title: Under-recognition of delirium in older adults by nurses in the intensive care unit setting.
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).
  
  
  CONCLUSIONS
  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.
authors: Division of Critical Care, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors: Anupon
authors: A
authors: Panitchote
authors: Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors: Kawin
authors: K
authors: Tangvoraphonkchai
authors: Intensive Care Unit of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors: Naluttaporn
authors: N
authors: Suebsoh
authors: Intensive Care Unit of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors: Wanaporn
authors: W
authors: Eamma
authors: Intensive Care Unit of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors: Bunruam
authors: B
authors: Chanthonglarng
authors: Divison of Neurology, Department of Internal Medicine, Faculty of Medicine and Northeastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand.
authors: Somsak
authors: S
authors: Tiamkao
authors: Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand. lpanit@kku.ac.th.
authors: Panita
authors: P
authors: Limpawattana
mesh_terms: D000368:Aged; D001569:Benzodiazepines / Q000627:therapeutic use; D002983:Clinical Competence / Q000592:standards; D015897:Comorbidity; D064648:Critical Care Nursing / Q000379:methods / Q000592:standards; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000451:nursing*; D003704:Dementia / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D004650:Employee Performance Appraisal / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000150:complications / Q000453:epidemiology; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology
chemical_list: D001569:Benzodiazepines
keywords: Awareness; Benzodiazepines; Confusion; Critical care; Nurse recognition