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Impact of polypharmacy on occurrence of delirium in elderly emergency patients.
J Am Med Dir Assoc 2014; 15(11):850.e11-5JA

Abstract

OBJECTIVE

To examine associations between polypharmacy and delirium diagnosed in elderly patients hospitalized in geriatric acute care unit after emergency hospital admission.

METHODS

Study design was an observational cohort study in the acute geriatric care unit of a university hospital. We included 410 consecutive patients admitted to the acute geriatric ward during 9 months. Within 72 hours of each patient's hospitalization, a clinically trained geriatrician collected the following data: sociodemographic details (age, sex, type of residence), predisposing factors for delirium, main cause of hospitalization, and current medications. Polypharmacy was defined as 6 or more drugs a day. Delirium was assessed by a geriatrician using the Confusion Assessment Method and was diagnosed on the basis of clinical history with an acute change in usual functional status, behavioral observation, and clinical and cognitive assessment.

RESULTS

Nearly 25% of hospitalized patients had delirium. The Confusion Assessment Method was positive in 69% of patients receiving polypharmacy and in 30% of those not receiving polypharmacy, a relative risk of 2.33. The proportion of elderly patients receiving polypharmacy was 58.53%.

CONCLUSIONS

In our study, polypharmacy is an independent risk factor for delirium in a population of elderly patients after emergency admission. In the geriatric population, delirium is an underestimated scourge and because of its medicosocial and economic consequences and its impact on morbidity and mortality, we need to give increased attention to the prevention and control of polypharmacy, which is a predisposing factor for delirium.

Authors+Show Affiliations

Gérontopôle, Service de Médecine Interne Gériatrique, CHU Toulouse Hôpital Casselardit, Toulouse, France. Electronic address: hein.c@chu-toulouse.fr.Gérontopôle, Service de Médecine Interne Gériatrique, CHU Toulouse Hôpital Casselardit, Toulouse, France.Gérontopôle, Service de Médecine Interne Gériatrique, CHU Toulouse Hôpital Casselardit, Toulouse, France.Pharmacologie Clinique, Faculté de Médecine, Toulouse, France; Inserm U1027, Faculté de médecine 37, Toulouse, France.Gérontopôle, Service de Médecine Interne Gériatrique, CHU Toulouse Hôpital Casselardit, Toulouse, France; Inserm U1027, Faculté de médecine 37, Toulouse, France.No affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

25405712

Citation

Hein, Christophe, et al. "Impact of Polypharmacy On Occurrence of Delirium in Elderly Emergency Patients." Journal of the American Medical Directors Association, vol. 15, no. 11, 2014, pp. 850.e11-5.
Hein C, Forgues A, Piau A, et al. Impact of polypharmacy on occurrence of delirium in elderly emergency patients. J Am Med Dir Assoc. 2014;15(11):850.e11-5.
Hein, C., Forgues, A., Piau, A., Sommet, A., Vellas, B., & Nourhashémi, F. (2014). Impact of polypharmacy on occurrence of delirium in elderly emergency patients. Journal of the American Medical Directors Association, 15(11), pp. 850.e11-5. doi:10.1016/j.jamda.2014.08.012.
Hein C, et al. Impact of Polypharmacy On Occurrence of Delirium in Elderly Emergency Patients. J Am Med Dir Assoc. 2014;15(11):850.e11-5. PubMed PMID: 25405712.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of polypharmacy on occurrence of delirium in elderly emergency patients. AU - Hein,Christophe, AU - Forgues,Adrien, AU - Piau,Antoine, AU - Sommet,Agnès, AU - Vellas,Bruno, AU - Nourhashémi,Fati, PY - 2014/08/27/received PY - 2014/08/28/accepted PY - 2014/11/19/entrez PY - 2014/11/19/pubmed PY - 2015/7/28/medline KW - Polypharmacy KW - delirium KW - drug-induced delirium KW - elderly KW - geriatrics SP - 850.e11 EP - 5 JF - Journal of the American Medical Directors Association JO - J Am Med Dir Assoc VL - 15 IS - 11 N2 - OBJECTIVE: To examine associations between polypharmacy and delirium diagnosed in elderly patients hospitalized in geriatric acute care unit after emergency hospital admission. METHODS: Study design was an observational cohort study in the acute geriatric care unit of a university hospital. We included 410 consecutive patients admitted to the acute geriatric ward during 9 months. Within 72 hours of each patient's hospitalization, a clinically trained geriatrician collected the following data: sociodemographic details (age, sex, type of residence), predisposing factors for delirium, main cause of hospitalization, and current medications. Polypharmacy was defined as 6 or more drugs a day. Delirium was assessed by a geriatrician using the Confusion Assessment Method and was diagnosed on the basis of clinical history with an acute change in usual functional status, behavioral observation, and clinical and cognitive assessment. RESULTS: Nearly 25% of hospitalized patients had delirium. The Confusion Assessment Method was positive in 69% of patients receiving polypharmacy and in 30% of those not receiving polypharmacy, a relative risk of 2.33. The proportion of elderly patients receiving polypharmacy was 58.53%. CONCLUSIONS: In our study, polypharmacy is an independent risk factor for delirium in a population of elderly patients after emergency admission. In the geriatric population, delirium is an underestimated scourge and because of its medicosocial and economic consequences and its impact on morbidity and mortality, we need to give increased attention to the prevention and control of polypharmacy, which is a predisposing factor for delirium. SN - 1538-9375 UR - https://www.unboundmedicine.com/medline/citation/25405712/Impact_of_polypharmacy_on_occurrence_of_delirium_in_elderly_emergency_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-8610(14)00545-3 DB - PRIME DP - Unbound Medicine ER -