Delirium Observation Screening Scale Research Articles

Validation of the Delirium Observation Screening Scale in long-term care facilities in Flanders.

The aim of this study was to validate the Delirium Observation Screening Scale (DOSS) in a population of long-term care facility (LTCF) residents in Flanders. Currently there is no validated screening tool for delirium available for the population in this setting in Flanders. A multisite, cross-sectional study was conducted in six LTCFs. A total of 338 residents aged 65 years and older were included. Sociodemographic and clinical data, including data from the Montreal Cognitive Assessment (MoCA), Confusion Assessment Method (CAM) and DOSS, were obtained by three trained nurse researchers. For the DOSS, internal consistency was determined, and inter-rater reliability was calculated. To validate the DOSS, the sensitivity, specificity, and positive and negative predictive value of the DOSS relative to the CAM were determined through receiver operating characteristic analysis. This article adheres to the Strengthening the Reporting of Observational Studies (STROBE) checklist for observational research. For 338 residents, delirium assessments were completed during an early or late shift. The prevalence of delirium was 14.2% as measured with the DOSS. The reliability (α) for the CAM and DOSS was assessed, as was the inter-rater reliability (κ) and the area under the curve. The sensitivity and specificity for a cut-off value of 3 on the DOSS by Youden's index were very high, as was the negative predictive value. The positive predictive value was good. This study showed that the DOSS is a reliable and valid instrument to screen for delirium in LTCF residents in Flanders. Geriatr Gerontol Int 2024; ••: ••-••.

Delirium detection tools show varying completion rates and positive score rates when used at scale in routine practice in general hospital settings: A systematic review.

Multiple short delirium detection tools have been validated in research studies and implemented in routine care, but there has been little study of these tools in real-world conditions. This systematic review synthesized literature reporting completion rates and/or delirium positive score rates of detection tools in large clinical populations in general hospital settings. PROSPERO (CRD42022385166). Medline, Embase, PsycINFO, CINAHL, and gray literature were searched from 1980 to December 31, 2022. Included studies or audit reports used a validated delirium detection tool performed directly with the patient as part of routine care in large clinical populations (n ≥ 1000) within a general acute hospital setting. Narrative synthesis was performed. Twenty-two research studies and four audit reports were included. Tools used alone or in combination were the Confusion Assessment Method (CAM), 4 'A's Test (4AT), Delirium Observation Screening Scale (DOSS), Brief CAM (bCAM), Nursing Delirium Screening Scale (NuDESC), and Intensive Care Delirium Screening Checklist (ICDSC). Populations and settings varied and tools were used at different stages and frequencies in the patient journey, including on admission only; inpatient, daily or more frequently; on admission and as inpatient; inpatient post-operatively. Tool completion rates ranged from 19% to 100%. Admission positive score rates ranged from: CAM 8%-51%; 4AT 13%-20%. Inpatient positive score rates ranged from: CAM 2%-20%, DOSS 6%-42%, and NuDESC 5-13%. Postoperative positive score rates were 21% and 28% (4AT). All but two studies had moderate-high risk of bias. This systematic review of delirium detection tool implementation in large acute patient populations found clinically important variability in tool completion rates, and in delirium positive score rates relative to expected delirium prevalence. This study highlights a need for greater reporting and analysis of relevant healthcare systems data. This is vital to advance understanding of effective delirium detection in routine care.

The prognostic validity of delirium severity as measured by Delirium Observation Screening Scale (DOS scale) on adverse outcomes.

To investigate whether an assessment of delirium severity at diagnosis using the Delirium Observation Screening Scale (DOS scale) predicts adverse outcomes in hospital and on discharge. A prospective cohort study was conducted on a convenience sample of patients admitted to an acute geriatric ward with delirium over an eight-month period. DOS scale was administered to the patients within 48 h of delirium diagnosis to measure delirium severity. Univariate logistic regression analysis was performed to evaluate the correlation between DOS scale and adverse outcomes. Fifty-nine patients were included in the study. There was a moderate correlation between increasing DOS scores and duration of delirium (r = 0.46, p < 0.001), as well as increasing DOS scores and decline in mobility on discharge (r = 0.35, p = 0.007). There was a weak correlation between increasing DOS scores and functional decline as measured by change in Katz Index from admission to discharge (r = -0.27, p = 0.04). No statistically significant correlations were found between DOS scores and in-hospital mortality, inpatient complication rates or discharge to higher level of care. Delirium severity as measured by DOS scale may be useful in predicting delirium duration and decline in mobility and function on discharge. Further research with larger sample sizes is needed to establish if this finding can be replicated and whether delirium severity predicts additional adverse outcomes. Measuring delirium severity at diagnosis may be useful for communicating prognostic information to family members and setting expectations and treatment goals.

A pre-anesthetic bolus of ketamine versus dexmedetomidine for prevention of postoperative delirium in elderly patients undergoing emergency surgery: a randomized, double-blinded, placebo-controlled study

BackgroundWe aimed to evaluate whether a single dose of ketamine or dexmedetomidine before induction of general anesthesia could reduce the incidence of postoperative delirium (primary outcome) or cognitive dysfunction (secondary outcome) in elderly patients undergoing emergency surgery.Patients and methodsThis randomized, double-blinded, placebo-controlled trial included 60 elderly patients who were scheduled for emergency surgery. The patients were randomly assigned into one of three groups (n = 20): group I received 0.9% normal saline, group II received 1 µg/kg dexmedetomidine, and group III received 1 mg/kg ketamine right before anesthesia induction. Patients were observed for three days after surgery and tested for postoperative delirium and cognitive dysfunction using the delirium observation screening scale and the mini-mental state examination score, respectively.ResultsThe dexmedetomidine group had the lowest incidence of delirium (p = 0.001) and cognitive dysfunction (p = 0.006) compared to the ketamine and placebo groups. The multivariate logistic regression model revealed that dexmedetomidine reduced the incidence of postoperative delirium by 32% compared to placebo (reference) (OR = 0.684, 95% CI: 0.240–0.971, p = 0.025), whereas ketamine increased the risk by threefold (OR = 3.012, 95% CI: 1.185–9.681, p = 0.013). Furthermore, dexmedetomidine reduced the incidence of postoperative cognitive dysfunction by 62% (OR = 0.375, 95% CI: 0.091–0.543, p = 0.012), whereas ketamine increased the risk by 4.5 times (OR = 4.501, 95% CI: 1.161–8.817, p = 0.006).ConclusionA single pre-anesthetic bolus of dexmedetomidine is a practical choice for preventing postoperative delirium in elderly patients undergoing emergency surgery.Trial registrationThis study was approved by the Ethics Committee of Aswan University Hospital (approval number: aswu/548/7/2021; registration date: 06/07/2021) and registered on ClinicalTrials.gov (NCT05341154) (22/04/2022).

The use of the DOS and Delirium Prevalence: a quantitative longitudinal study at a Swiss-German central hospital

The use of the DOS and Delirium Prevalence: a quantitative longitudinal study at a Swiss-German central hospital Abstract: Background: With a prevalence of 12-64%, delirium is a common complication in acute care, associated with negative outcomes such as increased mortality and prolonged length of stay. Many hospitals have guidelines to improve the delirium management. The Delirium Observation Screening Scale (DOS) Score is collected in the study hospital from all patients ≥ 70 years at each shift for at least 3 days. Delirium is diagnosed by a physician and coded according to ICD-10. Purpose: Evaluation of the delirium screening with the DOS according to internal guideline in terms of number of DOS assessments performed, prevalence of delirium (DOS score ≥ 3 points, CD-10 code delirium). Method: This retrospective quantitative single-centre longitudinal study used 2017 and 2018 data of 10046 cases. Statistical analysis methods were used to analyse prevalence of delirium and subgroup comparisons. Results: At least one DOS score was documented in 92% of cases aged ≥ 70-years (n = 5038). DOS implementation varied between 60% in the early, 49% in the late and 38% in the night shift. The prevalence of delirium was 12% according to DOS score ≥ 3 and 4% according to physician diagnosis of a delirium. Cases with a DOS score ≥ 3 were significantly older, more often female, had more comorbidities and were depressed. Conclusions: DOS is performed in most patients when indicated. The DOS implementation frequency varied depending on the shift.

Dose-dependent QTc interval prolongation under haloperidol and pipamperone in the management of delirium in a naturalistic setting.

Delirium is an acute, life-threatening neuropsychiatric disorder frequently occurring among hospitalized patients. Antipsychotic medications are often recommended for delirium management but are associated with cardiovascular risks. This study aimed to investigate the frequency and magnitude of QTc interval prolongation and clinically relevant side effects occurring in delirium patients managed with haloperidol and/or pipamperone. This descriptive retrospective cohort study evaluated 102 elderly (mean age: 73.2 years) inpatients with delirium treated with either haloperidol, pipamperone, a combination of both, or neither in a naturalistic setting over the course of up to 20 days or until the end of delirium. A total of 86.3% of patients were treated with haloperidol and/or pipamperone at a mean daily haloperidol-equipotent dose of 1.2 ± 1 mg. Non-cardiovascular side effects were registered in 2.9% of all patients and correlated with higher scores on the Delirium Observation Screening Scale. They did not occur more frequently under antipsychotic treatment. The frequency of QTc interval prolongation was comparably common among all groups, but prolongation magnitude was higher under antipsychotic treatment. It was positively correlated with antipsychotic dosage and the total number of QTc interval-prolonging substances administered. Critical QTc interval prolongation was registered in 21.6% (n = 19) of patients in the group treated with antipsychotics compared to 14.3% (n = 2) of patients in the unmedicated group; however, the difference was not statistically significant. Polypharmacy was associated with a higher risk of critical QTc interval prolongation and increased mortality during delirium. Delirium treatment with haloperidol and/or pipamperone was not associated with a higher risk of QTc-interval prolongation in this naturalistic patient sample but was greater in magnitude and correlated with equipotent dosage and the number of QT interval-prolonging substances used. Polypharmacy was associated with higher mortality and increased risk of critical QTc prolongation.

184 Paying attention to the feasibility of daily delirium screening in an acute hospital setting

Abstract Background Delirium is highly prevalent, yet two-thirds of cases remain undetected. Irish national guidance recommends daily delirium screening for all acute hospital in-patients at risk of delirium, including older patients. We conducted a series of stakeholder workshops to identify the screening tool considered most feasible for daily delirium screening by staff nurses in our hospital. Methods We identified four tools validated for daily delirium screening from the Scottish Intercollegiate Guidelines Network guidelines on ‘Risk Reduction and Management of Delirium’. These included the DOS-13 (Delirium Observation Screening Scale); RADAR (Recognising Acute Delirium As part of your Routine); mRASS (modified Richmond Agitation Screening Scale); and SQiD (Single Question in Delirium). Two workshops for local nursing delirium champions were held to discuss the feasibility of each of these instruments. Workshops commenced with teaching on delirium prevention, management and the rationale for daily screening. Factors relating to the time taken to conduct the assessment, training required, suitability for nursing staff use, diagnostic accuracy, and other issues relating to feasibility were explored. Results The RADAR was considered the instrument with the best balance between feasibility of implementation and diagnostic accuracy. The mRASS was preferred as the next best option, however there was concern that this instrument would require significantly more training. The DOS-13 was considered too time-consuming and too detailed, however it was proposed as a useful behavioural charting tool in patients with known delirium. Although the SQiD was considered the quickest test to conduct, it was felt that staff changeover would lead to reduced diagnostic accuracy. Conclusion RADAR was deemed the test of choice for daily delirium assessment in UHW acute wards. A delirium care bundle incorporating the RADAR was hence developed and training of staff has commenced. The next steps will be to evaluate its feasibility and efficacy in the real-world setting.

The Relationship Between Rejection of Care Behaviors and Pain and Delirium Severity in Hospital Dementia Care.

Rejection of care is common in hospitalized persons living with dementia. However, distinguishing between rejection of care behaviors related to care practices or other causes, such as pain or delirium, is challenging. The purpose of this study is to further understand the relationship between rejection of care and pain and delirium in hospitalized patients with dementia by identifying which rejection of care behaviors are associated with pain and delirium. Care encounters between hospitalized patients with dementia (n = 16) and nursing staff (n = 53) were observed on 88 separate occasions across 35 days. Rejection of care was measured using the 13 behaviors from the Resistiveness to Care Scale. Pain and delirium severity were measured using a variety of scales including the Pain Assessment in Advanced Dementia Scale, Checklist of Nonverbal Pain Indicators, and numeric rating scale for pain severity and the Confusion Assessment Method-Severity short form and Delirium Observation Screening Scale for delirium severity. Linear mixed modeling was used to determine the relationship between rejection of care behaviors and pain and delirium severity for each measure. About 48.9% of the observations included rejection of care, 49.9% included a patient in pain, and 12.5% included a patient with delirium. Cry, push away, scream/yell, and turn away indicated a higher pain severity across pain measures. No rejection of care behaviors were found to indicate delirium severity. Certain rejection of care behaviors may be helpful in identifying pain in hospitalized patients with dementia, suggesting that caregivers should be cognizant of pain when these rejection of care behaviors are present. However, in this sample rejection of care behaviors was not found to be useful for identifying delirium severity in hospital dementia care.

Forecasting Caseload of Critically Ill Patients Who Are Alert and Without Delirium for at Least Two Consecutive Days for the Assessment of Their Psychological Distress.

One-quarter of alert, non-delirious patients in critical care units report significant psychological distress. Treatment of this distress depends upon identifying these high-risk patients. Our aim was to characterize how many critical care patients remain alert and without delirium for at least two consecutive days and could thus predictably undergo evaluation for distress. This retrospective cohort study used data from a large teaching hospital in the United States of America, from October 2014 to March 2022. Patients were included ifthey were admitted to one of three intensive care units, and for >48 hours all delirium and sedation screenings were negative (Riker sedation-agitation scalefour, calm and cooperative, and no delirium based on all Confusion Assessment Method for the Intensive Care Unit scores negative and all Delirium Observation Screening Scale less than three).Means and standard deviations of means for counts and percentages are reported among the most recent six quarters. Means and standard deviations ofmeans for lengths of stay were calculated among all N=30 quarters.The Clopper-Pearson method was used to calculate the lower 99% confidence limit for the percentages of patients who would have had atmost one assessment ofdignity-related distress before intensive care unit discharge orchange in mental status. An average of 3.6 (standard deviation 0.2) new patients met the criteria daily. The percentages of all critical care patients (20%, standard deviation 2%) and hours (18%, standard deviation 2%) meeting criteria decreased slightly over the 7.5 years. Patients spent a mean of 3.8(standard deviation 0.1) days awake incritical care before their condition or site changed. In the context of assessing distress and potentially treating it before the date ofchange ofcondition (e.g., transfer), 66% (6818/10314) ofpatients would have zero or one assessment, lower 99% confidence limit of 65%. Approximately one-fifth of critically ill patients are alert and without delirium and thus could be evaluated for distress during their intensive care unit stay, mostly during a single visit. These estimates can be used to guide workforce planning.

Music to prevent deliriUm during neuroSurgerY (MUSYC): a single-centre, prospective randomised controlled trial

ObjectivesDelirium is a serious complication following neurosurgical procedures. We hypothesise that the beneficial effect of music on a combination of delirium-eliciting factors might reduce delirium incidence following neurosurgery and subsequently...

Accuracy of Delirium Screening Tools in Older People with Cancer-A Systematic Review.

The increase in life expectancy worldwide has led to a larger population of older people, which in turn entails a rising prevalence of cancer. One of the main complications of cancer is delirium, especially in advanced stages. To determine which delirium screening instrument is the most accurate in older people with cancer. A systematic review was designed. A literature search was performed in MEDLINE, EBSCO and SCOPUS; additional records were identified by handsearching. Selection criteria were studies involving people with cancer and a mean sample age of 60 years or older, assessing delirium, and reporting the metric properties of the assessment instrument. Studies with post-surgical patients and substance abuse delirium were excluded. From 2001 to 2021, 14 eligible studies evaluated 13 different assessment tools, reporting an incidence of delirium ranging from 14.3% to 68.3%. The Delirium Observation Screening Scale (DOSS) showed the best metric properties, followed by the Nursing Delirium Screening Scale (NuDESC), Confusion Assessment Method (CAM) and Memorial Delirium Assessment Scale (MDAS). Only two studies were considered to be at low risk of bias using the QUADAS-2 Tool. No study exclusively examined this population group. Screening tools for delirium are heterogeneous for older people with cancer, and there is a need to analyze metric properties exclusively in the older population. Registered on PROSPERO ID: CRD42022303530.

Interrater reliability and concurrent validity of 4AT for the detection of postoperative delirium: A prospective cohort study

Interrater reliability and concurrent validity of 4AT for the detection of postoperative delirium: A prospective cohort study Abstract. Background: Numerous tools for detecting postoperative delirium are available. Guidelines recommend the 4 A's Test (4AT). However, there is little evidence on the validity and reliability of the German version of 4AT. Aim: To assess the interrater reliability of the German version of 4AT test for the detection of postoperative delirium in general surgical and orthopedic-traumatological patients, and the concurrent validity with the Delirium Observation Screening Scale (DOS). Methods: The present work is part of a prospective cohort study with a sample of 202 inpatients (≥ 65 years) who underwent surgery. The interrater reliability of the 4AT (intraclass coefficients) was determined with a subsample of 33 subjects who were rated by two nurses. Concurrent validity between the DOS scale and the 4AT was calculated using Pearson's correlation coefficient. Results: Interrater reliability for the 4AT total score and dichotomized total score were 0.92 (95% CI 0.84-0.96) and 0.98 (95% CI 0.95-0.98), respectively. The correlation between DOS and 4AT (Pearson) was 0.54 (p < 0.001). Conclusions: The 4A test can be used by nurses as a screening instrument for the detection of postoperative delirium in older patients on general surgery and orthopedic traumatology wards. In case of positive 4AT results further assessment by nurse experts or physicians is required.

Postoperative Delirium After Intracranial Surgery: A Retrospective Cohort Study.

The clinical relevance of postoperative delirium (POD) in neurosurgery remains unclear and should be investigated because these patients are vulnerable. Hence, we investigated the impact of POD, by means of incidence and health outcomes, and identified independent risk factors. Adult patients undergoing an intracranial surgical procedure in the Erasmus Medical Center Rotterdam between June 2017 and September 2020 were retrospectively included. POD incidence, defined by a Delirium Observation Screening Scale (DOSS) ≥3 or antipsychotic treatment for delirium within 5 days after surgery, was calculated. Logistic regression analysis on the full data set was conducted for the multivariable risk factor and health outcome analyses. After including 2901 intracranial surgical procedures, POD was present in 19.4% with a mean onset in days of 2.62 (standard deviation, 1.22) and associated with more intensive care unit admissions and more discharge toward residential care. Onset of POD was not associated with increased length of hospitalization or mortality. We identified several independent nonmodifiable risk factors such as age, preexisting memory problems, emergency operations, craniotomy compared with burr-hole surgery, and severe blood loss. Moreover, we identified modifiable risk factors such as low preoperative potassium and opioid and dexamethasone administration. Our POD incidence rates and correlation with more intensive care unit admission and discharge toward residential care suggest a significant impact of POD on neurosurgical patients. We identified several modifiable and nonmodifiable risk factors, which shed light on the pathophysiologic mechanisms of POD in this cohort and could be targeted for future intervention studies.

Logistic Regression and Machine Learning Models for Predicting Whether Intensive Care Patients Who Are Alert and Without Delirium Remain As Such for at Least Two More Days.

Background Some intensive care unit patients are alert and without delirium for atleast two consecutive days. These patients, like other critically ill individuals, are at risk for dignity-related distress. An interval ofat least two days would provide for apalliative care multidisciplinary team to be consulted in the late morning or afternoon of day one and visit the next day. An assessment would include the administration of the validated Patient Dignity Inventory in a reflective manner. To determine whether dignity-related distress can be identified and treated during patients' intensive care unit stay, we evaluated whether asubstantive fraction of such patients (≥5%) have asubstantial (>90%) probability ofremaining alert and without delirium in the intensive care unit for at least four consecutive days. Methods The retrospective cohort study used data from one large teaching hospital in the United States of America, from 2012 to June 2022. The inclusion criteria were: a)adults, b)present in an intensive care unit at 12 PM one day and continually sofor the next 48 hours, c)during those two days had every Riker sedation-agitation scale score "4, calm and cooperative," and d) during those two days had all Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scores negative (i.e., no delirium) and all Delirium Observation Screening Scale (DOS) scores less than three (i.e., no delirium). Results Among the 10,314 patients alert and without delirium in an intensive care unit over two-day periods that included threesuccessive 12PMs, 3,826 (37%) maintained this status for at least two successive 12PMs. Six patient characteristics (e.g., hemodynamic infusion or ventilatory support) had value in predicting those 37% ofpatients. However, logistic regression and classification models each predicted a few (≈0.2%) patients with >90% probability of maintaining these criteria. Forecasts were inaccurate for nearly all patients remaining alert and without delirium in the intensive care unit (≈37%) because the models predicted no patient alert, without delirium, and in the intensive care unit for twodays would remain so for at least four days. That ≈63% accuracy was improved upon by random forest machine learning, but only with ≈3% improvement. Conclusion Although many intensive care unit patients remain alert and without delirium for several consecutive days, each patient has a high daily probability of intensive care unit discharge or deterioration in medical condition. Therefore, the results of our prediction modeling show that care models for the assessment and treatment of patients with intensive care unit-associated dignity-related distress should not rely solely on the intensive care unit team but instead should be taken from the perspective ofthe entire hospitalization.

Occurrence of Postoperative Delirium and the Use of Different Assessment Tools.

(1) Background: Postoperative delirium (POD) poses a high risk of worsening outcomes for patients and is also a burden for hospitals. The leading guidelines recommend standardized POD assessment and prevention. The aim of this subgroup analysis of the PRe-Operative Prediction of Postoperative DElirium by Appropriate SCreening (PROPDESC) trial was to compare different delirium assessments and to analyse the frequency of POD on five postoperative days. (2) Methods: This prospective observational trial enrolled 1097 patients in a university hospital from 2018 until 2019. The following POD assessment tools were used for five consecutive days: Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method for normal ward (CAM), 4 A's Test (4AT) and Delirium Observation Screening (DOS) scale. (3) Results: In a 5-day visit interval, most new POD developments occurred on the first and second postoperative day. A clear recommendation for a specific POD assessment tool based on our results cannot be given. (4) Conclusions: According to guidelines, a POD assessment should take place on the first five postoperative days, but of these, the first two are those of highest POD occurrence. The POD assessment tool used should at best include direct patient questioning and aspects of patient observation.

Frequency of Follow-Up Assessment for Post-Intensive Care Syndrome Among Alert and Non-Delirious Critically Ill Patients.

Many patients surviving critical illness develop post-intensive care syndrome, a constellation of psychological, physical, and cognitive symptoms which can have long-term consequences. Physicians and nurses at our large rural teaching hospital treat many of the critically ill patients in the state. Our focus has been the subset of these critically ill patients who were alert and not delirious for multiple consecutive days. The goal of our retrospective cohort study was to estimate the percentage of the patients with multiple intensive care unit days alert and not delirious who had follow-up assessments for post-intensive care syndrome within 15 months. The inclusion criteria for the case series of randomly selected patients were: adults defined as patients aged >17 years on the date of hospital admission between October 2014 and December 2020, present in a critical care unit at noon one day and continually so for another 48 hours, and for that interval, ≥≥48 hours had every Riker sedation-agitation scale "4, calm and cooperative," as well as either all Confusion Assessment Method for the Intensive Care Unit scores negative (i.e., no delirium) or Delirium Observation Screening Scale <3 (i.e., no delirium). Each patient was then categorized as having a fullone-yearfollow-up if there was an encounter at our hospital between 12 and 15 months after the last date meeting study inclusion criteria. All follow-up appointments completed within 15 months of the index intensive care unit stay were screened for systematic assessment for psychological and cognitive sequelae of critical illness. From a manual chart review of 366 records, 73 patients were found with follow-up ≥≥12 months. There were 21% (15/73) of the patients assessed for post-intensive care syndrome sequelae (99% confidence interval 10%-35%). The fact that far fewer than half the patients had documented assessments suggests that retrospective studies should not be used to judge the incidence ofpost-intensive care syndrome at our hospital. Prospective observational studies would be needed to judge outcomes among critically ill patients with multiple consecutive days of alert and without delirium.

Falls Incidence Compared Between a Multibedded Ward Hospital and a 100% Single-Occupancy Room Hospital: An Uncontrolled Before-After Study.

Single-occupancy patient rooms in hospitals have become popular because of the privacy they offer. A downside, however, is the lack of social control from other patients, which might increase the risk of falls and undetected delirium. To study whether the incidence of falls in single-occupancy patient rooms differs from that in multibedded patient rooms. Secondary aims were to establish differences in the context of falls and differences in delirium incidence. An uncontrolled observational before-after study was performed during 16 months before and 16 after moving to a hospital with 100% single-occupancy patient rooms. Fall data were retrieved from the hospital incident reporting system. The Delirium Observation Screening Scale (DOSS) was retrieved from the hospital electronic patient data system. Main outcomes were the number of falls per 1,000 patient days, assessed with a Poisson regression analysis, and delirium incidence in fallers. The incidence of falls was not significantly different between the before period (1.39 falls/1,000 patient days) and the after period (1.38 falls/1,000 patient days; p = .924). In the after period, falls in the bathroom were significantly more frequent than in the before period, respectively, 17.2% and 9.4% (p = .003). In both periods, one quarter of the patients who fell had been assessed for delirium. In the before period, 57/73 (78%) of those were suspected for delirium (DOSS ≥ 3) versus 37/55 (67%) in the after period (p = .225). In this study, we observed no change in incidence of falls after moving to a hospital with 100% single-occupancy bed rooms.

Delirium in older COVID-19 patients: Evaluating risk factors and outcomes.

ObjectivesA high incidence of delirium has been reported in older patients with Coronavirus disease 2019 (COVID‐19). We aimed to identify determinants of delirium, including the Clinical Frailty Scale, in hospitalized older patients with COVID‐19. Furthermore, we aimed to study the association of delirium independent of frailty with in‐hospital outcomes in older COVID‐19 patients.MethodsThis study was performed within the framework of the multi‐center COVID‐OLD cohort study and included patients aged ≥60 years who were admitted to the general ward because of COVID‐19 in the Netherlands between February and May 2020. Data were collected on demographics, co‐morbidity, disease severity, and geriatric parameters. Prevalence of delirium during hospital admission was recorded based on delirium screening using the Delirium Observation Screening Scale (DOSS) which was scored three times daily. A DOSS score ≥3 was followed by a delirium assessment by the ward physician In‐hospital outcomes included length of stay, discharge destination, and mortality.ResultsA total of 412 patients were included (median age 76, 58% male). Delirium was present in 82 patients. In multivariable analysis, previous episode of delirium (Odds ratio [OR] 8.9 [95% CI 2.3–33.6] p = 0.001), and pre‐existent memory problems (OR 7.6 [95% CI 3.1–22.5] p < 0.001) were associated with increased delirium risk. Clinical Frailty Scale was associated with increased delirium risk (OR 1.63 [95%CI 1.40–1.90] p < 0.001) in univariable analysis, but not in multivariable analysis. Patients who developed delirium had a shorter symptom duration and lower levels of C‐reactive protein upon presentation, whereas vital parameters did not differ. Patients who developed a delirium had a longer hospital stay and were more often discharged to a nursing home. Delirium was associated with mortality (OR 2.84 [95% CI1.71–4.72] p < 0.001), but not in multivariable analyses.ConclusionsA previous delirium and pre‐existent memory problems were associated with delirium risk in COVID‐19. Delirium was not an independent predictor of mortality after adjustment for frailty.

Delirium in elderly postoperative patients: A prospective cohort study

AimTo describe the incidence, time in days and risk factors for postoperative delirium in elderly patients.DesignProspective cohort study.MethodsPatients over 65 years were daily screened with the 4A's Test and the Delirium Observation Screening Scale for postoperative delirium. A psychiatrist assessed according to the DSM‐V. We performed descriptive and logistic regression analyses.ResultsFrom 202 patients, 7.5% (N = 15) had a diagnosed postoperative delirium, whereby 73.3% (N = 11) developed the delirium during the first 48 hr after surgery. The median duration was 1 day. Patients over 80 years suffering from heart failure with surgical drains, bladder catheter, central venous catheter had higher odds for developing a postoperative delirium. The incidence of postoperative delirium in our sample was lower compared with other surgical and ortho‐geriatric populations. Despite age, several modifiable postoperative factors were associated with the occurrence of postoperative delirium.

The Impact of Perioperative and Predisposing Risk Factors on the Development of Postoperative Delirium and a Possible Gender Difference.

(1) Background: Postoperative delirium (POD) is an undesirable event especially for older patients after surgery. Perioperative risks for POD development are multiple, but gender differences are still poorly considered. In this observational study, predisposing and precipitating risk factors of POD and the possible gender influence are distinguished. (2) Methods: This observational prospective trial enrolled 1097 patients in a tertiary hospital from September 2018 until October 2019. POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 ‘A’s Test (4AT) or Delirium Observation Screening (DOS) scale was positive on one of five assessment days. (3) Results: POD incidence was 23.5% and the mean age of study population was 72.3 ± 7.3 years. The multiple logistic regression model showed a significant impact of age (Odds Ratio (OR) 1.74; 95% Confidence Interval (CI): 1.37–2.22), American Society of Anesthesiologists (ASA) (OR 1.67; 95% CI: 1.25–2.26), surgery risk (OR 2.10; 95% CI: 1.52–2.95) and surgery duration (OR 1.17; 95% CI: 1.07–1.28), ventilation time (OR 1.64; 95% CI: 1.27–2.24), as well as the male sex (OR 1.74; 95% CI: 1.37–2.22) on POD risk. (4) Conclusions: Perioperative and predisposing risk factors had an impact on the development of POD. The influence of male sex should be considered in future research.