Quantifying the Severity of a Delirium Episode Throughout Hospitalization: the Combined Importance of Intensity and Duration

Journal of General Internal Medicine

Volumn 31, Issue 10, 2016, Pages 1164-1171

  Vasunilashorn, Sarinnapha M ^a,b   Marcantonio, Edward R ^a,b,c   Gou, Yun ^c   Pisani, Margaret A ^d   Travison, Thomas G ^a,b,c   Schmitt, Eva M ^c   Jones, Richard N ^e   Inouye, Sharon K ^a,b,c  

^a BETH ISRAEL DEACONESS MEDICAL CENTER   (United States)

^b HARVARD MEDICAL SCHOOL   (United States)

^c Hebrew Senior Life   (United States)

^d YALE UNIVERSITY SCHOOL OF MEDICINE   (United States)

^e BROWN UNIVERSITY   (United States)

Author keywords

cognitive change; delirium severity; duration; intensity

Indexed keywords

ADULT; AGED; ARTICLE; CLINICAL OUTCOME; COHORT ANALYSIS; DELIRIUM; DISEASE ASSOCIATION; DISEASE DURATION; DISEASE SEVERITY; FEMALE; HOSPITALIZATION; HUMAN; MAJOR CLINICAL STUDY; MALE; NURSING HOME; OUTCOME ASSESSMENT; PREDICTIVE VALIDITY; PROSPECTIVE STUDY; RISK FACTOR; FOLLOW UP; HOSPITAL READMISSION; PROGNOSIS; PSYCHOMETRY; SEVERITY OF ILLNESS INDEX; STATISTICS AND NUMERICAL DATA; TIME FACTOR; VERY ELDERLY;

AGED; AGED, 80 AND OVER; DELIRIUM; FEMALE; FOLLOW-UP STUDIES; HOSPITALIZATION; HUMANS; MALE; NURSING HOMES; PATIENT READMISSION; PROGNOSIS; PROSPECTIVE STUDIES; PSYCHOMETRICS; SEVERITY OF ILLNESS INDEX; TIME FACTORS;

EID: 84987917220     PISSN: 08848734     EISSN: 15251497     Source Type: Journal    
DOI: 10.1007/s11606-016-3671-9     Document Type: Article

References (30)

1. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383:911–22.
2. Rudolph JL, Jones RN, Rasmussen LS, Silverstein JH, Inouye SK, Marcantonio ER. Independent vascular and cognitive risk factors for postoperative delirium. Am J Med. 2007;120:807–13.
3. Martin BJ, Buth KJ, Arora RC, Baskett RJ. Delirium as a predictor of sepsis in post-coronary artery bypass grafting patients: a retrospective cohort study. Crit Care. 2010;14:171.
4. Marcantonio ER, Flacker JM, Michaels M, Resnick NM. Delirium is independently associated with poor functional recovery after hip fracture. J Am Geriatr Soc. 2000;48:618–24.
5. Witlox J, Eurelings LS, de Jonhe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304:443–51.
6. Marcantonio ER, Goldman L, Mangione CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA. 1994;271:134–9.
7. Inouye SK, Zhang Y, Han L, Leo-Summers L, Jones R, Marcantonio E. Recoverable cognitive dysfunction at hospital admission in older persons during acute illness. J Gen Intern Med. 2006;21:1276–81.
8. Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008;168:27–32.
9. Adamis D, Sharma N, Whelan PJP, MacDonald AJD. Delirium scales: a review of current evidence. Aging Ment Health. 2010;14:543–55.
10. Inouye SK, Kosar CM, Tommet D, et al. The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts. Ann Intern Med. 2014;160:526–33.
11. Schuurmans MJ, Deschamps PI, Markham SW, Shortridge-Baggett LM, Duursma SA. The measurement of delirium: review of scales. Res Theory Nurs Pract. 2003;17:207–24.
12. Smith MJ, Breitbart WS, Platt MM. A critique of instruments and methods to detect, diagnose, and rate delirium. J Pain Symptom Manag. 1995;10:35–77.
13. Trzepacz PT. A review of delirium assessment instruments. Gen Hosp Psychiatry. 1994;16:397–405.
14. Trezepacz PT, Baker RW, Greenhouse J. A symptom rating scale for delirium. Psychiatry Res. 1988;23:89–97.
15. Schmitt EM, Marcantonio ER, Alsop DC, et al. Novel risk markers and long-term outcomes of delirium: the Successful Aging after Elective Surgery (SAGES) study design and methods. J Am Med Dir Assoc. 2012;13:1–10.
16. Schmitt E, Saczynski J, Kosar C, et al. The Successful Aging after Elective Surgery (SAGES) Study: cohort description and data quality procedures. J Am Geriatr Soc. In press.
17. Inouye SK, Bogardus ST Jr, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340:669–76.
18. Inouye SK, Leo-Summers L, Zhang Y, Bogardus ST Jr, Leslie DL, Agostini JV. A chart-based method for identification of delirium: validation compared with interviewer ratings using the Confusion Assessment Method. J Am Geriatr Soc. 2005;53:312–8.
19. Leslie DL, Zhang Y, Holford TR, Bogardus ST, Leo-Summers LS, Inouye SK. Premature death associated with delirium at 1-year follow-up. Arch Intern Med. 2005;165:1657–62.
20. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Hortwitz RI. Clarifying confusion: the Confusion Assessment Method. A new method for detection of delirium. Ann Intern Med. 1990;113:941–8.
21. Inouye SK. The Confusion Assessment Methods (CAM): training manual and coding guide. New Haven: Yale University School of Medicine; 2003. http://www.hospitalelderlifeprogram.org/uploads/disclaimers/Long_CAM_Training_Manual_10-9-14.pdf Accessed 7 Mar 2016.
22. McAvay GJ, Van Ness PH, Bogardus ST Jr, et al. Older adults discharged from the hospital with delirium: 1-year outcomes. J Am Geriatr Soc. 2006;54:1245–50.
23. Davis DH, Skelly DT, Murray C, et al. Worsening cognitive impairment and neurodegenerative pathology progressively increase risk for delirium. Am J Geriatr Psychiatry. 2015;23:403–15.
24. Leslie DL, Zhang Y, Bogardus ST, Holford TR, Leo-Summers LS, Inouye SK. Consequences of preventing delirium in hospitalized older adults on nursing home costs. J Am Geriatr Soc. 2005;53:405–9.
25. Marcantonio ER, Ngo LH, O’Connor M, et al. 3D-CAM: derivation and validation of a 3-minute diagnostic interview of CAM-defined delirium: a cross-sectional diagnostic test study. Ann Intern Med. 2014;161:554–61.
26. Inouye SK. Hospital Elder Life Program (HELP). http://www.hospitalelderlifeprogram.org/ Accessed 7 Mar 2016.
27. Marcantonio E, Ta T, Duthie E, Resnick NM. Delirium severity and psychomotor types: their relationship with outcomes after hip fracture repair. J Am Geriatr Soc. 2002;50:850–7.
28. Cole MG, Ciampi A, Belzile E, Zhong L. Persistent delirium in older hospital patients: a systematic review of frequency and prognosis. Age Ageing. 2009;38:19–26.
29. Kiely DK, Marcantonio ER, Inouye SK, et al. Persistent delirium predicts greater mortality. J Am Geriatr Soc. 2008;57:55–61.
30. Page VJ, Ely EW, Gates S, et al. Effect of intravenous haloperidol on duration of delirium and coma in critically ill patients (Hope-ICU): a randomised, double-blind, placebo-controlled trial. Lancet Respir Med. 2013;1:515–23.