Gaps in patient care practices to prevent hospital-acquired delirium.
OBJECTIVE
To evaluate the current patient care practices that address the predisposing and precipitating factors contributing to the prevention of hospital-acquired delirium in the elderly.


METHODS
Prospective cohort (observational) study.


METHODS
Patients 65 years of age and older who were admitted to medical teaching units at the University of Alberta Hospital in Edmonton over a period of 7 months and who were at risk of delirium.


METHODS
Medical teaching units at the University of Alberta.


METHODS
Demographic data and information on predisposing factors for hospital-acquired delirium were obtained for all patients. Documented clinical practices that likely prevent common precipitants of delirium were also recorded.


RESULTS
Of the 132 patients enrolled, 20 (15.2%) developed hospital-acquired delirium. At the time of admission several predisposing factors were not documented (eg, possible cognitive impairment 16 [12%], visual impairment 52 [39.4%], and functional status of activities of daily living 99 [75.0%]). Recorded precipitating factors included catheter use, screening for dehydration, and medications. Catheters were used in 35 (26.5%) patients, and fluid intake-and-output charting assessed dehydration in 57 (43.2%) patients. At the time of admission there was no documentation of hearing status in 69 (52.3%) patients and aspiration risk in 104 (78.8%) patients. After admission, reorientation measures were documented in only 16 (12.1%) patients. Although all patients had brief mental status evaluations performed once daily, this was not noted to occur twice daily (which would provide important information about fluctuation of mental status) and there was no formal attention span testing. In this study, hospital-acquired delirium was also associated with increased mortality (P < .004), increased length of stay (P < .007), and increased institutionalization (P < .027).


CONCLUSIONS
Gaps were noted in patient care practices that might contribute to hospital-acquired delirium and also in measures to identify the development of delirium at an earlier stage. Effort should be made to educate health professionals to identify the predisposing and precipitating factors, and to screen for delirium. This might improve the prevention of delirium.
Alagiakrishnan
Kannayiram
K
Glenrose Rehabilitation Hospital, Edmonton, AB T5G 0B7. kalagiak@cha.ab.ca
Marrie
Thomas
T
Rolfson
Darryl
D
Coke
William
W
Camicioli
Richard
R
Duggan
D'Arcy
D
Launhardt
Bonnie
B
Fisher
Bruce
B
Gordon
Debbie
D
Hervas-Malo
Marilou
M
Magee
Bernice
B
Wiens
Cheryl
C
D000368:Aged; D000416:Alberta; D003693:Delirium / Q000209:etiology / Q000517:prevention & control*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004198:Disease Susceptibility; D005260:Female; D006760:Hospitalization; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D008297:Male