Impaired Arousal in Older Adults Is Associated With Prolonged Hospital Stay and Discharge to Skilled Nursing Facility

Journal of the American Medical Directors Association

Volumn 16, Issue 7, 2015, Pages 586-589

  Yevchak, Andrea M ^a   Han, Jin Ho ^b   Doherty, Kelly ^b   Archambault, Elizabeth G ^c   Kelly, Brittany ^c   Chandrasekhar, Rameela ^b   Ely, E Wesley ^b   Rudolph, James L ^c,d  

^a DUQUESNE UNIVERSITY   (United States)

^b VANDERBILT UNIVERSITY SCHOOL OF MEDICINE   (United States)

^c VETERANS AFFAIRS MEDICAL CENTER   (United States)

^d HARVARD UNIVERSITY   (United States)

Author keywords

Acute care; Arousal; Cognition; Transitional care

Indexed keywords

AGED; ARTICLE; COMORBIDITY; DATA ANALYSIS; DEMENTIA; FEMALE; HOSPITAL DISCHARGE; HOSPITALIZATION; HUMAN; LENGTH OF STAY; MAJOR CLINICAL STUDY; MALE; NURSING HOME; OUTCOME ASSESSMENT; PROSPECTIVE STUDY; RICHMOND AGITATION SEDATION SCALE; SECONDARY ANALYSIS; SLEEP AROUSAL DISORDER; TERTIARY CARE CENTER; TOTAL QUALITY MANAGEMENT; UNITED STATES; UNIVERSITY HOSPITAL; AROUSAL; MIDDLE AGED; PROPORTIONAL HAZARDS MODEL; VERY ELDERLY;

ACADEMIC MEDICAL CENTERS; AGED; AGED, 80 AND OVER; AROUSAL; FEMALE; HUMANS; LENGTH OF STAY; MALE; MIDDLE AGED; PATIENT DISCHARGE; PROPORTIONAL HAZARDS MODELS; PROSPECTIVE STUDIES; SKILLED NURSING FACILITIES; SOUTHEASTERN UNITED STATES;

EID: 84931565539     PISSN: 15258610     EISSN: 15389375     Source Type: Journal    
DOI: 10.1016/j.jamda.2015.01.093     Document Type: Article

References (27)

1. Inouye S.K., Westendorp R.G.J., Saczynski J.S. Delirium in elderly people. Lancet 2014, 383:911-922.
2. Fick D.M., Steis M.R., Waller J.L., Inouye S.K. Delirium superimposed on dementia is associated with prolonged length of stay and poor outcomes in hospitalized older adults. J Hosp Med 2013, 8:500-505.
3. Boustani M., Baker M.S., Campbell N., et al. Impact and recognition of cognitive impairment among hospitalized elders. J Hosp Med 2010, 5:69-75.
4. Morandi A., Davis D., Fick D.M., et al. Delirium superimposed on dementia strongly predicts worse outcomes in older rehabilitation inpatients. J Am Med Dir Assoc 2014, 15:349-354.
5. Inouye S.K., van Dyck C.H., Alessi C.A., et al. Clarifying confusion: The confusion assessment method-A new method for detection of delirium. Ann Intern Med 1990, 113:941-948.
6. O'Regan N.A., Ryan D.J., Boland E., et al. Attention! A good bedside test for delirium?. J Neurol Neurosurg Psychiatry 2014, 85:1122-1131.
7. Folstein M.F., Folstein S.E., McHugh P.R. "Mini-mental state": A practical method for grading the cognitive state of patients for the clinician. J Psychiatry Res 1975, 12:189-198.
8. Kolanowski A.M., Fick D.M., Yevchak A.M., et al. Pay attention!: The critical importance of assessing attention in older adults with dementia. J Gerontol Nurs 2012, 38:23-27.
9. Sessler C.N., Gosnell M.S., Grap M.J., et al. The Richmond Agitation and Sedation Scale. Am J Respir Crit Care Med 2002, 166:1338-1344.
10. Chester J.G., Beth Harrington M., Rudolph J.L. Serial administration of a modified Richmond Agitation and Sedation Scale for delirium screening. J Hosp Med 2012, 7:450-453. on behalf of the VADWG.
11. Flaherty J.H., Rudolph J., Shay K., et al. Delirium is a serious and under-recognized problem: Why assessment of mental status should be the sixth vital sign. J Am Med Dir Assoc 2007, 8:273-275.
12. The DSM-5 criteria, level of arousal and delirium diagnosis: Inclusiveness is safer. BMC Med 2014, 12:141. European Delirium Assocaiton, American Delirium Socetiy.
13. Han J.H., Wilson A., Vasilevskis E.E., et al. Diagnosing delirium in older emergency department patients: Validity and reliability of the delirium triage screen and the brief confusion assessment method. Ann Emerg Med 2013, 62:457-465.
14. Han J.H., Eden S., Shintani A., et al. Delirium in older emergency department patients is an independent predictor of hospital length of stay. Acad Emerg Med 2011, 18:451-457.
15. Flaherty J.H., Morley J.E. Delirium in the nursing home. J Am Med Dir Assoc 2013, 14:632-634.
16. Rockwood K. Making delirium prevention acceptable in nursing homes. J Am Med Dir Assoc 2014, 15:6-7.
17. Kolanowski A., Mogle J., Fick D.M., et al. Pain, delirium, and physical function in skilled nursing home patients with dementia. J Am Med Dir Assoc 2015, 16:37-40.
18. Vithoulkas G., Muresanu D.F. Conscience and consciousness: A definition. J Med Life 2014, 7:104-108.
19. Boly M., Seth A., Wilke M., et al. Consciousness in humans and nonhuman animals: Recent advances and future directions. Front Psychol 2013, 4:625.
20. Srinivasan N. Interdependence of attention and consciousness. Progress in Brain Research 2007, Volume 168:65-75. Elsevier, Philadelphia, PA.
21. Rajlakshmi A.K., Mattoo S.K., Grover S. Relationship between cognitive and non-cognitive symptoms of delirium. Asian J Psychiatry 2013, 6:106-112.
22. Ely E.W., Truman B., Shintani A., et al. Monitoring sedation status over time in ICU patients: Reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 2003, 289:2983-2991.
23. Tieges Z., McGrath A., Hall R.J., MacLullich A.M.J. Abnormal level of arousal as a predictor of delirium and inattention: An exploratory study. Am J Geriatr Psychiatry 2013, 21:1244-1253.
24. Covinsky K.E., Palmer R.M., Fortinsky R.H., et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age. J Am Geriatr Soc 2003, 51:451-458.
25. Connolly A., Gaehl E., Martin H., et al. Underdiagnosis of dementia in primary care: Variations in the observed prevalence and comparisons to the expected prevalence. Aging Ment Health 2011, 15:978-984.
26. Enns E., Rhemtulla R., Ewa V., et al. A controlled quality improvement trial to reduce the use of physical restraints in older hospitalized adults. J Am Geriatr Soc 2014, 62:541-545.
27. Han J.H., Vasilevskis E.E., Shintani A., et al. Impaired arousal at initial presentation predicts 6-month mortality: An analysis of 1084 acutely ill older patients. J Hosp Med 2014, 9:772-778.