title: Prevalence, course and factors associated with delirium in elderly patients with advanced cancer: a longitudinal observational study.
abstract: OBJECTIVE
  The aim of this study was to investigate the prevalence of delirium on admission, the course of delirium during a 2-week period after admission and factors associated with delirium on admission, among elderly patients with advanced cancer.
  
  
  METHODS
  Patients aged ≥ 65 years with incurable lung or gastroenterological cancer and the Eastern Cooperative Oncology Group Performance Status 2 or greater were continuously sampled after admission to a university hospital. Participants were evaluated for DSM-IV-TR delirium by trained psychiatrists and the delirium subtype was assessed using the Delirium Motor Subtype Scale within 4 days after admission and again 2 weeks later. In addition, we assessed associated factors with delirium on admission.
  
  
  RESULTS
  Among 73 eligible patients, complete data were available from 61 on admission and 49 after 2 weeks. Twenty-six patients (43%) met delirium criteria on admission (hypoactive: 58%, unspecified: 35%, hyperactive: 4%, mixed: 4%). Of these, 19 (73%) remained delirious 2 weeks later. Of 35 patients without delirium on admission, 21 (60%) remained delirium-free 2 weeks later and 7(20%) became delirious. Overall, 33/61 (54%) developed delirium at some point during the study. Patients receiving steroids at admission were more likely to have delirium (odds ratio = 5.0; 95% confidence interval = 1.5-16).
  
  
  CONCLUSIONS
  Given the high prevalence of the delirium, all patients with advanced cancer should be screened for delirium both on admission and regularly thereafter. In addition, medical staff should be aware that steroid use on admission is an additional indicator of elevated risk for delirium.
authors.affiliation: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya.
authors.forename: Megumi
authors.initials: M
authors.lastname: Uchida
authors.affiliation: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya okuyama@med.nagoya-cu.ac.jp.
authors.forename: Toru
authors.initials: T
authors.lastname: Okuyama
authors.affiliation: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Nakaguchi
authors.affiliation: Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya.
authors.forename: Mikinori
authors.initials: M
authors.lastname: Miyazaki
authors.affiliation: Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya.
authors.forename: Masaki
authors.initials: M
authors.lastname: Sakamoto
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kamiya
authors.affiliation: Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Takeyama
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
authors.affiliation: Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: David
authors.initials: D
authors.lastname: Meagher
authors.affiliation: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Akechi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: advanced cancer; associated factor; course; delirium; prevalence