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Consequences of not recognizing delirium superimposed on dementia in hospitalized elderly individuals.
J Gerontol Nurs. 2000 Jan; 26(1):30-40.JG

Abstract

OBJECTIVE

The purpose of this study was to describe the recognition and management of delirium in hospitalized patients with and without dementia.

DESIGN

A descriptive, exploratory design was used with a convenience sample of 20 hospitalized older patients who were observed indepth using qualitative interviews and observations of 13 family members and 11 staff members.

SETTING

This research was conducted on the medical-surgical units of a 550-bed, nonprofit, state-supported teaching hospital in the southeastern United States. The facility provides primary and tertiary care with five intensive care units and eight medical-surgical units.

PARTICIPANTS

This study did not exclude individuals with dementia or pre-existing delirium. Subjects were not excluded on the basis of race or gender. Twenty patients in the sample underwent observation and mental and functional status testing. Thirteen family members and 11 staff members were interviewed and observed.

MEASUREMENTS

In Phase 1 of the study, patients had daily mental status testing performed by the investigator. In Phase 2, family members and staff members were interviewed about the confusion event. For each patient, demographics and information regarding their health status and current diagnosis and treatment were obtained. The Mini-Mental State Examination (MMSE) and the Confusion Assessment Method were completed on each subject within 36 hours of being admitted to the hospital. The Cornell Depression Scale and Katz Activities of Daily Living scale were completed within 48 hours of admission.

RESULTS

The prevalence of delirium in this study was 60%. The incidence, or new onset of delirium, was 30%. The presence of delirium was associated with new onset incontinence, lower baseline MMSE scores, depression, weight loss, and comorbidity. Of the eight individuals with delirium superimposed on dementia, 63% (n = 5) were re-admitted to the hospital within 30 days, compared to none of the individuals with delirium in the absence of dementia. Delirium superimposed on dementia also was less likely to be recognized by nurses and physicians.

CONCLUSIONS

Delirium in individuals with dementia should be assessed and treated routinely because the failure to recognize delirium superimposed on dementia promptly has significant negative personal, social and financial consequences.

Authors+Show Affiliations

Department of Medicine, Medical College of Georgia, Augusta, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10776167

Citation

Fick, D, and M Foreman. "Consequences of Not Recognizing Delirium Superimposed On Dementia in Hospitalized Elderly Individuals." Journal of Gerontological Nursing, vol. 26, no. 1, 2000, pp. 30-40.
Fick D, Foreman M. Consequences of not recognizing delirium superimposed on dementia in hospitalized elderly individuals. J Gerontol Nurs. 2000;26(1):30-40.
Fick, D., & Foreman, M. (2000). Consequences of not recognizing delirium superimposed on dementia in hospitalized elderly individuals. Journal of Gerontological Nursing, 26(1), 30-40.
Fick D, Foreman M. Consequences of Not Recognizing Delirium Superimposed On Dementia in Hospitalized Elderly Individuals. J Gerontol Nurs. 2000;26(1):30-40. PubMed PMID: 10776167.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Consequences of not recognizing delirium superimposed on dementia in hospitalized elderly individuals. AU - Fick,D, AU - Foreman,M, PY - 2000/4/25/pubmed PY - 2000/4/29/medline PY - 2000/4/25/entrez SP - 30 EP - 40 JF - Journal of gerontological nursing JO - J Gerontol Nurs VL - 26 IS - 1 N2 - OBJECTIVE: The purpose of this study was to describe the recognition and management of delirium in hospitalized patients with and without dementia. DESIGN: A descriptive, exploratory design was used with a convenience sample of 20 hospitalized older patients who were observed indepth using qualitative interviews and observations of 13 family members and 11 staff members. SETTING: This research was conducted on the medical-surgical units of a 550-bed, nonprofit, state-supported teaching hospital in the southeastern United States. The facility provides primary and tertiary care with five intensive care units and eight medical-surgical units. PARTICIPANTS: This study did not exclude individuals with dementia or pre-existing delirium. Subjects were not excluded on the basis of race or gender. Twenty patients in the sample underwent observation and mental and functional status testing. Thirteen family members and 11 staff members were interviewed and observed. MEASUREMENTS: In Phase 1 of the study, patients had daily mental status testing performed by the investigator. In Phase 2, family members and staff members were interviewed about the confusion event. For each patient, demographics and information regarding their health status and current diagnosis and treatment were obtained. The Mini-Mental State Examination (MMSE) and the Confusion Assessment Method were completed on each subject within 36 hours of being admitted to the hospital. The Cornell Depression Scale and Katz Activities of Daily Living scale were completed within 48 hours of admission. RESULTS: The prevalence of delirium in this study was 60%. The incidence, or new onset of delirium, was 30%. The presence of delirium was associated with new onset incontinence, lower baseline MMSE scores, depression, weight loss, and comorbidity. Of the eight individuals with delirium superimposed on dementia, 63% (n = 5) were re-admitted to the hospital within 30 days, compared to none of the individuals with delirium in the absence of dementia. Delirium superimposed on dementia also was less likely to be recognized by nurses and physicians. CONCLUSIONS: Delirium in individuals with dementia should be assessed and treated routinely because the failure to recognize delirium superimposed on dementia promptly has significant negative personal, social and financial consequences. SN - 0098-9134 UR - https://www.unboundmedicine.com/medline/citation/10776167/Consequences_of_not_recognizing_delirium_superimposed_on_dementia_in_hospitalized_elderly_individuals_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=10776167.ui DB - PRIME DP - Unbound Medicine ER -