Delirium Is Common, and Associated with Acute Changes and Illness In Nursing Home Residents
Although patients of any age and robustness can develop delirium, older people, as well as those with functional impairment, severe comorbidities, and dementia, are most at risk. According to a new study in the January issue of JAMDA, delirium in nursing home residents can often be associated with acute changes in condition and illness.
In Delirium During Acute Events in Nursing Home Patients, 34 (60%) patients with one or more acute events developed delirium. In 31 (91%) of these patients, the delirium was present when the physician was alerted about the acute change. Delirium lasted for more than one week in 15 of 34 patients; and five patients were hospitalized. In 18 of the patients with delirium, an infection was the precipitating factor. At the same time, regular benzodiazepine use and a diagnosis of vascular dementia were significantly associated with delirium. In two patients, no direct cause of the delirium could be found.
The authors concluded, “As nursing home patients hold many predisposing factors for delirium, the high prevalence of delirium in our study confirms previous research. However, our finding…implied that delirium might be even more common among nursing home patients than previously reported.” They noted that the high rate of dementia in nursing home patients can make the diagnosis of delirium challenging “as neuropsychiatric symptoms in dementia can be difficult to differentiate from delirium.” However, in their study, they observed, the precipitating factors for delirium were identified in all patients except two. This, they stressed, illustrates the importance of looking for acute illness or troublesome conditions in patients who develop any sudden change.
This study was conducted by researchers at the University of South-Eastern Norway, Drammen, Norway; and Department of Long-term Care, Municipality of Drammen, Drammen, Norway.
JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.