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 stu...
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Frontiers Media S.A.
2020-10-01
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Online Access: | https://www.frontiersin.org/article/10.3389/fmed.2020.581069/full |
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DOAJ |
language |
English |
format |
Article |
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DOAJ |
author |
Nirit Tzur Efraim Nirit Tzur Efraim Evgeniya Zikrin Evgeniya Zikrin David Shacham David Shacham Dori Katz Dori Katz Evgeni Makulin Evgeni Makulin Leonid Barski Leonid Barski Lior Zeller Lior Zeller Carmi Bartal Carmi Bartal Tamar Freud Svetlana Lebedinski Yan Press Yan Press Yan Press Yan Press Yan Press |
spellingShingle |
Nirit Tzur Efraim Nirit Tzur Efraim Evgeniya Zikrin Evgeniya Zikrin David Shacham David Shacham Dori Katz Dori Katz Evgeni Makulin Evgeni Makulin Leonid Barski Leonid Barski Lior Zeller Lior Zeller Carmi Bartal Carmi Bartal Tamar Freud Svetlana Lebedinski Yan Press Yan Press Yan Press Yan Press Yan Press Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and Outcomes Frontiers in Medicine delirium occurence risk facors detection rate outcomes |
author_facet |
Nirit Tzur Efraim Nirit Tzur Efraim Evgeniya Zikrin Evgeniya Zikrin David Shacham David Shacham Dori Katz Dori Katz Evgeni Makulin Evgeni Makulin Leonid Barski Leonid Barski Lior Zeller Lior Zeller Carmi Bartal Carmi Bartal Tamar Freud Svetlana Lebedinski Yan Press Yan Press Yan Press Yan Press Yan Press |
author_sort |
Nirit Tzur Efraim |
title |
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_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_sort |
delirium in internal medicine departments in a tertiary hospital in israel: occurrence, detection rates, risk factors, and outcomes |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Medicine |
issn |
2296-858X |
publishDate |
2020-10-01 |
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. |
topic |
delirium occurence risk facors detection rate outcomes |
url |
https://www.frontiersin.org/article/10.3389/fmed.2020.581069/full |
work_keys_str_mv |
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doaj-795e194d99e545aaa9cec973b80d56b12020-11-25T03:34:50ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2020-10-01710.3389/fmed.2020.581069581069Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and OutcomesNirit Tzur Efraim0Nirit Tzur Efraim1Evgeniya Zikrin2Evgeniya Zikrin3David Shacham4David Shacham5Dori Katz6Dori Katz7Evgeni Makulin8Evgeni Makulin9Leonid Barski10Leonid Barski11Lior Zeller12Lior Zeller13Carmi Bartal14Carmi Bartal15Tamar Freud16Svetlana Lebedinski17Yan Press18Yan Press19Yan Press20Yan Press21Yan Press22Department of Psychiatry, Soroka Medical Center, Beer-Sheva, IsraelFaculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, IsraelFaculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, IsraelDepartment of Geriatrics, Soroka Medical Center, Beer-Sheva, IsraelFaculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, IsraelDepartment of Geriatrics, Soroka Medical Center, Beer-Sheva, IsraelFaculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, IsraelDepartment of Geriatrics, Soroka Medical Center, Beer-Sheva, IsraelFaculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, IsraelDepartment of Geriatrics, Soroka Medical Center, Beer-Sheva, IsraelFaculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, IsraelDepartment of Internal Medicine F, Soroka Medical Center, Beer-Sheva, IsraelFaculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, IsraelDepartment of Internal Medicine C, Soroka Medical Center, Beer-Sheva, IsraelFaculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, IsraelDepartment of Internal Medicine E, Soroka Medical Center, Beer-Sheva, IsraelFaculty of Health Sciences, Siaal Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, IsraelClinical Pharmacy Services, Pharmacy Department, Clalit Health Services, Beer-Sheva, IsraelFaculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, IsraelDepartment of Geriatrics, Soroka Medical Center, Beer-Sheva, IsraelFaculty of Health Sciences, Siaal Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, IsraelUnit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel0Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Beer-Sheva, IsraelBackground: 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.https://www.frontiersin.org/article/10.3389/fmed.2020.581069/fulldeliriumoccurencerisk facorsdetection rateoutcomes |