prospektive monozentrische Beobachtungsstudie wurde in der interdisziplinären Notaufnahme eines kommunalen Lehrkrankenhauses mit etwa 80.000 Besuchern pro Jahr durchgeführt. Mit der Confusion Assessment Method (CAM) wurden 133 Patienten ≥ 75 Jahre untersucht, die sich konsekutiv in der Notaufnahme vorstellten. Komorbiditäten wurde mittels Anamnese und Durchsicht der Patientenunterlagen erhoben. Mortalität und die aktuelle Versorgungsform wurden anhand eines strukturierten Telefoninterviews 28 Tage nach Vorstellung in der Notaufnahme erhoben.

Ergebnisse

Eine positive CAM wurde in 14,3 % der Fälle erhoben und 68,4 % der Patienten mit positiver CAM wurden von den Ärzten der Notaufnahme nicht als delirant erkannt. Die 28-Tage-Mortalität war bei Patienten mit Delir erhöht. Die Abhängigkeit von externen Hilfen, Polypharmakotherapie, vorbestehende Einschränkungen der Kognition und Mobilität sowie das Bestehen einer Pflegestufe zeigten einen engen Zusammenhang mit dem Vorhandensein eines Delirs.

Schlussfolgerung

Bei älteren Patienten mit bekannten Risikofaktoren sollte in der Notaufnahme regelmäßig ein Delir-Assessment mittels eines validierten Instruments, z. B. CAM, erfolgen.

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Compliance with ethical guidelines

Conflict of interest. K. Singler, U.Thiem, M. Christ, P. Zenk, R. Biber, C.C. Sieber and H-J. Heppner state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Correspondence to K. Singler M.D., MME.

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Singler, K., Thiem, U., Christ, M. et al. Aspects and assessment of delirium in old age. Z Gerontol Geriat 47, 680–685 (2014). https://doi.org/10.1007/s00391-014-0615-z

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  • DOI: https://doi.org/10.1007/s00391-014-0615-z

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