Assessing delirium in acute geriatric wards

Leiv Otto WatneOslo University Hospital, Norway

Delirium- An acute change in cognition and attention

- Common condition: - At admission (medical

patients): 10 - 31%- Occurance rate per

admission (medical patients) 11- 42 %.

- Hip fracture patients: 4 - 53%- ICU patients: 50 - 80 %

Siddiqi N, House AO, Holmes JD. Age Ageing. 2006 Jul;35(4):350-64. Bruce AJ, Int Psychogeriatr. 2007 Apr;19(2):197-214. Epub 2006 Sep 14.Jones, SF. Curr Opin Crit Care. 2012 Apr;18(2):146-51.

- Cork University Hospital, Irland: 407 acute adult inpatients beds

- 15th of May 2010 were all patients assessed for delirium

- 19,6 % had delirium

Only 43,6% had delirium or one of its synonyms documented in the case notes!!

Ryan DJ, BMJ Open. 2013 Jan 7;3

- Aim: ”to systematically review the evidence on the accuracy of bedside intstruments in diagnosing the presence of delirium”

- Compared screening instruments to a ”golden standard”

- Recommend: CAM, DRS-R98, MDAS

Wong CL, JAMA. 2010 Aug 18;304(7)

From the original paper: - Can be completed in less than 5 minutes- Sensitivity 94-100 %- Specificity 90-95 %

Inouye S, Ann Intern Med. 1990 Dec 15;113(12):941-8.

Assessing delirium in acute geriatric wards

How to do it?!!

Delirium assessments

• For research: CAM, MDAS and/or DRS-R98• For clinical work: ?