[Delirium in Chilean elderly inpatients: an overlooked problem].
BACKGROUND
Delirium is a common underdiagnosed and undertreated problem in elderly inpatients, associated to higher morbidity, mortality and health cost.


OBJECTIVE
To evaluate the prevalence of delirium at hospital admission in medically ill elderly patients and the attending physician's diagnosis and treatment of delirium.


METHODS
In a prospective and descriptive study, consecutive patients aged 65 years or more, admitted to an internal medicine ward were evaluated by independent physicians, during the first 48 h of admission, to asses the presence of delirium. Diagnosis of delirium was based on the Confusion Assessment Method. Medical and nurse records were reviewed. Family was interviewed when necessary.


RESULTS
One hundred eight patients (52% women, age range 65-94 years) with an APACHE II score of 11.6+/-5, were evaluated. Fifty seven patients (53%) had delirium (32% hyperactive, 72% hypoactive and 5% mixed). Delirium prevalence was significantly higher in older patients (66% among those aged 75 years or older versus 30% in younger, p <0.05) and among patients with more severe conditions (88% among those with an APACHE score over 16 versus 47% below that value, p <0.05). Medical records of patients with delirium showed that this diagnosis was present only in 32% and cognitive deficit was described in 73%. Ten percent of patients with delirium received sedative medication and 38% were physically restricted. There were no environmental interventions to prevent or control delirium.


CONCLUSIONS
Delirium in elderly inpatients at this unit is an extraordinarily prevalent problem, seriously under diagnosed (68%) and under treated. This study should alerts our medical community to improve the diagnosis and management of delirium in elderly inpatients.
Carrasco
Marcela
M
Programa de Geriatría, Pontificia Universidad Católica de Chile. mcarras@med.puc.cl
Hoyl
Trinidad
T
Marín
Pedro Paulo
PP
Hidalgo
Jaime
J
Lagos
Carmen
C
Longton
Cristóbal
C
Chávez
Pamela
P
Valenzuela
Eduardo
E
Arriagada
Domingo
D
D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D002677:Chile / Q000453:epidemiology; D003693:Delirium / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D010819:Physician's Role; D011446:Prospective Studies