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Symptoms of delirium predict incident delirium in older long-term care residents

Published online by Cambridge University Press:  01 March 2013

Martin G. Cole ,
Jane McCusker ,
Philippe Voyer ,
Johanne Monette ,
Nathalie Champoux ,
Antonio Ciampi ,
Minh Vu ,
Alina Dyachenko  and
Eric Belzile
Martin G. Cole*
Affiliation:
Department of Psychiatry, St. Mary's Hospital Center, Montreal, Quebec, Canada St. Mary's Research Centre, St. Mary's Hospital Center, Montreal, Quebec, Canada Department of Psychiatry, McGill University, Montreal, Quebec, Canada
Jane McCusker
Affiliation:
St. Mary's Research Centre, St. Mary's Hospital Center, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
Philippe Voyer
Affiliation:
Faculty of Nursing Sciences, Laval University, Quebec, Canada
Johanne Monette
Affiliation:
Division of Geriatric Medicine, Jewish General Hospital, Montreal, Quebec, Canada Donald Berman Maimonides Geriatric Center, McGill University, Montreal, Quebec, Canada
Nathalie Champoux
Affiliation:
Département de médecine familiale, Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montreal, Quebec, Canada
Antonio Ciampi
Affiliation:
St. Mary's Research Centre, St. Mary's Hospital Center, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
Minh Vu
Affiliation:
Division of Geriatric Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
Alina Dyachenko
Affiliation:
St. Mary's Research Centre, St. Mary's Hospital Center, Montreal, Quebec, Canada
Eric Belzile
Affiliation:
St. Mary's Research Centre, St. Mary's Hospital Center, Montreal, Quebec, Canada
*
Correspondence should be addressed to: Dr Martin G. Cole, Department of Psychiatry, St. Mary's Hospital Center, 3830 Avenue Lacombe, Montreal, Quebec H3T 1M5, Canada. Phone: +514-345-3511, x3839; Fax: +514-734-2652. Email: martin.cole@ssss.gouv.qc.ca.
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Abstract

Background: Detection of long-term care (LTC) residents at risk of delirium may lead to prevention of this disorder. The primary objective of this study was to determine if the presence of one or more Confusion Assessment Method (CAM) core symptoms of delirium at baseline assessment predicts incident delirium. Secondary objectives were to determine if the number or the type of symptoms predict incident delirium.

Methods: The study was a secondary analysis of data collected for a prospective study of delirium among older residents of seven LTC facilities in Montreal and Quebec City, Canada. The Mini-Mental State Exam (MMSE), CAM, Delirium Index (DI), Hierarchic Dementia Scale, Barthel Index, and Cornell Scale for Depression were completed at baseline. The MMSE, CAM, and DI were repeated weekly for six months. Multivariate Cox regression models were used to determine if baseline symptoms predict incident delirium.

Results: Of 273 residents, 40 (14.7%) developed incident delirium. Mean (SD) time to onset of delirium was 10.8 (7.4) weeks. When one or more CAM core symptoms were present at baseline, the Hazard Ratio (HR) for incident delirium was 3.5 (95% CI = 1.4, 8.9). The HRs for number of symptoms present ranged from 2.9 (95% CI = 1.0, 8.3) for one symptom to 3.8 (95% CI = 1.3, 11.0) for three symptoms. The HR for one type of symptom, fluctuation, was 2.2 (95% CI = 1.2, 4.2).

Conclusion: The presence of CAM core symptoms at baseline assessment predicts incident delirium in older LTC residents. These findings have potentially important implications for clinical practice and research in LTC settings.

Keywords

deliriumdelirium symptomsrisk factorslong-term care
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 6 , June 2013 , pp. 887 - 894
Copyright
Copyright © International Psychogeriatric Association 2013

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