Delirium – Epidemiologia

Delirium
Epidemiologia

Delirium stanowi jedno z najczęstszych zaburzeń ostrej dysfunkcji narządów w środowiskach szpitalnych, z częstością występowania sięgającą 20-80% na oddziałach intensywnej terapii (OIT), a u pacjentów wentylowanych mechanicznie nawet do 87%. W innych środowiskach klinicznych częstość ta waha się od 3% do 42%, zależnie od populacji i rodzaju oddziału (np. 23% na oddziałach medycznych, 5-10% po operacjach ogólnych, do 42% po zabiegach ortopedycznych). Czynniki ryzyka dzieli się na predysponujące, takie jak demencja, podeszły wiek, wcześniejsze zaburzenia poznawcze, choroby układu oddechowego, nadużywanie alkoholu oraz wywołujące, w tym stosowanie benzodiazepin, obecność inwazyjnych urządzeń medycznych, unieruchomienie fizyczne, żywienie dojelitowe, leki przeciwdrgawkowe oraz ciężkość choroby oceniana wskaźnikami SOFA i SAPS3. Diagnostyka delirium opiera się na standaryzowanych narzędziach, takich jak CAM-ICU, ICDSC, NEECHAM oraz 4AT, jednak mimo ich dostępności delirium pozostaje często niedodiagnozowane, co utrudnia skuteczne leczenie i prewencję.

Epidemiologia delirium

Delirium jest jednym z najczęstszych przyczyn ostrej dysfunkcji narządów we wszystkich środowiskach szpitalnych, występującym nawet u 80% krytycznie chorych pacjentów wymagających opieki na oddziale intensywnej terapii (OIT)¹. Liczne badania wskazują na dużą zmienność w częstości występowania delirium, która może być różna w zależności od badanej populacji i dostępnych technik diagnostycznych²³.

Częstość występowania delirium różni się znacząco w zależności od populacji pacjentów – osoby w podeszłym wieku, z pogorszeniem funkcji poznawczych i cierpiące na cięższe choroby są narażone na wyższe ryzyko⁴. W systematycznym przeglądzie 42 kohort w 40 badaniach, 10-31% nowych przyjęć do szpitala spełniało kryteria delirium, a częstość rozwoju delirium podczas hospitalizacji wahała się od 3% do 29%⁵.

Występowanie w różnych środowiskach klinicznych

Występowanie delirium różni się znacząco w zależności od środowiska klinicznego:

Oddziały intensywnej terapii: Częstość występowania delirium jest najwyższa, osiągając od 20% do 80%, a u pacjentów wentylowanych mechanicznie nawet do 80-87%⁴⁶⁷. W międzynarodowym badaniu wieloośrodkowym częstość występowania delirium na OIT wynosiła 32,3%⁸.
Oddziały medyczne: Delirium jest powszechne u hospitalizowanych pacjentów medycznych. Meta-analiza z 2020 roku obejmująca 33 badania pacjentów hospitalizowanych na oddziałach medycznych wykazała ogólną częstość występowania delirium na poziomie 23%⁹.
Oddziały chirurgiczne: Częstość występowania delirium pooperacyjnego (POD) po operacjach ogólnych wynosi 5-10%, a po zabiegach ortopedycznych nawet do 42%⁵. W badaniu FINDERI częstość występowania POD po operacjach kardiochirurgicznych wynosiła 21%¹⁰.
Szpitalne oddziały ratunkowe (SOR): Delirium występuje często u starszych pacjentów SOR, dotykając 8-10% pacjentów¹¹. W innym badaniu wskazano, że delirium dotyka do 17% starszych pacjentów SOR¹².
Opieka paliatywna: W jednostkach opieki paliatywnej częstość występowania delirium wynosi od 26% do 62% podczas przyjęcia, wzrastając do 88% w ostatnich godzinach życia¹³.
Placówki opieki długoterminowej: W badaniu międzynarodowym stwierdzono częstość występowania delirium na poziomie około 12%, przy czym wskaźniki były wyższe w placówkach rehabilitacyjnych (13,6-14,1%) w porównaniu z domami opieki (3,3-9,9%)¹⁴¹⁵.

Delirium w różnych grupach wiekowych

Chociaż delirium może wystąpić w każdym wieku, istnieją znaczące różnice w jego epidemiologii w zależności od grupy wiekowej:

Osoby starsze: Delirium występuje najczęściej u pacjentów w podeszłym wieku⁵. U pacjentów powyżej 65 roku życia częstość występowania zaburzeń poznawczych (w tym delirium) podczas hospitalizacji wynosi 38,5%, a u osób powyżej 85 roku życia przekracza 50%¹⁶¹⁷.
Dzieci: Delirium jest również częstym powikłaniem poważnych chorób u dzieci. Badania wykazały, że częstość występowania delirium na pediatrycznych oddziałach intensywnej terapii przekracza 25%¹⁸. W badaniu obejmującym 1547 kolejnych pacjentów pediatrycznych, delirium zdiagnozowano u 267 (17%)¹⁹.

Różnice demograficzne

Występowanie delirium może różnić się w zależności od czynników demograficznych:

U osób powyżej 65 roku życia delirium częściej występuje u mężczyzn²⁰.
Natomiast delirium częściej obserwuje się u kobiet powyżej 85 roku życia z chorobami współistniejącymi²⁰.
Nie ma preferencji rasowych dla delirium, ale młodsi pacjenci afroamerykańscy rzadziej rozwijają delirium w porównaniu z osobami rasy kaukaskiej w tym samym wieku²⁰.

Czynniki ryzyka delirium

Czynniki ryzyka delirium można ogólnie podzielić na czynniki predysponujące (podatność pacjenta) i czynniki wywołujące (potencjalnie modyfikowalne)²¹. Zrozumienie tych czynników jest kluczowe dla opracowania skutecznych strategii prewencji i leczenia.

Czynniki predysponujące

Liczne czynniki podatności pacjenta zidentyfikowano w różnych środowiskach klinicznych:

Demencja: Jest to najbardziej konsekwentnie obserwowany czynnik podatności na delirium²¹.
Wiek: Podeszły wiek jest znaczącym czynnikiem ryzyka delirium we wszystkich środowiskach⁷.
Wcześniejsze zaburzenia poznawcze: Pacjenci z istniejącymi wcześniej zaburzeniami poznawczymi są bardziej narażeni na rozwój delirium²².
Choroby układu oddechowego: Zostały zidentyfikowane jako czynnik predysponujący do delirium⁷.
Nadużywanie alkoholu: Jest istotnym czynnikiem ryzyka delirium⁷²³.
Wcześniejsze występowanie delirium: Epizod delirium w przeszłości zwiększa ryzyko kolejnego epizodu.
Zaburzenia neurologiczne: W badaniu nad delirium u pacjentów z COVID-19 choroby współistniejące neurologiczne były związane z wyższym ryzykiem rozwoju delirium²⁴.

Czynniki wywołujące

Wśród potencjalnie modyfikowalnych czynników wywołujących delirium, następujące zostały zidentyfikowane jako szczególnie istotne:

Leki psychoaktywne: Ekspozycja na benzodiazepiny jest najsilniej związana z delirium, szczególnie w warunkach OIT²⁵²³. W międzynarodowym badaniu wieloośrodkowym stosowanie midazolamu było zidentyfikowane jako potencjalnie modyfikowalny czynnik ryzyka²⁶.
Inwazyjne urządzenia medyczne: Używanie inwazyjnych urządzeń jest związane z większym ryzykiem rozwoju delirium²⁶.
Unieruchomienie fizyczne: W jednym z badań unieruchomienie fizyczne zwiększało częstość występowania delirium²⁷.
Żywienie dojelitowe: Zostało zidentyfikowane jako czynnik zwiększający częstość występowania delirium²⁷.
Leki przeciwdrgawkowe: Stosowanie leków przeciwdrgawkowych również zwiększa częstość występowania delirium²⁷.
Ciężkość choroby: Wyższy wskaźnik ciężkości choroby przy przyjęciu, wyrażony wyższymi wynikami SOFA i SAPS3, jest związany z diagnozą delirium⁸.
Zaburzenia biochemiczne: W badaniu pacjentów z COVID-19, podwyższone poziomy mocznika i dehydrogenazy mleczanowej przy przyjęciu były związane z rozwojem delirium²⁴.

U dzieci zidentyfikowano podobne czynniki ryzyka. W analizie wieloczynnikowej niezależnymi predyktorami delirium u dzieci były: wiek ≤ 2 lat, opóźnienie rozwojowe, ciężkość choroby, wcześniejsza śpiączka, wentylacja mechaniczna oraz stosowanie benzodiazepin i leków przeciwcholinergicznych¹⁹.

Metody wykrywania i nadzoru delirium

Wykrywanie delirium pozostaje wyzwaniem klinicznym, a brak rozpoznania jest jedną z największych przeszkód w jego łagodzeniu²⁸. Rozpoznanie delirium wymaga standaryzowanej oceny przy użyciu zwalidowanych narzędzi diagnostycznych.

Narzędzia do oceny delirium

Różne narzędzia do oceny delirium zostały opracowane i zwalidowane w różnych środowiskach klinicznych:

CAM-ICU (Confusion Assessment Method for ICU): Jest to jedno z najczęściej używanych narzędzi do oceny delirium w OIT²⁹⁶. W wieloośrodkowym badaniu, 354 pacjentów wentylowanych mechanicznie miało codzienną ocenę delirium przy użyciu CAM-ICU⁷.
ICDSC (Intensive Care Delirium Screening Checklist): Podobnie jak CAM-ICU, jest powszechnie stosowaną metodą oceny delirium w OIT²⁹²³.
NEECHAM (NEECHAM Confusion Scale): Badania wskazują, że skala NEECHAM ma wysoką moc predykcyjną w przewidywaniu delirium i może zapewnić dokładne i szybkie informacje o stanie pacjenta³⁰.
4AT: Jest to często stosowane narzędzie do wykrywania delirium, szczególnie w placówkach opieki długoterminowej. Około 70% uczestniczących placówek opieki długoterminowej zgłosiło używanie zwalidowanego narzędzia do wykrywania, przy czym 4AT było najczęściej stosowanym³¹.

Wyzwania w wykrywaniu delirium

Mimo dostępności zwalidowanych narzędzi, wykrywanie delirium nadal napotyka na wyzwania:

Badanie w Irlandii wykazało, że delirium pozostaje znacznie niedodiagnozowane w szpitalach, jeśli nie jest stosowane formalne narzędzie oceny. Na oddziałach, gdzie stosowano osobisty osąd do wykrywania delirium, wskaźnik występowania wynosił 11,5%, podczas gdy na oddziałach stosujących formalne narzędzie oceny wynosił 15,9%³²³³.
Mimo zgłaszania używania formalnego narzędzia, 27% pacjentów na oddziałach nie zostało ocenionych pod kątem delirium, a kolejne 11% było nieokreślonych lub niemożliwych do przetestowania³³.
Pomimo wysiłków w kierunku wdrożenia regularnych badań przesiewowych przy użyciu ICDSC lub CAM-ICU, wiele ocen jest nadal nieprawidłowych, nawet przy użyciu tych wiarygodnych narzędzi²⁹.

Środowisko kliniczne	Częstość występowania delirium	Najczęściej stosowane narzędzia oceny	Główne czynniki ryzyka
Oddział Intensywnej Terapii	20-80% (do 87% u pacjentów wentylowanych mechanicznie)	CAM-ICU, ICDSC	Benzodiazepiny, urządzenia inwazyjne, ciężkość choroby
Oddziały medyczne	23% (10-31% przy przyjęciu, 3-29% w trakcie hospitalizacji)	CAM, 4AT	Wiek, demencja, polipragmazja
Oddziały chirurgiczne	5-10% (ogólne), do 42% (ortopedyczne), 21% (kardiochirurgiczne)	CAM, 4AT	Typ operacji, leki sedatywne, znieczulenie ogólne
Szpitalne Oddziały Ratunkowe	8-17%	CAM-ICU, 4AT	Wiek, istniejące zaburzenia poznawcze
Opieka paliatywna	26-62% (do 88% w ostatnich godzinach życia)	CAM, MDAS	Zaawansowana choroba, polipragmazja
Placówki opieki długoterminowej	~12% (3,3-14,1% w zależności od typu placówki)	4AT	Upośledzenie funkcji, choroby współistniejące, polipragmazja

Konsekwencje delirium

Delirium wiąże się z istotnymi negatywnymi następstwami dla pacjentów, systemów opieki zdrowotnej i społeczeństwa jako całości.

Konsekwencje kliniczne

Pacjent, który doświadcza delirium, jest narażony na liczne niekorzystne wyniki kliniczne:

Zwiększona śmiertelność: Delirium jest związane ze zwiększoną krótko- i długoterminową śmiertelnością¹. Meta-analiza wykazała 95% zwiększone ryzyko śmiertelności u pacjentów z delirium w porównaniu do pacjentów bez delirium, nawet po skorygowaniu zmiennych zakłócających⁴. W międzynarodowym badaniu na OIT delirium wiązało się ze zwiększoną śmiertelnością na OIT (20% vs 5,7%) i śmiertelnością szpitalną (24% vs 8,3%)⁸.
Dłuższy pobyt w szpitalu: Delirium jest związane z dłuższym pobytem na OIT i dłuższym pobytem w szpitalu¹⁷. W jednym badaniu pacjenci z delirium mieli średni czas pobytu w szpitalu 22 dni (11-40) w porównaniu do 7 dni (4-18) u pacjentów bez delirium⁸.
Pogorszenie funkcji poznawczych: Delirium wiąże się ze zmniejszeniem długoterminowej funkcji poznawczej¹. Jest silnym czynnikiem ryzyka demencji u najstarszych osób³⁴.
Zwiększone powikłania opieki szpitalnej: Pacjenci z delirium doświadczają więcej powikłań związanych z opieką szpitalną¹.
Dłuższy czas wentylacji mechanicznej: U dzieci delirium wiąże się z przedłużoną wentylacją mechaniczną¹⁸.

W badaniu obejmującym pacjentów w wieku 65 lat i starszych hospitalizowanych z powodu zaburzeń poznawczych, w porównaniu z pacjentami bez takich zaburzeń, wyniki były gorsze: długość pobytu 25,0 vs 11,8 dni, śmiertelność 30-dniowa 13,6% vs 9,0%, śmiertelność roczna 40,0% vs 26,0%, śmierć lub ponowne przyjęcie w ciągu roku 62,4% vs 51,5% (wszystkie P≤0,01)¹⁶.

Konsekwencje ekonomiczne

Delirium wiąże się ze znacznymi kosztami ekonomicznymi:

Szacowane koszty wynoszą od 16 303 do 64 421 dolarów na pacjenta⁴⁹.
Roczne obciążenie krajowe w Stanach Zjednoczonych szacuje się na 143-152 miliardy dolarów rocznie⁴.
W 2008 roku oszacowano, że delirium kosztuje system opieki zdrowotnej od 38 do 152 miliardów dolarów rocznie⁹.

Podtypy delirium i ich rozpowszechnienie

Delirium można podzielić na różne podtypy w zależności od profilu psychoruchowego. Znajomość tych podtypów jest ważna, ponieważ mogą one różnić się pod względem identyfikacji, przebiegu klinicznego i wyników.

Główne podtypy delirium

Dwa najczęstsze typy delirium w OIT to mieszane i hipoaktywne⁶:

Delirium hipoaktywne: Charakteryzuje się zmniejszoną aktywnością psychoruchową, apatią i zmniejszoną świadomością. Jest to najpowszechniejszy typ delirium wśród osób starszych³⁵, ale często jest przeoczany lub niedodiagnozowany.
Delirium hiperaktywne: Charakteryzuje się zwiększoną aktywnością psychoruchową, pobudzeniem i potencjalnie agresywnym zachowaniem. Jest to najłatwiejszy do rozpoznania typ, ale nie najpowszechniejszy.
Delirium mieszane: Pacjenci wykazują cechy zarówno hipoaktywnego, jak i hiperaktywnego delirium, często fluktuując między tymi stanami.

W badaniu pacjentów, którzy przeszli elektywną operację z pooperacyjnym przyjęciem na OIT, 6-miesięczna śmiertelność wynosiła 32% u pacjentów z delirium hipoaktywnym w porównaniu do 8,7% u osób z innymi typami delirium⁶.

Delirium w kontekście COVID-19

Pandemia COVID-19 dostarczyła nowych informacji na temat epidemiologii delirium w kontekście ostrej choroby zakaźnej.

W jednym z pierwszych badań epidemiologii i korelacji klinicznych delirium w dużej grupie pacjentów hospitalizowanych z powodu zapalenia płuc COVID-19, 94 pacjentów (11%) rozwinęło delirium podczas pobytu³⁶. Delirium było związane z dramatycznym wzrostem śmiertelności, chociaż związek ten nie był niezależny od stanu układu oddechowego³⁶.

Pacjenci z delirium byli starsi, mieli choroby współistniejące neurologiczne i wyższe poziomy mocznika i dehydrogenazy mleczanowej przy przyjęciu²⁴.

Wyzwania i perspektywy w nadzorze nad delirium

Pomimo znacznego postępu w zrozumieniu epidemiologii delirium, nadal istnieją istotne wyzwania w jego nadzorze i badaniach.

Luki w obecnym nadzorze

Pomimo dowodów wskazujących na wysoką częstość występowania delirium, jego związaną z nim chorobowość i możliwości interwencji, wiele instytucji nie posiada rygorystycznych strategii zapobiegania i łagodzenia delirium²⁸. Brak rozpoznania delirium jest jedną z największych przeszkód w jego łagodzeniu²⁸.

Delirium jest często jatrogenim powikłaniem hospitalizacji, jednak wdrażanie strategii zapobiegania delirium pozostaje w tyle za innymi jatrogennymi powikłaniami, takimi jak upadki, zakażenia szpitalne, takie jak zakażenia układu moczowego związane z cewnikiem (CAUTI) i odleżyny²⁸.

Potrzeby badawcze

Przyszłe badania muszą pracować nad zrozumieniem epidemiologii w różnych środowiskach i skupić się na modyfikowalnych czynnikach ryzyka, które można zintegrować z istniejącymi protokołami zapobiegania i leczenia delirium³⁷³⁸.

Konieczne są badania epidemiologiczne w niewybranych populacjach. Badania w takich populacjach mają potencjał do rozwiązania kilku pytań o znaczeniu klinicznym w delirium³⁹.

Potrzebne są szeroko zakrojone badania longitudinalne do zbadania długoterminowych następstw delirium u dzieci¹⁸.

Istnieje potrzeba bardziej rygorystycznych metodologicznie badań nad związkiem między delirium a upadkami, zrozumienia, w jaki sposób i dlaczego ten związek działa dwukierunkowo, oraz zidentyfikowania potencjalnych czynników modyfikujących zaangażowanych w ten proces⁴⁰.

Obiecujące strategie nadzoru

Kilka strategii wykazało obiecujące wyniki w poprawie nadzoru nad delirium:

Regularna edukacja i szkolenia, zaangażowanie zespołu multidyscyplinarnego oraz ukierunkowana interwencja w obszarach o wysokiej częstości występowania delirium okazały się skuteczne w osiąganiu postępów w kierunku celów projektu⁴¹.
Wdrożenie standaryzowanych i obiektywnych podejść do identyfikacji delirium jest istotnie potrzebne w placówkach opieki długoterminowej na całym świecie⁴².
POSTOPED (badanie w szkockim szpitalu trzeciorzędowym) sugeruje, że delirium jest najczęstszym powikłaniem pooperacyjnym u osób starszych i jest znacznie niedodiagnozowane i nierozpoznawane. Personel medyczny powinien oceniać pacjentów za pomocą specyficznego i czułego zwalidowanego narzędzia oceny, 4AT, przy przyjęciu i 1 dzień po operacji (aby uwzględnić ustąpienie znieczulenia)⁴³.

Zarówno CAM-ICU, jak i ICDSC zostały szeroko zwalidowane w wielu różnych populacjach pacjentów OIT i są zalecane do rutynowego monitorowania w codziennej praktyce²³.

Wnioski

Delirium jest powszechnym i poważnym zespołem neuropsychiatrycznym, który występuje w różnych środowiskach klinicznych, z najwyższą częstością występowania na oddziałach intensywnej terapii. Dotyka pacjentów w każdym wieku, ale jest szczególnie powszechne wśród osób starszych i krytycznie chorych.

Chociaż delirium jest zapobiegalne w 30% do 40% przypadków szpitalnych⁹, często pozostaje nierozpoznane i nieleczone w szpitalu. Liczne czynniki ryzyka zostały zidentyfikowane, a wśród nich stosowanie benzodiazepin, urządzeń inwazyjnych i ciężkość choroby są najbardziej konsekwentnie związane ze zwiększonym ryzykiem.

Delirium wiąże się z istotnymi konsekwencjami klinicznymi, w tym zwiększoną śmiertelnością, dłuższym pobytem w szpitalu, pogorszeniem funkcji poznawczych i zwiększonymi kosztami opieki zdrowotnej. Szacowane koszty wynoszą od 16 303 do 64 421 dolarów na pacjenta, a roczne obciążenie krajowe w Stanach Zjednoczonych wynosi 143-152 miliardy dolarów.

Pomimo dostępności zwalidowanych narzędzi do wykrywania delirium, takich jak CAM-ICU, ICDSC i 4AT, wykrywanie delirium nadal napotyka na wyzwania, a wiele przypadków pozostaje niedodiagnozowanych.

Przyszłe badania powinny skupić się na zrozumieniu epidemiologii delirium w różnych środowiskach i skupić się na modyfikowalnych czynnikach ryzyka, które można zintegrować z istniejącymi protokołami zapobiegania i leczenia. Systematyczne wdrażanie strategii wykrywania, zapobiegania i leczenia delirium pozostaje głównym wyzwaniem dla organizacji opieki zdrowotnej na całym świecie.

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Materiały źródłowe

#1 Epidemiology and risk factors for delirium across hospital settings
https://pmc.ncbi.nlm.nih.gov/articles/PMC3580997/
Delirium is one of the most common causes of acute end-organ dysfunction across hospital settings, occurring in as high as 80% of critically ill patients that require intensive care unit (ICU) care. […] Across many hospital settings (emergency department, general medical ward, postoperative and ICU), a patient who experiences delirium is more likely to experience increased short- and long-term mortality, decreases in long-term cognitive function, increases in hospital length of stay and increased complications of hospital care. […] With the development of reliable setting-specific delirium-screening instruments, researchers have been able to highlight the predisposing and potentially modifiable risk factors that place patients at highest risk. […] Among the large number of risk factors discovered, administration of potent sedative medications, most notably benzodiazepines, is most consistently and strongly associated with an increased burden of delirium.
#2 Epidemiology, risk factors, diagnosis, and potentially effective strategies to improve delirium in patients admitted to intensive care units: A narrative review
https://www.jnursrcp.com/article_184242.html
Delirium is prevalent in intensive care units (ICUs), causing significant financial burden and devastating consequences. […] The primary objective of this article is to furnish comprehensive insights into delirium, encompassing its epidemiology, risk factors, diagnosis, and strategies for preventing its occurrence among patients in the ICUs. […] Delirium is prevalent in intensive care units (ICUs), causing significant financial burden and devastating consequences. […] It has a considerable impact on morbidity and mortality rate, higher hospital and ICU costs, which appear to increase linearly with the severity of delirium, and a 3-fold increase in the 6-month mortality rate. […] Numerous studies demonstrate a wide range of delirium occurrences, which may vary depending on the features of the population under investigation and the available diagnostic techniques.
#3 Epidemiology, risk factors, diagnosis, and potentially effective strategies to improve delirium in patients admitted to intensive care units: A narrative review
https://www.jnursrcp.com/article_184242.html
The prevalence of delirium varies between 9% and 87% across several studies. […] Risk factors that cause delirium in patients can be divided into three general categories. […] The CAM-ICU and the ICDSC are the most commonly used tools to assess delirium in the ICU because the examination of the patients using these tools requires less time and education, and are also suitable for individuals who are unable to speak. […] Despite efforts to implement regular delirium screenings using the ICDSC or the CAM-ICU, many assessments are still incorrect, even when these reliable tools are used. […] Delirium is a common disorder in hospitalized patients, particularly those admitted to the ICU. […] It is suggested that forthcoming studies concentrate on enhancing the precision of forecasting delirium commencement by utilizing AIP parameters upon admission to the ICU, the attentiveness of nurses in detecting alterations in cognitive function, and prompt identification and treatment of delirium which could result in decreased ICU stays, improved patient outcomes, and minimized reliance on pharmaceutical interventions. […] Considering the importance of delirium, especially in patients hospitalized in ICU and its high incidence rate, much research has been conducted to investigate its causes, risk factors, diagnosis methods, epidemiology, and strategies to improve the diagnosis of this mental disorder.
#4
https://scitemed.com/article/2687/Epidemiology,-Mechanisms,-Diagnosis,-and-Treatment-of-Delirium-A-Narrative-Review
Delirium is a common syndrome that affects up to 30% of hospitalized adults. […] The prevalence varies significantly depending on the patient population, as patients with advanced age, cognitive decline, and more severe medical illness are at higher risk. […] In intensive care unit (ICU) settings the prevalence is significantly higher, where rates of over 80% have been reported in mechanically ventilated patients. […] Delirium is associated with a multitude of adverse clinical outcomes, including longer time to extubation and increases in length of stay in both ICU and general medical settings, thus putting patients at risk for additional medical complications associated with prolonged hospitalization. […] Of greatest concern, elderly patients with delirium face increased mortality, with a meta-analysis finding a 95% increased hazard for mortality for delirious patients compared to non-delirious controls, even after adjusting for confounding variables. […] Delirium is also associated with increased healthcare utilization, with estimated costs of between $16,303 to $64,421 per patient and an annual national burden of $143-152 billion per year in the United States.
#5 Delirium: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/793247-overview
Delirium is common in the United States. In a systematic review of 42 cohorts in 40 studies, 10-31% of new hospital admissions met criteria for delirium and the incidence of developing delirium during the admission ranged from 3-29%. […] For patients in intensive care units the prevalence of delirium may reach as high as 80%. […] Prevalence of postoperative delirium following general surgery is 5-10% and as high as 42% following orthopedic surgery. As many as 80% of patients develop delirium near death. Delirium is extremely common among nursing home residents. […] Delirium can occur at any age, but it occurs more commonly in patients who are elderly and have compromised mental status. Delirium can occur on top of an underlying dementia. This diagnosis here requires not only a careful mental status but also a thorough history from the patient’s family and the staff as well as a comprehensive chart review.
#6 Delirium in the ICU: an overview | Annals of Intensive Care | Full Text
https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-2-49
Delirium is extremely common in the intensive care unit (ICU) especially amongst mechanically ventilated patients. […] In a multicenter study, the prevalence of delirium in ICU patients was 32.3%. […] In specialized ICUs, the prevalence of delirium may be higher. […] The incidence of delirium in the ICU ranges from 45% to 87%. […] The two most common types of delirium in the ICU are mixed and hypoactive. […] In a study of patients who underwent elective surgery with postoperative ICU admission, the 6-month mortality was 32% in patients with hypoactive delirium compared with 8.7% in those with other types of delirium. […] Delirium was assessed daily by study nurses with the use of CAM-ICU. […] After adjusting for clinically relevant variables, including age, severity of illness, comorbid conditions, and use of sedatives and analgesic medications, delirium remained associated with a 3.2-fold increase in 6-month mortality and a 2-fold increase in hospital stay duration.
#7 Delirium in the ICU: an overview | Annals of Intensive Care | Full Text
https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-2-49
In a multicenter study, 354 mechanically ventilated patients had daily assessment for delirium with the use of CAM-ICU. […] Delirium in the ICU also is associated with more mechanical ventilation days, longer ICU stay, and longer hospital stay. […] In a study of non-ICU patients who underwent hip fracture repair, older age and male sex have been associated with an increased and independent risk of delirium. […] A systematic review that included six observational studies evaluated risk factors for delirium by multivariate analysis. […] Twenty-five risk factors were significantly associated with delirium, and among those four were recognized as predisposing to delirium: respiratory disease, older age, alcohol abuse, and dementia. […] In the ICU, benzodiazepines appear to have a more prominent role in the development of delirium.
#8 Delirium epidemiology in critical care (DECCA): an international study | springermedizin.de
https://www.springermedizin.de/delirium-epidemiology-in-critical-care-decca-an-international-st/9732660
Delirium is a frequent source of morbidity in intensive care units (ICUs). Most data on its epidemiology is from single-center studies. Our aim was to conduct a multicenter study to evaluate the epidemiology of delirium in the ICU. […] In total, 975 patients were screened, and 497 fulfilled inclusion criteria and were enrolled (median age, 62 years; 52.5% men; 16.7% and 19.9% for ICU and hospital mortality); 64% were admitted to the ICU because of medical causes, and sepsis was the main diagnosis (n = 76; 15.3%). […] The prevalence of delirium was 32.3%. Compared with patients without delirium, those with the diagnosis of delirium had a greater severity of illness at admission, demonstrated by higher sequential organ-failure assessment (SOFA (P = 0.004)) and simplified acute physiology score 3 (SAPS3) scores (P 0.0001). Delirium was associated with increased ICU (20% versus 5.7%; P = 0.002) and hospital mortality (24 versus 8.3%; P = 0.0017), and longer ICU (P 0.0001) and hospital length of stay (LOS) (22 (11 to 40) versus 7 (4 to 18) days; P 0.0001).
#9 Why We Must Prevent and Appropriately Manage Delirium | Journal of Ethics | American Medical Association
https://journalofethics.ama-assn.org/article/why-we-must-prevent-and-appropriately-manage-delirium/2023-10
Delirium is common and increases in prevalence with age and medical complexity. A 2020 meta-analysis of 33 studies of medical adult inpatients found an overall delirium prevalence of 23%. This figure, however, underestimates the prevalence of delirium in critically ill and palliative care patients, which is estimated to be 32% and 75%, respectively. Delirium affects more than 2.3 million older Americans annually, complicating 17.5 million inpatient days. It was estimated in 2008 that delirium costs up to $64 421 per inpatient and costs the health care system between $38 billion and $152 billion per year. Delirium disproportionately affects older patients and will therefore become an even larger issue as the population continues to age. […] Although delirium is preventable in 30% to 40% of inpatient cases, it is often underrecognized and undertreated in the hospital.
#10 Preoperative Delirium Risk Screening in Patients Undergoing a Cardiac Surgery: Results from the Prospective Observational FINDERI Study. – DZNEPUB
https://pub.dzne.de/record/270181
Postoperative delirium (POD) is a common complication of cardiac surgery that is associated with higher morbidity, longer hospital stay, cognitive decline, and mortality. […] However, a standardized screening assessment for POD risk has not been established. […] The primary aim was to analyze the predictive value of the Delirium Risk Screening Questionnaire (DRSQ) prior to cardiac surgery. […] The incidence of POD was 21%. […] Both the DRSQ and the three-rule decision tree might be helpful in predicting POD risk before cardiac surgery. […] Delirium: epidemiology (MeSH) […] Postoperative Complications: epidemiology (MeSH)
#11 Epidemiology and risk factors for delirium across hospital settings
https://pmc.ncbi.nlm.nih.gov/articles/PMC3580997/
Delirium occurs frequently in older ED patients, affecting 810% of patients. […] The short-term and long-term consequences of discharging delirious patients are unknown and needs further study, especially in light of one study that observed delirium at discharge was associated with increased 6-month mortality. […] Similar to other patient cohorts, delirium in the postoperative setting has been associated with significant increases in hospital stay, functional decline, prolonged cognitive dysfunction and mortality. […] Among the unique vulnerability risk factors of the postoperative setting is the relationship of delirium to the type of operation. […] Across multiple types of surgical interventions, numerous patient vulnerability characteristics have been reported as risk factors for POD.
#12 ED Delirium
https://eddelirium.org/
Delirium commonly occurs in acutely ill older patients, affecting up to 17% of older emergency department patients and up to 64% of hospitalized older medical inpatients. […] Delirium has devastating consequences. It is an independent predictor of short-term and long-term mortality across multiple clinical environments. Approximately one out of three older emergency department patients with delirium will die within 6-months. […] Delirium is a significant threat to the older patients independence and quality of life; it is associated with accelerated cognitive and functional decline, increased rates of nursing home placement, and longer hospital length of stays. […] Because the vast majority of delirious emergency department patients are admitted to the hospital, much of this websites content will be applicable to downstream providers (i.e., inpatient wards).
#13 Delirium epidemiology, systems and nursing practice in palliative care inpatient settings: A descriptive mixed methods project (The DePAC Project)
https://researchonline.nd.edu.au/theses/119/
Delirium is a distressing and serious acute neurocognitive disorder frequently experienced by hospitalised patients yet under-recognised by nurses. […] A mixed methods design was used to examine delirium in palliative care inpatient settings from epidemiological, systems and nursing practice perspectives. […] Internationally, delirium prevalence in palliative care inpatient units ranged from 26% to 62% during admission, increasing up to 88% in the last hours of life. […] Almost all evidence-based guidelines for delirium exclude evidence and recommendations directly acknowledging the care needs of patients who are approaching the end of their life. […] Strategies for recognising and assessing delirium are missing from palliative care unit systems. […] Ambiguous terminology and nurses poor conceptual understanding of delirium contributes to under-recognition and inadequate assessment. […] More careful navigation of palliative care patients away from an incipient or existing episode of delirium is entirely possible and must become core business within specialist palliative care inpatient units.
#14 Epidemiology and assessments of delirium in nursing homes and rehabilitation facilities: a cross-country perspective | springermedizin.de
https://www.springermedizin.de/epidemiology-and-assessments-of-delirium-in-nursing-homes-and-re/50924568
A reported delirium point prevalence of approximately 12% was found, with higher rates in rehabilitation facilities compared to nursing homes, along with significant variability in screening and assessment practices. […] Implementing standardized and objective approaches to delirium identification is crucially needed in long-term care settings worldwide. […] The aim of this study is to explore the epidemiology of delirium in LCT facilities (LCTFs) across multiple countries, focusing on point prevalence and assessment methods. […] Overall, 12.4% (n=221/1787) of residents were reported to have delirium in the morning, and 12.0% (n=167/1389) were reported to have delirium in the evening. Notably, delirium point prevalence was significantly higher both in the morning (13.6% vs. 9.9%, p=0.026) and in the evening (14.1% vs. 3.3%, p0.001) in RFs compared to NHs.
#15 Epidemiology and assessments of delirium in nursing homes and rehabilitation facilities: a cross-country perspective | springermedizin.de
https://www.springermedizin.de/epidemiology-and-assessments-of-delirium-in-nursing-homes-and-re/50924568
Most of the RFs declared to investigate it at least once a day (40.0% vs 6.9% in NHs), while the majority of the NHs only in case of sudden consciousness changes (79.3% vs 26.2% in RFs). […] Our study found an overall reported delirium point prevalence of roughly 12%, with higher rates in RFs compared to NHs. […] To date, most research on delirium has primarily focused on acute care settings. […] Our findings contribute to this underexplored area and highlight that the use of validated instruments enhances the detection of delirium. […] The overall prevalence of delirium in RFs has been reported to range from approximately 10% to 16%. […] This difference in prevalence rates between RFs and NHs observed in our study is notable, with RFs reporting a higher prevalence of delirium at both time points.
#16 Epidemiology and outcomes of people with dementia, delirium, and unspecified cognitive impairment in the general hospital: prospective cohort study of 10,014 admissions | BMC Medicine | Full Text
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0899-0
CSD was present in 38.5% of all patients admitted aged over 65, and in more than half of those aged over 85. Overall, 16.7% of older people admitted had delirium alone, 7.9% delirium superimposed on known dementia, 9.4% known dementia alone, and 4.5% unspecified cognitive impairment (AMT score8/10, no delirium, no known dementia). […] Outcomes were worse in those with CSD compared to those without LOS 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year death or readmission 62.4% vs. 51.5% (all P0.01). […] CSD is common in older inpatients and associated with considerably worse outcomes, with little variation between different types of CSD. Healthcare systems should systematically identify and develop care pathways for older people with CSD admitted as medical emergencies, and avoid only focusing on condition-specific pathways such as those for dementia or delirium alone.
#17 Article | Epidemiology and outcomes of people with dementia, delirium, and unspecified cognitive impairment in the general hospital: prospective cohort study of 10,014 admissions | University of Stirling
https://www.stir.ac.uk/research/hub/publication/522671
A CSD was present in 38.5% of all patients admitted aged over 65, and in more than half of those aged over 85. […] Overall, 16.7% of older people admitted had delirium alone, 7.9% delirium superimposed on known dementia, 9.4% known dementia alone, and 4.5% unspecified cognitive impairment (AMT score 8/10, no delirium, no known dementia). […] Outcomes were worse in those with CSD compared to those without LOS 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year death or readmission 62.4% vs. 51.5% (allP 0.01). […] CSD is common in older inpatients and associated with considerably worse outcomes, with little variation between different types of CSD. […] Healthcare systems should systematically identify and develop care pathways for older people with CSD admitted as medical emergencies, and avoid only focusing on condition-specific pathways such as those for dementia or delirium alone.
#18
https://journals.lww.com/co-pediatrics/fulltext/2020/12000/pediatric_delirium__epidemiology_and_outcomes.7.aspx
Delirium is a frequent complication of serious medical illness in children. The purpose of this review is to highlight recent data on the epidemiology and outcomes related to pediatric delirium, and discuss prevention strategies. […] Delirium rates in the pediatric ICU are greater than 25%. Delirium in children is associated with prolonged mechanical ventilation and hospital length of stay, increased costs, and excess mortality. Pediatric delirium may affect postdischarge cognition and quality of life. […] Widespread screening is needed in critically ill children to detect and mitigate delirium. The identification of modifiable risk factors has provided an opportunity for delirium prevention. Large-scale longitudinal studies are needed to investigate the long-term sequelae of delirium in children.
#19 Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium.
https://vivo.weill.cornell.edu/display/pubid28288026
OBJECTIVES: Delirium occurs frequently in adults and is an independent predictor of mortality. However, the epidemiology and outcomes of pediatric delirium are not well-characterized. The primary objectives of this study were to describe the frequency of delirium in critically ill children, its duration, associated risk factors, and effect on in-hospital outcomes, including mortality. […] Of 1,547 consecutive patients, delirium was diagnosed in 267 (17%) and lasted a median of 2 days (interquartile range, 1-5). […] In multivariable analysis, independent predictors of delirium included age less than or equal to 2 years old, developmental delay, severity of illness, prior coma, mechanical ventilation, and receipt of benzodiazepines and anticholinergics.
#20 Delirium epidemiology and demographics – wikidoc
https://www.wikidoc.org/index.php/Delirium_epidemiology_and_demographics
The prevalence of delirium is approximately 23,000 per 100,000 hospitalized patients worldwide. […] Between May 2009 to August 2012, the incidence of delirium was estimated to be 8700 cases per 100,000 African-Americans in Indianapolis. […] Delirium is more commonly observed among elderly patients, especially age 65 year-old. […] Male 65 year-old are more commonly affected with delirium. […] Delirium is more commonly observed among Female 85-year-old with medical comorbidities. […] There is no racial predilection for delirium. […] Young African-American patients are less likely to develop delirium compared with Caucasians of the same age.
#21 Epidemiology and risk factors for delirium across hospital settings
https://pmc.ncbi.nlm.nih.gov/articles/PMC3580997/
An additional 2931% of hospitalised older patients admitted without delirium will develop delirium (incident delirium). […] Risk factors for delirium across any setting, including the medical ward, can be categorised into patient vulnerability (or predisposing) factors and potentially modifiable (or precipitating) factors. […] Numerous patient vulnerability factors have been identified in this setting, but dementia is the most consistently observed vulnerability factor for delirium. […] Several potentially modifiable factors of delirium have been identified in the hospital literature. […] Importantly, delirium can be precipitated by iatrogenic events and, therefore, may be avoidable if appropriate action is taken. […] The ED plays a vital role in the health care of the ageing population and serves as the gateway for the majority of hospital admissions.
#22 Delirium epidemiology in critical care (DECCA): an international study | Critical Care | Full Text
https://ccforum.biomedcentral.com/articles/10.1186/cc9333
Delirium is a frequent source of morbidity in intensive care units (ICUs). Most data on its epidemiology is from single-center studies. Our aim was to conduct a multicenter study to evaluate the epidemiology of delirium in the ICU. […] In this 1-day international study, delirium was frequent and associated with increased mortality and ICU LOS. The main modifiable risk factors associated with the diagnosis of delirium were the use of invasive devices and sedatives (midazolam). […] The impact of delirium on relevant clinical outcomes is not restricted to the hospital setting, as delirium is also an independent predictor of 6-month mortality and long-term cognitive impairment. […] Our findings have significant clinical and research implications. First, they confirm the previous findings from single-center studies showing that among medical/surgical ICU patients, delirium is associated with adverse outcomes, including prolonged ICU hospital stay, and is an independent predictor of increased short-term mortality.
#23 Epidemiology, diagnosis and management of delirium in the intensive care unit: a narrative review of the literature | e-journal.gr
https://e-journal.gr/en/epidemiology-diagnosis-and-management-of-delirium-in-the-intensive-care-unit-a-narrative-review-of-the-literature/
Delirium, a serious and common manifestation of brain dysfunction in critically ill patients gained great attention over the last decade. […] Important risk factors such as use of benzodiazepines, coma, preexisting cognitive impairment, alcoholism and high severity of illness at ICU admission were identified. […] Screening tools like the CAM-ICU and the ICDSC were extensively validated in many different ICU patient populations and are recommended for routine monitoring in everyday practice. […] Sedation with novel sedatives such as dexmedetomidine, implementation of non pharmaceutical, preventive interventions and early mobilization of patients may reduce the incidence of this syndrome. […] The role of haloperidol and atypical antipsychotics in the prevention and treatment of ICU delirium is still under investigation.
#24
https://link.springer.com/article/10.1007/s40520-020-01699-6
The incidence of delirium in our population was, however, lower (11%) than that predicted for COVID-19. […] In spite of these limitations, this study represents one of the first reports of delirium epidemiology and clinical correlates in a large group of patients hospitalized with COVID-19 pneumonia, confirming that delirium is one of the main complications of the severe forms of this novel disease. […] In patients hospitalized with suspect COVID-19 pneumonia during the pandemic peak, delirium was a common complication of stay, associated with older age, neurological comorbidities and higher serum urea and lactate-dehydrogenase levels at admission.
#25 Epidemiology and risk factors for delirium across hospital settings
https://pmc.ncbi.nlm.nih.gov/articles/PMC3580997/
Among the potentially modifiable factors, multiple prospective cohort studies have examined the effects of perioperative psychoactive medications on POD. […] Similar to analgesic therapy, the risk of general anaesthesia on POD is not clear. […] The prevalence of delirium in ICU cohort studies has been reported as low as 2030%, and as high as 7080% or more. […] Incident delirium has similarly been described from 22 to 83%. […] Despite the heterogeneity, there are predisposing risk factors that are of broad importance in the ICU setting. […] Among the most modifiable precipitants, exposure to benzodiazepines appear to be the most strongly associated with delirium. […] These data highlight the importance of sedation choice and avoidance of benzodiazepines in the prevention of delirium in the ICU. […] Continued identification of novel risk factors and validation of previously reported risk factors will play a critical role in risk prediction and development of new prevention and treatment paradigms.
#26 Delirium epidemiology in critical care (DECCA): an international study | Critical Care | Full Text
https://ccforum.biomedcentral.com/articles/10.1186/cc9333
This 1-day point-prevalence international study confirms previous findings from single-center studies showing that delirium occurs frequently and is independently associated with adverse outcomes in general ICU patients. Among clinical characteristics associated with the diagnosis of delirium, the use of invasive devices and midazolam were identified and may be considered potentially modifiable risk factors.
#27 Prevalence and risk factors associated with delirium at a critical care unit – Acta Paulista de Enfermagem
https://acta-ape.org/en/article/prevalence-and-risk-factors-associated-with-delirium-at-a-critical-care-unit/
Identify the prevalence and risk factors associated with delirium in patients in a critical care unit in northeastern Brazil. […] Univariate analysis indicated that delirium was prevalent among 45.9%, middle age (49.8 17.4 vs. 44.0 17.6, p=0.003) and neurosurgery (62.5% vs. 26.1%, pdelirium. […] Age, physical restraint, tube feeding, and the use of anticonvulsants increase the prevalence of delirium in our sample. […] Keywords: Critical care; Delirium; Epidemiology; Intensive care units; Prevalence; Risk factors.
#28 Why We Must Prevent and Appropriately Manage Delirium | Journal of Ethics | American Medical Association
https://journalofethics.ama-assn.org/article/why-we-must-prevent-and-appropriately-manage-delirium/2023-10
Despite the evidence pointing to the high prevalence of delirium, its associated morbidity, and opportunities to intervene, many institutions lack rigorous delirium prevention and mitigation strategies. Lack of recognition of delirium is one of the biggest barriers to its mitigation. […] Delirium is often an iatrogenic complication of hospitalization, yet implementation of delirium prevention strategies lags behind other iatrogenic complications, such as falls, nosocomial infections like catheter associated urinary tract infections (CAUTIs), and pressure injuries. […] There are policies we can and should implement to mitigate deliriums prevalence and resulting mortality in hospitalized older adults.
#29 Epidemiology, risk factors, diagnosis, and potentially effective strategies to improve delirium in patients admitted to intensive care units: A narrative review
https://www.jnursrcp.com/article_184242.html
The prevalence of delirium varies between 9% and 87% across several studies. […] Risk factors that cause delirium in patients can be divided into three general categories. […] The CAM-ICU and the ICDSC are the most commonly used tools to assess delirium in the ICU because the examination of the patients using these tools requires less time and education, and are also suitable for individuals who are unable to speak. […] Despite efforts to implement regular delirium screenings using the ICDSC or the CAM-ICU, many assessments are still incorrect, even when these reliable tools are used. […] Delirium is a common disorder in hospitalized patients, particularly those admitted to the ICU. […] It is suggested that forthcoming studies concentrate on enhancing the precision of forecasting delirium commencement by utilizing AIP parameters upon admission to the ICU, the attentiveness of nurses in detecting alterations in cognitive function, and prompt identification and treatment of delirium which could result in decreased ICU stays, improved patient outcomes, and minimized reliance on pharmaceutical interventions. […] Considering the importance of delirium, especially in patients hospitalized in ICU and its high incidence rate, much research has been conducted to investigate its causes, risk factors, diagnosis methods, epidemiology, and strategies to improve the diagnosis of this mental disorder.
#30 Journal of Health Sciences & Surveillance System – Articles List
https://jhsss.sums.ac.ir/?_action=article&kw=97986&_kw=Delirium
Delirium measurement instruments should be highly sensitive, and their instruction for the users should also be short-term and straightforward. […] The objective of the present study was to investigate the validation of the NEECHAM confusion scale in predicting the delirium of ICU patients in Kermanshah health care and educational centers in 2015. […] The NEECHAM confusion scale was used to investigate the delirium of patients. […] The results of this study indicated that 45.2 percent of people have delirium. […] The NEECHAM confusion scale has a large area under the ROC curve. Therefore, it has high predicting power in the prediction of delirium. […] According to the findings of this study, it can be said the NEECHAM confusion scale has the validity to be able to provide accurate and rapid information about patients’ delirious status. […] Therefore, nurses working in intensive care units can use this tool to diagnose patients with delirium and prevent delirium complications quickly.
#31
https://link.springer.com/article/10.1007/s41999-025-01207-x
Our study found an overall reported delirium point prevalence of roughly 12%, with higher rates in RFs compared to NHs. […] Approximately 70% of the participating LTCFs reported using a validated detection tool, with the 4AT being the most commonly employed. […] The overall prevalence of delirium in RFs has been reported to range from approximately 10% to 16%. […] The difference in prevalence rates between RFs and NHs observed in our study is notable, with RFs reporting a higher prevalence of delirium at both time points. […] This difference in routine assessment practices likely contributed to the higher detection rates observed in RFs. […] This study highlights significant variability in reported delirium positive score rates based on the choice of detection tools and the timing and frequency of evaluations.
#32 Informal judgement of delirium status underestimates delirium prevalence: World Delirium Awareness Day point prevalence results from Ireland | Published in Delirium Communications
https://deliriumcommunicationsjournal.com/article/92222-informal-judgement-of-delirium-status-underestimates-delirium-prevalence-world-delirium-awareness-day-point-prevalence-results-from-ireland
Delirium is an encephalopathy characterized by acute onset, fluctuation, and prominent deficits in attention and alertness, due to one or more physical disorders, interventions or medications. It is associated with increased mortality and morbidity, and with incidence and worsening of dementia; thus, delirium prevention and timely detection and appropriate management are crucial. […] This study aimed to determine delirium prevalence in Irish clinical sites. […] The overall study was an observational, cohort study of the point prevalence of delirium (and current delirium practice) in multiple clinical sites on a single day (i.e. World Delirium Awareness Day, March 2023). In this study, the point prevalence of delirium is reported in Irish sites. […] Overall, 27% of patients on wards which reported using a formal tool had not been assessed for delirium. Delirium prevalence, using a formal assessment tool, was 15.9% overall, with the highest rate in geriatric wards (20.5%). However, on wards where personal judgment to detect delirium was utilized, the prevalence rate was 11.5%, implying that delirium may have been under-detected on these wards.
#33 Informal judgement of delirium status underestimates delirium prevalence: World Delirium Awareness Day point prevalence results from Ireland | Published in Delirium Communications
https://deliriumcommunicationsjournal.com/article/92222-informal-judgement-of-delirium-status-underestimates-delirium-prevalence-world-delirium-awareness-day-point-prevalence-results-from-ireland
Delirium screening can quickly rule out delirium or lead to more formal assessment where screening is positive or equivocal. Delirium is prevalent in Irish hospitals and appears to be under-detected unless a formal screening tool is used; equally, delirium screening is not universally applied on wards reporting that they use a formal tool. Together, this indicates that delirium is still under-diagnosed in Irish hospitals. […] The reported prevalence of delirium in Irish hospitals on wards that used a formal assessment tool was 15.9%, with the highest prevalence in geriatric wards (20.5%). Where formal assessment tools were used on a ward, the rate of known delirium was higher, but more than a quarter of patients on these wards were not assessed and a further 11% were indeterminate or untestable, also indicating missed cases. Thus, we must conclude that delirium remains significantly under-detected as yet in Irish hospitals.
#34 Delirium | Nature Reviews Disease Primers
https://www.nature.com/articles/s41572-020-00223-4
Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. […] Delirium in critically ill patients: impact on long-term health-related quality of life and cognitive functioning. […] Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. […] Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients.
#35
https://www.ijmedicine.com/index.php/ijam/article/view/1949
Delirium is an acute disorder of attention and cognition. It occurs in 20% to 79% of hospitalized older patients. It is also common in ICU patients, occurring in 20% to 50% of non-mechanically ventilated ICU patients and in 60% to 80% of mechanically ventilated ICU patients. […] Delirium in elderly ICU patients is significantly prevalent, which is a poor prognostic factor, leading to higher morbidity and mortality. Of the three subtypes- hypoactive delirium is the most common type of delirium among elderly. Yet, it is often overlooked or under-diagnosed. Hence clinicians and/or trained nursing staff managing the patients in the ICUs, should routinely screen the patients for delirium, using brief screening measures, which in turn can improve the patients outcome.
#36
https://link.springer.com/article/10.1007/s40520-020-01699-6
Delirium incidence and clinical correlates in coronavirus disease-19 (COVID-19) pneumonia are still poorly investigated. […] To describe the epidemiology of delirium in patients hospitalized for suspect COVID-19 pneumonia during the pandemic peak in an academic hospital of Northern Italy, identify its clinical correlations and evaluate the association with mortality. […] Ninety-four patients (11%) developed delirium during stay. […] Delirium represents a common complication of COVID-19 and a marker of severe disease course, especially in older patients with neuropsychiatric comorbidity. […] Delirium was also associated with dramatic increase in mortality, but this association was not independent of respiratory conditions. […] This study represents one of the earliest reports on the epidemiology and clinical correlations of delirium in moderate and severe COVID-19.
#37 Epidemiology and risk factors for delirium across hospital settings
https://pmc.ncbi.nlm.nih.gov/articles/PMC3580997/
Future studies must work to understand the epidemiology across settings and focus upon modifiable risk factors that can be integrated into existing delirium prevention and treatment protocols. […] As the underlying mechanism of delirium may be variable, it is therefore not surprising that the epidemiology and associated risk factors vary from one setting to another. […] Importantly, the predisposing and precipitating factors that place a patient at high risk in one setting (e.g., postoperative) may be non-existent in others (e.g., intensive care unit (ICU)). […] The goal of this review is to consider the unique and shared knowledge that has been acquired about the epidemiology and risk factors of delirium across inpatient settings. […] Delirium is common in hospitalised general medical patients.
#38 Epidemiology and risk factors for delirium across hospital settings | CoLab
https://colab.ws/articles/10.1016%2Fj.bpa.2012.07.003
Delirium is one of the most common causes of acute end-organ dysfunction across hospital settings, occurring in as high as 80% of critically ill patients that require intensive care unit (ICU) care. […] Across many hospital settings (emergency department, general medical ward, postoperative and ICU), a patient who experiences delirium is more likely to experience increased short- and long-term mortality, decreases in long-term cognitive function, increases in hospital length of stay and increased complications of hospital care. […] Future studies must work to understand the epidemiology across settings and focus upon modifiable risk factors that can be integrated into existing delirium prevention and treatment protocols.
#39 The Epidemiology of Delirium: Challenges and Opportunities for Population Studies
https://pmc.ncbi.nlm.nih.gov/articles/PMC3837358/
Delirium is a serious and common acute neuropsychiatric syndrome that is associated with short- and long-term adverse health outcomes. However, relatively little delirium research has been conducted in unselected populations. Epidemiologic research in such populations has the potential to resolve several questions of clinical significance in delirium. […] Most of these questions have been addressed by studies in a range of settings. However, very little delirium research has been undertaken from a population-based perspective. This is essential if we hope to contextualize the many strands of investigation, otherwise limited by virtue of selected samples, within a common denominator. […] For delirium research, we need to consider how explicitly the population is defined. To understand how delirium relates to adverse cognitive outcomes, an optimal design would start with a broad, unselected denominator (i.e., a true population-based study) followed up with serial cognitive, mood, and functional assessments.
#40 The association between delirium and falls in older adults in the community: a systematic review | medRxiv
https://www.medrxiv.org/content/10.1101/2024.03.12.24303708v1.full
We found limited evidence for the association between delirium and falls. […] More methodologically rigorous research is needed to understand the complex relationship, establish how and why this operates bi-directionally and identify potential modifying factors involved. […] Delirium and falls share common risk factors including older age, prior history of falls, impaired balance and gait, visual and auditory impairment, cognitive impairment, and polypharmacy. […] In hospital settings there is an increased incidence of falls in patients with delirium, and increased risk of delirium in people who had falls. […] However, little is known about the association between delirium and falls in community settings. […] Our objective was to conduct a rigorous systematic review of the association between delirium and falls in community settings.
#41 POSTOPED: improving surveillance of postoperative delirium in a Scottish tertiary hospital | BMJ Open Quality
https://bmjopenquality.bmj.com/content/12/1/e002161
Delirium is the most common postoperative complication among patients over the age of 65 years. It is associated with increased morbidity and is a significant financial cost to healthcare systems. […] Delirium is the most common surgical complication among those aged above 65 years of age. […] In 2018, 25% of all hip fracture repair patients in England met the diagnostic criteria for delirium. […] Delirium contributes significantly to mortality. […] Our findings suggest that a combination of regular education and training, involvement of the multidisciplinary team as well as targeted intervention in areas of high prevalence of our problem of interest was effective in producing progress towards the project aims. […] Improvements were seen despite, rather than due to, the introduction of 4AT assessment stickers on the wards, where uptake was virtually absent.
#42
https://link.springer.com/article/10.1007/s41999-025-01207-x
To explore delirium prevalence and assessment methods in long-term care facilities across multiple countries. […] A reported delirium point prevalence of approximately 12% was found, with higher rates in rehabilitation facilities compared to nursing homes, along with significant variability in screening and assessment practices. […] Implementing standardized and objective approaches to delirium identification is crucially needed in long-term care settings worldwide. […] Delirium represents a significant healthcare challenge in long-term care settings. […] The overall reported delirium point prevalence was approximately 12%, with higher rates in RFs than in NHs. […] Despite the well-documented impact of delirium on residents, the international variability in clinical practices within LTCFs highlights the current inadequacy in adopting effective and consistent strategies to address this condition.
#43 POSTOPED: improving surveillance of postoperative delirium in a Scottish tertiary hospital | BMJ Open Quality
https://bmjopenquality.bmj.com/content/12/1/e002161
Our focus in this project was on surveillance with acute inpatients. […] Of note is that delirium is an outcome measure in the National Hip Fracture database as a postsurgical complication. […] This project was conducted in a single centre, however, a top-down approach could also be of benefit, as it is noted that the National Emergency Laparotomy Audit does not include delirium or 4AT surveillance as an outcome measure, despite the procedure encumbering similar delirium antecedent factors. […] In summary, delirium is the most common postoperative complication in the elderly and is significantly underdiagnosed and recognised. Medical staff should assess patients with a specific and sensitive validated scoring tool, the 4AT, on admission and 1 day postoperatively (to allow for the wearing off of anaesthetic). Doing so will enable earlier recognition of potential triggering causes as well as earlier treatment, and thus reduce mortality and morbidity due to both delirium and its associated effects.