Abstract
Objective
Our aim was to measure the prevalence of delirium, its clinical features, and outcomes in older patients referred to a memory clinic.
Methods
A retrospective cohort study of 109 older outpatients with delirium referred to a memory clinic with a home care service. Delirium was diagnosed using the confusion assessment method and dementia with the DSM-5 criteria. We collected information on cognitive and functional status, mortality, institutionalization, and hospitalization during 6 months following the delirium episode.
Results
Delirium prevalence was 3.6%, mostly of hyperactive type. Delirium worsened functional (ADL 2.95 ± 1.95 vs. 2.16 ± 1.84) and cognitive (MMSE 13.88 ± 8.96 vs.11.0 ± 9.49) status after 6 months compared to the baseline. The mortality rate was 29.4%, and 28.3% were admitted to a long-term facility after the episode of delirium. Of these patients, more than half were hospitalized during the follow-up. Of the 109 patients with delirium, 85 were managed at home and 24 were hospitalized. Patients who were hospitalized had more severe behavioral symptoms during the delirium episode. There was no difference in mortality and institutionalization according to the home or hospital management.
Conclusions
This retrospective cohort study adds novel information to the existing literature of an understudied setting and population. The study supports the need to further investigate the feasibility and efficacy of the hospital at home models for the prevention and management of delirium in a high-risk population.
Similar content being viewed by others
References
Inouye SK, Westendorp RG, Saczynski JS (2014) Delirium in elderly people. Lancet 383:911–922
Eeles EM, Hubbard RE, White SV et al (2010) Hospital use, institutionalisation and mortality associated with delirium. Age Ageing 39:470–475
Davis DH, Muniz Terrera G, Keage H et al (2012) Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain J Neurol 135:2809–2816
Morandi A, Davis D, Fick DM et al (2014) Delirium superimposed on dementia strongly predicts worse outcomes in older rehabilitation inpatients. J Am Med Dir Assoc 15:349–354
Morandi A, Di Santo SG, Zambon A et al (2019) Delirium, dementia, and in-hospital mortality: the results from the Italian Delirium Day 2016, a national multicenter study. J Gerontol Ser Biol Sci Med Sci 74:910–916
Morandi A, Lucchi E, Turco R et al (2015a) Delirium superimposed on dementia: a quantitative and qualitative evaluation of informal caregivers and health care staff experience. J Psychosom Res 79:272–280
Morandi A, Lucchi E, Turco R et al (2015b) Delirium superimposed on dementia: a quantitative and qualitative evaluation of patient experience. J Psychosom Res 79:281–287
Fong TG, Racine AM, Fick DM et al (2019) The caregiver burden of delirium in older adults with Alzheimer disease and related disorders. J Am Geriatr Soc 67:2587–2592
Grossi E, Lucchi E, Gentile S et al (2019) Preliminary investigation of predictors of distress in informal caregivers of patients with delirium superimposed on dementia. Aging Clin Exp Res 32:339–344
Lerner AJ, Hedera P, Koss E et al (1997) Delirium in Alzheimer disease. Alzheimer Dis Assoc Disord 11:16–20
de Lange E, Verhaak PF, van der Meer K (2013) Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: a review. Int J Geriatr Psychiatry 28:127–134
Hasegawa N, Hashimoto M, Yuuki S et al (2013) Prevalence of delirium among outpatients with dementia. Int Psychogeriatr IPA 25:1877–1883
Addesi D, Maio R, Smirne N et al (2018) Prevalence of delirium in a population of elderly outpatients with dementia: a retrospective study. J Alzheimer’s Dis 61:251–257
Verloo H, Goulet C, Morin D et al (2016) Nursing intervention versus usual care to improve delirium among home-dwelling older adults receiving homecare after hospitalization: feasibility and acceptability of a randomized controlled trail. BMC Nurs 15:19
Inouye SK, van Dyck CH, Alessi CA et al (1990) Clarifying confusion: the confusion assessment method A new method for detection of delirium. Ann Intern Med 113:941–948
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA
Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198
Hughes CP, Berg L, Danziger WL et al (1982) A new clinical scale for the staging of dementia. Br J Psychiatry J ment Sci 140:566–572
Cummings JL, Mega M, Gray K et al (1994) The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology 44:2308–2314
Parmelee PA, Thuras PD, Katz IR et al (1995) Validation of the Cumulative Illness Rating Scale in a geriatric residential population. J Am Geriatr Soc 43:130–137
Katz S (1983) Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 31:721–727
Bellelli G, Morandi A, Trabucchi M et al (2018) Italian intersociety consensus on prevention, diagnosis, and treatment of delirium in hospitalized older persons. Intern Emerg Med 13:113–121
Network SIG: Risk reduction and management of delirium. https://www.sign.ac.uk/sign-157-delirium.html.
Morandi A, Davis D, Bellelli G et al (2017) The diagnosis of delirium superimposed on dementia: an emerging challenge. J Am Med Dir Assoc 18:12–18
Inouye SK, Foreman MD, Mion LC et al (2001) Nurses’ recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Arch Intern Med 161:2467–2473
Gual N, Richardson SJ, Davis DHJ, Bellelli G, Hasemann W, Meagher D, Kreisel SH, MacLullich AMJ, Cerejeira J, Inzitari M, Morandi A (2019) Impairments in balance and mobility identify delirium in patients with comorbid dementia. Int Psychogeriatr. 31(5):749–753. https://doi.org/10.1017/S1041610218001345
Richardson SJ, Davis DHJ, Bellelli G et al (2017) Detecting delirium superimposed on dementia: diagnostic accuracy of a simple combined arousal and attention testing procedure. Int Psychogeriatr 29(10):1585–1593
Morandi A, Han JH, Meagher D et al (2016) Detecting delirium superimposed on dementia: evaluation of the diagnostic performance of the Richmond Agitation and Sedation Scale. J Am Med Dir Assoc 17:828–833
Bellelli G, Speciale S, Morghen S et al (2011) Are fluctuations in motor performance a diagnostic sign of delirium? J Am Med Dir Assoc 12:578–583
Landreville P, Voyer P, Carmichael PH (2013) Relationship between delirium and behavioral symptoms of dementia. Int Psychogeriatr IPA 25:635–643
Siddiqi N, Harrison JK, Clegg A et al (2016) Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev 3:5563
Pozzi C, Tatzer VC, Alvarez EA et al (2020) The applicability and feasibility of occupational therapy in delirium care. Eur Geriatr Med 11:209–216
Pozzi C, Lanzoni A, Lucchi E et al (2020) Activity-based occupational therapy intervention for delirium superimposed on dementia in nursing home setting: a feasibility study. Aging Clin Exp Res 32:827–833
Pozzi C, Lanzoni A, Lucchi E et al (2018) A pilot study of community-based occupational therapy for persons with dementia (COTID-IT Program) and their caregivers: evidence for applicability in Italy. Aging Clin Exp Res 31(9):1299–1304
Holtta E, Laakkonen ML, Laurila JV et al (2011) The overlap of delirium with neuropsychiatric symptoms among patients with dementia. Am J Geriatr Psychiatry 19:1034–1041
Kakuma R, du Fort GG, Arsenault L et al (2003) Delirium in older emergency department patients discharged home: effect on survival. J Am Geriatr Soc 51:443–450
Caplan GA, Coconis J, Board N et al (2006) Does home treatment affect delirium? A randomised controlled trial of rehabilitation of elderly and care at home or usual treatment (The REACH-OUT trial). Age Ageing 35:53–60
Tibaldi V, Aimonino N, Ponzetto M et al (2004) A randomized controlled trial of a home hospital intervention for frail elderly demented patients: behavioral disturbances and caregiver’s stress. Arch Gerontol Geriatr Suppl 9:431–436
Chia J, Eeles EM, Tattam K et al (2020) Outcomes for patients with delirium receiving hospital-in-the-home treatment: an Australian perspective. Australas J Ageing 39(2):e215–e219
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
The Health Trust (AUSL) of Modena approved the study.
Statement of human and animal rights
The study was conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Manni, B., Federzoni, L., Zucchi, P. et al. Prevalence and management of delirium in community dwelling older people with dementia referred to a memory clinic. Aging Clin Exp Res 33, 2243–2250 (2021). https://doi.org/10.1007/s40520-020-01753-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40520-020-01753-3