Delirium superimposed on dementia: A quantitative and qualitative evaluation of informal caregivers and health care staff experience.
OBJECTIVE
Delirium superimposed on dementia is common and potentially distressing for patients, caregivers, and health care staff. We quantitatively and qualitatively assessed the experience of informal caregiver and staff (staff nurses, nurse aides, physical therapists) caring for patients with delirium superimposed on dementia.


METHODS
Caregivers' and staff experience was evaluated three days after delirium superimposed on dementia resolution (T0) with a standardized questionnaire (quantitative interview) and open-ended questions (qualitative interview); caregivers were also evaluated at 1-month follow-up (T1).


RESULTS
A total of 74 subjects were included; 33 caregivers and 41 health care staff (8 staff nurses, 20 physical therapists, 13 staff nurse aides/health care assistants). Overall, at both T0 and T1, the distress level was moderate among caregivers and mild among health care staff. Caregivers reported, at both T0 and T1, higher distress related to deficits of sustained attention and orientation, hypokinesia/psychomotor retardation, incoherence and delusions. The distress of health care staff related to each specific item of the Delirium-O-Meter was relatively low except for the physical therapists who reported higher level of distress on deficits of sustained/shifting attention and orientation, apathy, hypokinesia/psychomotor retardation, incoherence, delusion, hallucinations, and anxiety/fear. The qualitative evaluation identified important categories of caregivers' and staff feelings related to the delirium experience.


CONCLUSIONS
This study provides information on the implication of the experience of delirium on caregivers and staff. The distress related to delirium superimposed on dementia underlines the importance of providing continuous training, support and experience for both the caregivers and health care staff to improve the care of patients with delirium superimposed on dementia.
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.
Donna M
DM
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
D017028:Caregivers / Q000523:psychology*; D015331:Cohort Studies; D003693:Delirium / Q000451:nursing* / Q000523:psychology; D003704:Dementia / Q000451:nursing* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000592:standards*; D011446:Prospective Studies; D011795:Surveys and Questionnaires
Caregivers' experience; Delirium superimposed on dementia; Stress