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Longitudinal patterns of delirium severity scores in long-term care settings

Published online by Cambridge University Press:  31 August 2016

Antonio Ciampi ,
Chun Bai ,
Alina Dyachenko ,
Jane McCusker ,
Martin G. Cole  and
Eric Belzile
Antonio Ciampi*
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada St Mary's Hospital Research Centre, Montreal, Quebec, Canada
Chun Bai
Affiliation:
St Mary's Hospital Research Centre, Montreal, Quebec, Canada
Alina Dyachenko
Affiliation:
St Mary's Hospital Research Centre, Montreal, Quebec, Canada
Jane McCusker
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada St Mary's Hospital Research Centre, Montreal, Quebec, Canada
Martin G. Cole
Affiliation:
Department of Psychiatry, St. Mary's Hospital Center and McGill University, Montreal, Quebec, Canada
Eric Belzile
Affiliation:
St Mary's Hospital Research Centre, Montreal, Quebec, Canada
*
Correspondence should be addressed to: Antonio Ciampi, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. Email: [email protected].
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Abstract

Background:

The delirium index (DI) is a valid measure of delirium severity. We proposed to describe longitudinal patterns of severity scores in older long-term care (LTC) residents.

Methods:

A prospective cohort study of 280 residents in seven LTC facilities in Montreal and Quebec City, Canada, was conducted. DI, Barthel Index, Mini-Mental State Examination, Charlson Comorbidity Index, Cornell Scale for Depression in Dementia, dementia assessment by an MD, and prevalent or incident probable delirium defined according to the Confusion Assessment Method were completed at baseline. The DI was also assessed weekly for 6 months. Demographic characteristics were abstracted from resident charts. Cluster analysis for longitudinal data was used to describe longitudinal patterns of DI scores.

Results:

During the 24 weeks following enrolment, 28 (10.0%) of 280 residents who had prevalent delirium and 76 (27.1%) who had incident delirium were included in our analysis. Average observation period was 18.3 weeks. Four basic types of time evolution patterns were discovered: Improvement, Worsening, Fluctuating, and Steady, including 22%, 18%, 25%, and 35%, of the residents, respectively. With the exception of the Worsening pattern, the average trajectory was stabilized at the 4th week or earlier. Poor baseline cognitive and physical function and greater severity of delirium predicted worse trajectories over 24 weeks.

Conclusions:

The longitudinal patterns of DI scores found in LTC residents resemble those found in an earlier study of delirium in acute care (AC) settings. However, compared to AC patients, LTC residents have a smaller DI variability over time, a less frequent Improvement pattern, and more frequent Worsening and Fluctuating patterns.

Keywords

deliriumcourselong-term caredelirium indexclustering trajectories
Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 1 , January 2017 , pp. 11 - 17
Copyright
Copyright © International Psychogeriatric Association 2016 

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References

Adamis, D., Treloar, A., Martin, F. C. and Macdonald, A. J. (2006). Recovery and outcome of delirium in elderly medical inpatients. Archives of Gerontology and Geriatrics, 43, 289–298.CrossRefGoogle ScholarPubMed
Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988a). Cornell scale for depression in dementia. Biological Psychiatry, 23, 271–284.CrossRefGoogle ScholarPubMed
Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988b). Use of the cornell scale in nondemented patients. Journal of the American Geriatrics Society, 36, 230–236.CrossRefGoogle ScholarPubMed
Psychiatric Association Task Force on DSM-IV. (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, 4th ed., Washington, DC: American Psychiatric Association.Google Scholar
Beresin, E. (1988). Delirium in the elderly. Journal of Geriatric Psychiatry and Neurology, 1, 127–143.Google Scholar
Cattell, R. B. (1966). The screen test for the number of factors. Multivariate Behavioral Research, 1, 245–276.CrossRefGoogle Scholar
Charlson, M. E., Pompei, P., Ales, K. L. and MacKenzie, R. C. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40, 373–383.CrossRefGoogle ScholarPubMed
Cole, M. G., Ciampi, A., Belzile, E. and Zhong, L. (2009). Persistent delirium in older hospital patients: a systematic review of frequency and prognosis. Age and Ageing, 38, 19–26.Google Scholar
Cole, M. G., McCusker, J., Ciampi, A. and Dyachenko, A. (2007). An exploratory study of diagnostic criteria for delirium in older medical inpatients. Journal of Neuropsychiatry and Clinical Neurosciences, 19, 151–156.CrossRefGoogle ScholarPubMed
Cole, M. G. et al. (2012). The course of delirium in older long-term care residents. International Journal of Geriatric Psychiatry, 27, 1291–1297.Google Scholar
Dosa, D., Intrator, O., McNicoll, L., Cang, Y. and Teno, J. (2007). Preliminary derivation of a nursing home confusion assessment method based on data from the minimum data set. Journal of the American Geriatrics Society, 55, 1099–1105.Google Scholar
Elie, M., Cole, M. G., Primeau, F. J. and Bellavance, F. (1998). Delirium risk factors in elderly hospitalized patients. Journal of General Internal Medicine, 13, 204–212.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Hastie, T., Tibshirani, R. and Friedman, J. H. (2009). The Elements of Statistical Learning : Data Mining, Inference, and Prediction, 2nd ed., New York, NY: Springer.Google Scholar
Hatcher, L. (1994). A Step-by-Step Approach to Using the SAS System for factor analysis and structural equation modeling. Cary, NC: SAS Institute.Google Scholar
Inouye, S. K. and Charpentier, P. A. (1996). Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA, 275, 852–857.Google Scholar
Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P. and Horwitz, R. I. (1990). Clarifying confusion: the confusion assessment method, a new method for detection of delirium. Annals of Internal Medicine, 113, 941–948.Google Scholar
Inouye, S. K., Viscoli, C. M., Horwitz, R. I., Hurst, L. D. and Tinetti, M. E. (1993). A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Annals of Internal Medicine, 119, 474–481.CrossRefGoogle ScholarPubMed
Inouye, S. K., Zhang, Y., Jones, R. N., Kiely, D. K., Yang, F. and Marcantonio, E. R. (2007). Risk factors for delirium at discharge: development and validation of a predictive model. Archives of Internal Medicine, 167, 1406–1413.Google Scholar
Kaiser, H. F. (1960). The application of electronic-computers to factor-analysis. Educational and Psychological Measurement, 20, 141–151.CrossRefGoogle Scholar
Kaufman, L. and Rousseeuw, P. J. (2005). Finding Groups in Data: An Introduction to Cluster Analysis. Hoboken, NJ: Wiley.Google Scholar
Khattree, R. and Naik, D. N. (2000). Multivariate Data Reduction and Discrimination with SAS Software. Cary, NC: SAS Institut Inc.Google Scholar
Kiely, D. K., Jones, R. N., Bergmann, M. A., Murphy, K. M., Orav, E. J. and Marcantonio, E. R. (2006). Association between delirium resolution and functional recovery among newly admitted postacute facility patients. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 61, 204–208.Google Scholar
Leffondré, K. et al. (2004). Statistical measures were proposed for identifying longitudinal patterns of change in quantitative health indicators. Journal of Clinical Epidemiology, 57, 1049–1052.Google Scholar
Levkoff, S. E. et al. (1994). Progression and resolution of delirium in elderly patients hospitalized for acute care. The American Journal of Geriatric Psychiatry, 2, 230–238.Google Scholar
Mahoney, F. I. and Barthel, D. W. (1965). Functional evaluation: the barthel index. Maryland State Medical Journal, 14, 61–65.Google Scholar
Marcantonio, E. R., Simon, S. E., Bergmann, M. A., Jones, R. N., Murphy, K. M. and Morris, J.N. (2003). Delirium symptoms in post-acute care: prevalent, persistent, and associated with poor functional recovery. Journal of the American Geriatrics Society, 51, 4–9.Google Scholar
McCusker, J., Cole, M., Abrahamowicz, M., Han, L., Podoba, J. E. and Ramman-Haddad, L. (2001). Environmental risk factors for delirium in hospitalized older people. Journal of the American Geriatrics Society, 49, 1327–1334.Google Scholar
McCusker, J., Cole, M. G., Dendukuri, N. and Belzile, E. (2004). The delirium index, a measure of the severity of delirium: new findings on reliability, validity and responsiveness. Journal of the American Geriatrics Society, 52, 1744–1749.Google Scholar
McCusker, J., Cole, M. G., Dendukuri, N., Han, L. and Belzile, E. (2003). The course of delirium in older medical inpatients: a prospective study. Journal of General Internal Medicine, 18, 696–704.CrossRefGoogle ScholarPubMed
McCusker, J. et al. (2011a). Prevalence and incidence of delirium in long-term care. International Journal of Geriatric Psychiatry, 26, 1152–1161.CrossRefGoogle ScholarPubMed
McCusker, J. et al. (2011b). Use of nurse-observed symptoms of delirium in long-term care: effects on prevalence and outcomes of delirium. International Psychogeriatrics, 23, 602–608.Google Scholar
O'Keeffe, S. and Lavan, J. (1997). The prognostic significance of delirium in older hospital patients. Journal of the American Geriatrics Society, 45, 174–178.CrossRefGoogle ScholarPubMed
Pitkala, K. H., Laurila, J. V., Strandberg, T. E. and Tilvis, R. S. (2006). Multicomponent geriatric intervention for elderly inpatients with delirium: a randomized, controlled trial. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 61A, 176–181.Google Scholar
Rockwood, K. (1993). The occurrence and duration of symptoms in elderly patients with delirium. Journal of Gerontology, 48, M162–M166.Google Scholar
Rudberg, M. A., Pompei, P., Foreman, M. D., Ross, R. E. and Cassel, C. K. (1997). The natural history of delirium in older hospitalized patients: a syndrome of heterogeneity. Age and Ageing, 26, 169–174.Google Scholar
Siddiqi, N., House, A. O. and Holmes, J. D. (2006). Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age and Ageing, 35, 350–364.Google Scholar
Sylvestre, M. P., McCusker, J., Cole, M., Regeasse, A., Belzile, E. and Abrahamowicz, M. (2006). Classification of patterns of delirium severity scores over time in an elderly population. International Psychogeriatrics, 18, 667–680.Google Scholar
Tabachnick, B. G. and Fidell, L. S. (2013). Using Multivariate Statistics, 6th ed., Boston: Pearson Education.Google Scholar
Treloar, A. J. and Macdonald, A. J. D. (1997). Outcome of delirium: part 1: outcome of delirium diagnosed by DSM-III-R, ICD-10 and CAMDEX and derivation of the reversible cognitive dysfunction scale among acute geriatric inpatients. International Journal of Geriatric Psychiatry, 12, 609–613.Google Scholar
von Gunten, A., Mosimann, U. P. and Antonietti, J.-P. (2013). A longitudinal study on delirium in nursing homes. American Journal of Geriatric Psychiatry, 21, 963–972.CrossRefGoogle ScholarPubMed
Voyer, P., Richard, S., Doucet, L. and Carmichael, P. (2009). Detecting delirium and subsyndromal delirium using different diagnostic criteria among demented long-term care residents. Journal of the American Medical Directors Association, 10, 181–188.Google Scholar
Witlox, J., Eurelings, L. S., de Jonghe, J. F., Kalisvaart, K. J., Eikelenboom, P. and van Gool, W. A. (2010). Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA, 304, 443–451.Google Scholar