Delirium superimposed on dementia: A quantitative and qualitative evaluation of patient experience.
OBJECTIVE
Delirium superimposed on dementia is common and is associated with adverse outcomes. Yet little is known about the patients' personal delirium experiences. We used quantitative and qualitative methods to assess the delirium superimposed on dementia experience among older patients.


METHODS
We conducted a prospective cohort study among patients with delirium superimposed on dementia who were admitted to a rehabilitation ward. Delirium was diagnosed using DSM-IV-TR criteria. Delirium severity and symptoms were evaluated with the Delirium-O-Meter (D-O-M). The experience of delirium was assessed after delirium resolution (T0) and one month later (T1) with a standardized questionnaire and a qualitative interview. Level of distress was measured with the Delirium Experience Questionnaire.


RESULTS
Of the 30 patients included in the study, 50% had mild dementia; 33% and 17% had moderate and severe dementia. Half of the patients had evidence of the full range of D-O-M delirium symptoms. We evaluated 30 patients at T0 and 20 at T1. At T0, half of the patients remembered being confused as part of the delirium episode, and reported an overall moderate level of related distress. Patients reported high distress related to memories of anxiety/fear, delusions, restlessness, hypokinesia, and impaired orientation. Qualitative interviews revealed six main aspects of patient delirium experiences: Emotions; Cognitive Impairment; Psychosis; Memories; Awareness of Change; and Physical Symptoms.


CONCLUSIONS
The study provides novel information on the delirium experience in patients with dementia. These findings are the key for health care providers to improve the everyday care of this important group of frail older patients.
Department of Rehabilitation and Aged Care of the Ancelle Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy. Electronic address: morandi.alessandro@gmail.com.
Alessandro
A
Morandi
Department of Rehabilitation and Aged Care of the Ancelle Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy. Electronic address: elena.lucchi@ancelle.it.
Elena
E
Lucchi
Department of Rehabilitation and Aged Care of the Ancelle Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy. Electronic address: renatoturco@virgilio.it.
Renato
R
Turco
Department of Rehabilitation and Aged Care of the Ancelle Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy. Electronic address: sara.morghen@ancelle.it.
Sara
S
Morghen
Department of Rehabilitation and Aged Care of the Ancelle Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy. Electronic address: fabio.guerini@ancelle.it.
Fabio
F
Guerini
Department of Rehabilitation and Aged Care of the Ancelle Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy. Electronic address: rossana.santi@ancelle.it.
Rossana
R
Santi
Department of Rehabilitation and Aged Care of the Ancelle Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy. Electronic address: simona.gentile@ancelle.it.
Simona
S
Gentile
Graduate-entry Medical School, Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity, Graduate Entry Medical School, University of Limerick, Limerick, Ireland. Electronic address: david.meagher@ul.ie.
David
D
Meagher
Faculty of Nursing sciences, Université Laval, Quebec City, Canada. Electronic address: philippe.voyer@fsi.ulaval.ca.
Philippe
P
Voyer
College of Nursing, The Pennsylvania State University, USA. Electronic address: dmf21@psu.edu.
Donna
D
Fick
Hebrew SeniorLife, Institute for Aging Research, Harvard Medical School, USA. Electronic address: EvaSchmitt@hsl.harvard.edu.
Eva M
EM
Schmitt
Hebrew SeniorLife, Institute for Aging Research, Harvard Medical School, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: sharoninouye@hsl.harvard.edu.
Sharon K
SK
Inouye
Geriatric Research Group, Brescia, Italy; University of Tor Vergata, Rome, Rome, Italy. Electronic address: trabucchi.m@grg-bs.it.
Marco
M
Trabucchi
Geriatric Research Group, Brescia, Italy; Department of Health Sciences, University of Milano-Bicocca and Geriatric Medicine, San Gerardo Hospital, Monza, Italy; Milan Center for Neuroscience (Neuro-Mi), Milan, Italy. Electronic address: giuseppe.bellelli@unimib.it.
Giuseppe
G
Bellelli
D000368:Aged; D015331:Cohort Studies; D003693:Delirium / Q000451:nursing* / Q000523:psychology; D003704:Dementia / Q000451:nursing* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011446:Prospective Studies; D011795:Surveys and Questionnaires
Delirium experience; Delirium stress; Delirium superimposed on dementia