title: Detection and management of hyperactive and hypoactive delirium in older patients during hospitalization: a retrospective cohort study evaluating daily practice.
abstract: The objectives of the study are to study daily hospital practice regarding detection and management and to study hyperactive and hypoactive delirium of older patients during their hospitalization.
  
  
  
  A retrospective cohort study evaluating care as usual for older hospitalized patients with delirium at Maastricht University Medical Center+, a university hospital in the Netherlands, was performed. Inclusion criteria were older hospitalized patients (65+ years), diagnosed with delirium between 1 January and 31 December 2014. Data were retrieved from the patients' medical files. Delirium was categorized as hyperactive or hypoactive. Primary outcome measures were prevalence and management (pharmacological, reorientation, screening for delirium and delirium consultations, and physical restraints). Secondary outcomes were short-term adverse outcomes.
  
  
  
  Prevalence of delirium was 5% (N = 401), of which 77% (n = 307) was hyperactive and 23% (n = 94) was hypoactive. Significantly, more patients with a hyperactive delirium received medication to manage the delirium than patients with a hypoactive delirium (89% vs. 77%, respectively, p = 0.004). No other significant differences between the subtypes were found.
  
  
  
  There was probably a strong under-recognition of delirium. Drugs were the main intervention of choice, especially for patients with hyperactive delirium. The two subtypes did not differ on non-pharmacological management. The retrospective nature of this study sheds light on the status quo of recognition, management, and care as usual for the different delirium subtypes in daily hospital practice, which may help in forming new guidelines and protocols for the detection and treatment of delirium for older patients in hospitals.
authors.affiliation: Care and Public Health Research Institute (CAPHRI) and Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.
authors.forename: Eveline L
authors.initials: EL
authors.lastname: van Velthuijsen
authors.affiliation: Care and Public Health Research Institute (CAPHRI) and Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.
authors.forename: Sandra M G
authors.initials: SMG
authors.lastname: Zwakhalen
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.
authors.forename: Wubbo J
authors.initials: WJ
authors.lastname: Mulder
authors.affiliation: Alzheimer Center Limburg, MHeNS School for Mental Health and NeuroScience, Maastricht, The Netherlands.|Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.
authors.forename: Frans R J
authors.initials: FRJ
authors.lastname: Verhey
authors.affiliation: Care and Public Health Research Institute (CAPHRI) and Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.
authors.forename: Gertrudis I J M
authors.initials: GIJM
authors.lastname: Kempen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003693:Delirium / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011595:Psychomotor Agitation / Q000628:therapy; D012044:Regression Analysis; D012149:Restraint, Physical / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D014150:Antipsychotic Agents
keywords: care as usual; delirium; management; prevalence; psychomotor subtypes