title: "Delirium Day": a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool.
abstract: BACKGROUND
  To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy.
  
  
  METHODS
  This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints.
  
  
  RESULTS
  The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not.
  
  
  CONCLUSIONS
  Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys.
authors.affiliation: School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy. giuseppe.bellelli@unimib.it.|Geriatric Unit, San Gerardo University Hospital, Monza, Italy. giuseppe.bellelli@unimib.it.|Geriatric Research Group, Brescia, Italy. giuseppe.bellelli@unimib.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bellelli
authors.affiliation: Geriatric Research Group, Brescia, Italy.|Department of Rehabilitation and Aged Care "Fondazione Camplani" Hospital, Cremona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Morandi
authors.affiliation: Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Foundation S Lucia, Roma, Italy.
authors.forename: Simona G
authors.initials: SG
authors.lastname: Di Santo
authors.affiliation: Redaelli Geriatric Institute, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mazzone
authors.affiliation: Geriatrics and Geriatric Emergency Care, IRCCS-INRCA, Ancona, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cherubini
authors.affiliation: Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Mossello
authors.affiliation: Section of Geriatrics, Città della Salute e della Scienza - Molinette, Torino, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Bo
authors.affiliation: Medicine and Rehabilitation Department, Istituto Clinico S. Anna, Brescia, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Bianchetti
authors.affiliation: Department of Geriatric and Internal Medicine, Poliambulanza Hospital, Brescia, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Rozzini
authors.affiliation: Geriatric Unit, San Gerardo University Hospital, Monza, Italy.
authors.forename: Ermellina
authors.initials: E
authors.lastname: Zanetti
authors.affiliation: Institute of Biomedical Technologies, National Research Council, Segrate (Milan), Italy.|Italian Society of Neurology for Dementia (SINDEM), Siena, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Musicco
authors.affiliation: Geriatric Unit, Department of Neuromotor Physiology, ASMN Hospital, Reggio Emilia, Italy.|Italian Society of Hospital and Community Geriatrics (SIGOT), Roma, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ferrari
authors.affiliation: Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.|Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese, Telese Terme (BN), Italy.|Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Ferrara
authors.affiliation: Geriatric Research Group, Brescia, Italy.|Tor Vergata, Rome University, Rome, Italy.|Italian Psychogeriatric Association (AIP), Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Trabucchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D011795:Surveys and Questionnaires
keywords: 4AT; Delirium; Hospital; Multicenter; Prevalence