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Under-recognition of delirium in older adults by nurses in the intensive care unit setting

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Abstract

Background

Nurses have the key roles to detect delirium in hospitalized older patients but under-recognition of delirium among nurses is prevalent. The objectives of this study were to identify the under-recognition rate of delirium by intensive care nurses (ICU) using Confusion Assessment Method for the ICU (CAM–ICU) and factors associated with under-recognition.

Methods

Participants were older patients aged ≥65 years who were admitted to the ICU of Srinagarind Medical School, Khon Kaen, Thailand from May 2013 to August 2014. Baseline characteristics were collected. Delirium was rated by a trained clinical researcher using the CAM–ICU. Demographic data were analyzed using descriptive statistics. Univariate and multiple logistic regressions were used to analyze the outcomes.

Results

Delirium occurred in 44 of 99 patients (44.4 %). Nurses could not identify delirium in 29.6 % of patients compared with researchers. Pre-existing dementia and depression were found in 47.7 % of patients. Pneumonia or other causes of respiratory failure were the most common causes of admission to ICU (47.7 %). Independent factors associated with under-recognition by nurses were identified—heart failure [adjusted odds ratio (OR), 77.8; 95 % confidence interval (CI) 2.5–2,543, p = 0.01] and pre-existing taking treatment with benzodiazepines (adjusted OR, 22.6; 95 % CI 1.8–85, p = 0.01).

Discussion

Under-recognition of delirium is a frequent issue. New independent factors associated with under-recognition were identified. Awareness of delirium in the patients with these factors is recommended.

Conclusions

This study supports the finding of high under-recognition rates of delirium among hospitalized older adults in ICU. Patients with heart failure and receiving benzodiazepines were identified as barriers of recognition of delirium.

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Acknowledgments

We wish to acknowledge Professor James A. Will, University of Wisconsin-Madison, for editing the manuscript via the Faculty of Medicine Publication Clinic, Khon Kaen University, Thailand. This manuscript was funded by the Neuroscience Research and Development Group, Khon Kaen University, Thailand.

Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the authorship and/or publication of this article.

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Authors and Affiliations

  1. Division of Critical Care, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    Anupon Panitchote

  2. Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    Kawin Tangvoraphonkchai

  3. Intensive Care Unit of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    Naluttaporn Suebsoh, Wanaporn Eamma & Bunruam Chanthonglarng

  4. Divison of Neurology, Department of Internal Medicine, Faculty of Medicine and Northeastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand

    Somsak Tiamkao

  5. Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand

    Panita Limpawattana

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  1. Anupon Panitchote
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  2. Kawin Tangvoraphonkchai
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Correspondence to Panita Limpawattana.

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Panitchote, A., Tangvoraphonkchai, K., Suebsoh, N. et al. Under-recognition of delirium in older adults by nurses in the intensive care unit setting. Aging Clin Exp Res 27, 735–740 (2015). https://doi.org/10.1007/s40520-015-0323-6

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  • DOI: https://doi.org/10.1007/s40520-015-0323-6

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