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Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and Outcomes

Background: The aim of the study was to assess the occurrence rate of delirium among elderly hospitalized patients in the medicine wards of a large tertiary hospital, to identify risk factors, and to evaluate the diagnostic rate for delirium among the medical teams. Methods: A 3-month prospective st...

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Autores principales: Efraim, Nirit Tzur, Zikrin, Evgeniya, Shacham, David, Katz, Dori, Makulin, Evgeni, Barski, Leonid, Zeller, Lior, Bartal, Carmi, Freud, Tamar, Lebedinski, Svetlana, Press, Yan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604336/
https://www.ncbi.nlm.nih.gov/pubmed/33195329
http://dx.doi.org/10.3389/fmed.2020.581069
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author Efraim, Nirit Tzur
Zikrin, Evgeniya
Shacham, David
Katz, Dori
Makulin, Evgeni
Barski, Leonid
Zeller, Lior
Bartal, Carmi
Freud, Tamar
Lebedinski, Svetlana
Press, Yan
author_facet Efraim, Nirit Tzur
Zikrin, Evgeniya
Shacham, David
Katz, Dori
Makulin, Evgeni
Barski, Leonid
Zeller, Lior
Bartal, Carmi
Freud, Tamar
Lebedinski, Svetlana
Press, Yan
author_sort Efraim, Nirit Tzur
collection PubMed
description Background: The aim of the study was to assess the occurrence rate of delirium among elderly hospitalized patients in the medicine wards of a large tertiary hospital, to identify risk factors, and to evaluate the diagnostic rate for delirium among the medical teams. Methods: A 3-month prospective study of patients 65 years of age and above in three medicine wards: in two wards patients were examined by trained study team members using the Confusion Assessment Method (CAM), while the third was a control ward where CAM was not administered. The third ward served to control for the effect of the presence of investigators in the other wards as a potential confounding factor. Based on the results of this assessment patients were defined as suffering from subsyndromal delirium, full delirium (these two groups were later combined into an “any symptoms of delirium” group), and no delirium. The rate of diagnosis by the medical team was obtained from the electronic medical records. Results: The full delirium rate was 5.1%, the rate of subsyndromal delirium was 14.6%, and the rate of any symptoms of delirium was 19.6%. Absence of a partner, pain, anemia, hyponatremia, hypocalcemia, and the use of drugs with an anticholinergic burden were factors for any symptoms of delirium as well as for subsyndromal delirium. Subsyndromal delirium and any symptoms of delirium were associated with a reduced chance of being discharged to home and a higher 3-month mortality rate. A diagnosis of delirium was found in only 19.4% of the patients with any symptoms of delirium in the medical records. Conclusions: Delirium is a common problem among elderly hospitalized patients, but it is diagnosed sub-optimally by the medical team. There is a need for further training of the medical teams and implementation of delirium assessment as part of the ward's routine.
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spelling pubmed-76043362020-11-13 Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and Outcomes Efraim, Nirit Tzur Zikrin, Evgeniya Shacham, David Katz, Dori Makulin, Evgeni Barski, Leonid Zeller, Lior Bartal, Carmi Freud, Tamar Lebedinski, Svetlana Press, Yan Front Med (Lausanne) Medicine Background: The aim of the study was to assess the occurrence rate of delirium among elderly hospitalized patients in the medicine wards of a large tertiary hospital, to identify risk factors, and to evaluate the diagnostic rate for delirium among the medical teams. Methods: A 3-month prospective study of patients 65 years of age and above in three medicine wards: in two wards patients were examined by trained study team members using the Confusion Assessment Method (CAM), while the third was a control ward where CAM was not administered. The third ward served to control for the effect of the presence of investigators in the other wards as a potential confounding factor. Based on the results of this assessment patients were defined as suffering from subsyndromal delirium, full delirium (these two groups were later combined into an “any symptoms of delirium” group), and no delirium. The rate of diagnosis by the medical team was obtained from the electronic medical records. Results: The full delirium rate was 5.1%, the rate of subsyndromal delirium was 14.6%, and the rate of any symptoms of delirium was 19.6%. Absence of a partner, pain, anemia, hyponatremia, hypocalcemia, and the use of drugs with an anticholinergic burden were factors for any symptoms of delirium as well as for subsyndromal delirium. Subsyndromal delirium and any symptoms of delirium were associated with a reduced chance of being discharged to home and a higher 3-month mortality rate. A diagnosis of delirium was found in only 19.4% of the patients with any symptoms of delirium in the medical records. Conclusions: Delirium is a common problem among elderly hospitalized patients, but it is diagnosed sub-optimally by the medical team. There is a need for further training of the medical teams and implementation of delirium assessment as part of the ward's routine. Frontiers Media S.A. 2020-10-19 /pmc/articles/PMC7604336/ /pubmed/33195329 http://dx.doi.org/10.3389/fmed.2020.581069 Text en Copyright © 2020 Efraim, Zikrin, Shacham, Katz, Makulin, Barski, Zeller, Bartal, Freud, Lebedinski and Press. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Efraim, Nirit Tzur
Zikrin, Evgeniya
Shacham, David
Katz, Dori
Makulin, Evgeni
Barski, Leonid
Zeller, Lior
Bartal, Carmi
Freud, Tamar
Lebedinski, Svetlana
Press, Yan
Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and Outcomes
title Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and Outcomes
title_full Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and Outcomes
title_fullStr Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and Outcomes
title_full_unstemmed Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and Outcomes
title_short Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and Outcomes
title_sort delirium in internal medicine departments in a tertiary hospital in israel: occurrence, detection rates, risk factors, and outcomes
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604336/
https://www.ncbi.nlm.nih.gov/pubmed/33195329
http://dx.doi.org/10.3389/fmed.2020.581069
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