Abstract
Poor recognition of delirium among hospitalized elderlies is a typical challenge for health care professionals. Considering methodological insufficiency for assessing time-varying diseases, a continuous-time Markov multi-state transition model (CTMMTM) was used to investigate delirium evolution in elderly patients. This is a longitudinal observational study performed in September 2016 in an Italian hospital. Change of delirium states was modeled according to the 4AT score. A Cox model (CM) and a CTMMTM were used for identifying factors affecting delirium onset both with a two-state and three-state model. In this study, 78 patients were enrolled and evaluated for 5 days. Both the CM and the CTMMTM show that urine catheter (UC), aging, drugs, and invasive devices (ID) are risk factors for delirium onset. The CTMMTM model shows that transition from no-delirium/cognitive impairment to delirium was associated with aging (HR = 1.14; 95%CI, 1.05, 1.23) and neuroleptics (HR = 4.3; 1.57, 11.77), dopaminergic drugs (HR = 3.89; 1.2, 12.6), UC (HR = 2.92; 1.09, 7.79) and ID (HR = 1.67; 103, 2.71). These results are confirmed by the multivariable model. Aging, ID, antibiotics, drugs affecting the central nervous system, and absence of moving ability are identified as the significant predictors of delirium. Additionally, it seems that modeling with CTMMTM may show associations that are not directly detectable with the traditional CM.
Highlights
The elderly population is increasing [1] and during hospitalization, they often experienced delirium due to their age and disease severity [2,3]
The level of mobilization is a factor that influences the delirium onset, our results show that patients who had a higher level of functional activity, had a lower probability of facing delirium as already found by in Solà-Miravete [45]
The small follow-up period of observation might be an obstacle for the identification of delirium which can be experienced with high frequency in a longer follow-up. Older age, drugs, those affecting the central nervous system, and invasive devices play an important role in delirium onset
Summary
The elderly population is increasing [1] and during hospitalization, they often experienced delirium due to their age and disease severity [2,3]. As an acute neuropsychiatric syndrome, is characterized by symptoms fluctuation, shift attention, impaired consciousness, and cognition disturbance like disorientation, memory impairment, and language alteration [5,8]. This mental syndrome may include disorganized thinking, disturbance in the sleep–wake cycle, and psychomotor activity [8,9]. Substantial attention has been focused on drugs and devices frequently used in the hospital setting that may induce delirium [10,12,13,14,15]
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