Delirium in the geriatric unit: proton-pump inhibitors and other risk factors.
BACKGROUND
Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies.


OBJECTIVE
Evaluate specific factors for development of delirium in a geriatric ward setting.


METHODS
Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men), admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission. Comprehensive geriatric assessments including a structured interview, physical examination, geriatric functional assessment, blood sampling, ECG, abdominal ultrasound, chest X-ray, Confusion Assessment Method for diagnosis of delirium, Delirium-O-Meter to assess delirium severity, Richmond Agitation-Sedation Scale to assess sedation or agitation, visual analog scale and Doloplus-2 scale to assess pain level were performed.


RESULTS
Multivariate logistic regression analysis revealed five independent factors associated with development of delirium in geriatric inpatients: transfer between hospital wards (odds ratio [OR] =2.78; confidence interval [CI] =1.54-5.01; P=0.001), preexisting dementia (OR =2.29; CI =1.44-3.65; P<0.001), previous delirium incidents (OR =2.23; CI =1.47-3.38; P<0.001), previous fall incidents (OR =1.76; CI =1.17-2.64; P=0.006), and use of proton-pump inhibitors (OR =1.67; CI =1.11-2.53; P=0.014).


CONCLUSIONS
Transfer between hospital wards, preexisting dementia, previous delirium incidents, previous fall incidents, and use of proton-pump inhibitors are predictive of development of delirium in the geriatric inpatient setting.
Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
Iwona
I
Otremba
Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
Krzysztof
K
Wilczyński
Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
Jan
J
Szewieczek
D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003693:Delirium / Q000175:diagnosis*; D003704:Dementia / Q000523:psychology*; D005260:Female; D015577:Geriatric Assessment; D006760:Hospitalization / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D010360:Patient Transfer; D011044:Poland; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors
D054328:Proton Pump Inhibitors
Confusion Assessment Method; Delirium-O-Meter; Richmond Agitation-Sedation Scale; comprehensive geriatric assessment; delirium; geriatric ward