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The utility of nursing instruments for daily screening for delirium: Delirium causes substantial functional impairment

Published online by Cambridge University Press:  27 November 2019

Leonie Bode Open the ORCID record for Leonie Bode [Opens in a new window] ,
Florian Isler ,
Simon Fuchs Open the ORCID record for Simon Fuchs [Opens in a new window] ,
Justus Marquetand ,
Heidi Petry ,
Jutta Ernst ,
Maria Schubert ,
David Garcia Nuñez ,
Roland von Känel  and
Soenke Boettger Open the ORCID record for Soenke Boettger [Opens in a new window]
Leonie Bode
Affiliation:
Department of Colsultation-Liaison Psychiatry an Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
Florian Isler
Affiliation:
Department of Colsultation-Liaison Psychiatry an Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
Simon Fuchs
Affiliation:
Department of Colsultation-Liaison Psychiatry an Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
Justus Marquetand
Affiliation:
Department of Colsultation-Liaison Psychiatry an Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
Heidi Petry
Affiliation:
ZKPW, University Hospital Zurich, Zurich, Switzerland
Jutta Ernst
Affiliation:
Institute of Nursing Science, University Hospital Zurich, Zurich, Switzerland
Maria Schubert
Affiliation:
School of Health Professions, Zurich University of Applied Science School of Health Professions, Winterthur, Switzerland
David Garcia Nuñez
Affiliation:
Department of Psychiatry, University of Basel, University Hospital Basel, Basel, Switzerland
Roland von Känel
Affiliation:
Department of Colsultation-Liaison Psychiatry an Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
Soenke Boettger*
Affiliation:
Department of Colsultation-Liaison Psychiatry an Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
*
Author for correspondence: Soenke Boettger, Department of Colsultation-Liaison Psychiatry an Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland. E-mail: [email protected]
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Abstract

Objective

Nursing assessments have been recommended for the daily screening for delirium; however, the utility of individual items have not yet been tested. In a first step in establishing the potential of the electronic Patient Assessment-Acute Care (ePA-AC) as such, the impact of delirium on the functional domains was assessed.

Method

In this prospective observational cohort study, 277 patients were assessed and 118 patients were delirious. The impact of delirium on functional domains of the ePA-AC related to self-initiated activity, nutrition, and elimination was determined with simple logistic regressions.

Results

Patients with delirium were older, sicker, were more commonly sedated during the assessment, stayed longer in the intensive care unit (ICU) and floors, and less commonly discharged home. A general pattern was the loss of abilities and full functioning equivalent to global impairment. For self-initiated mobility, in and out of the bed sizable limitations were noted and substantial inability to transfer caused friction and shearing. Similarly, any exhaustion and fatigue were associated with delirium. For self-initiated grooming and dressing, the impairment was greater in the upper body. Within the nutritional domain, delirium affected self-initiated eating and drinking, the amount of food and fluids, energy and nutrient, as well as parenteral nutrition requirement. In delirious patients, the fluid demand was rather increased than decreased, tube feeding more often required and dysphagia occurred. For the elimination domain, urination was not affected — of note, most patients were catheterized, whereas abilities to initiate or control defecation were affected.

Significance of results

Delirium was associated with sizable impairment in the level of functioning. These impairments could guide supportive interventions for delirious patients and perspectively implement nursing instruments for delirium screening.

Keywords

AssessmentDeliriumElectronic Patient Assessment-Acute Care (ePA-AC)Functional impairmentNursing
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Issue 3 , June 2020 , pp. 293 - 300
Copyright
Copyright © Cambridge University Press 2019

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References

American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision. Washington, DC: American Psychiatric Association, pp. 124–127.Google Scholar
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th ed.Washington, DC: American Psychiatric Association, pp. 124–127.Google Scholar
Balas, MC, Happ, MB, Yang, W, et al. (2009) Outcomes associated with delirium in older patients in surgical ICUs. Chest 135, 18–25.CrossRefGoogle ScholarPubMed
Baranowski, SL and Patten, SB (2000) The predictive value of dysgraphia and constructional apraxia for delirium in psychiatric inpatients. The Canadian Journal of Psychiatry 45, 75–78.CrossRefGoogle ScholarPubMed
Bickel, H, Gradinger, R, Kochs, E, et al. (2008) High risk of cognitive and functional decline after postoperative delirium. A three-year prospective study. Dementia and Geriatric Cognitive Disorders 26, 26–31.CrossRefGoogle ScholarPubMed
Brummel, NE and Girard, TD (2013) Preventing delirium in the intensive care unit. Critical Care Clinics 29, 51–65.CrossRefGoogle ScholarPubMed
Bucht, G, Gustafson, Y and Sandberg, O (1999) Epidemiology of delirium. Dementia and Geriatric Cognitive Disorders 10, 315–318.CrossRefGoogle ScholarPubMed
Ely, EW, Shintani, A, Truman, B, et al. (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291, 1753–1762.CrossRefGoogle ScholarPubMed
Gottesman, RF, Grega, MA, Bailey, MM, et al. (2010) Delirium after coronary artery bypass graft surgery and late mortality. Annals of Neurology 67, 338–344.Google ScholarPubMed
Gual, N, Richardson, SJ, Davis, DHJ, et al. (2019) Impairments in balance and mobility identify delirium in patients with comorbid dementia. International Psychogeriatrics 31, 749–753.CrossRefGoogle ScholarPubMed
Heymann, A, Radtke, F, Schiemann, A, et al. (2010) Delayed treatment of delirium increases mortality rate in intensive care unit patients. Journal of International Medical Research 38, 1584–1595.CrossRefGoogle ScholarPubMed
Hunstein, D (2012) ePAAC©: ergebnisorientiertes PflegeAssessment AcuteCare (Version 2.0). pp. 1–72.Google Scholar
Inouye, SK, Westendorp, RG and Saczynski, JS (2014) Delirium in elderly people. Lancet 383, 911–922.CrossRefGoogle ScholarPubMed
Koster, S, Hensens, AG and van der, PJ (2009) The long-term cognitive and functional outcomes of postoperative delirium after cardiac surgery. The Annals of Thoracic Surgery 87, 1469–1474.CrossRefGoogle ScholarPubMed
Norkiene, I, Ringaitiene, D, Misiuriene, I, et al. (2007) Incidence and precipitating factors of delirium after coronary artery bypass grafting. Scandinavian Cardiovascular Journal 41, 180–185.CrossRefGoogle ScholarPubMed
Ouimet, S, Kavanagh, BP, Gottfried, SB, et al. (2007) Incidence, risk factors and consequences of ICU delirium. Intensive Care Medicine 33, 66–73.CrossRefGoogle ScholarPubMed
Pun, BT and Ely, EW (2007) The importance of diagnosing and managing ICU delirium. Chest 132, 624–636.CrossRefGoogle ScholarPubMed
Rosen, SF, Clagett, GP, Valentine, RJ, et al. (2002) Transient advanced mental impairment: An underappreciated morbidity after aortic surgery. Journal of Vascular Surgery 35, 376–381.CrossRefGoogle ScholarPubMed
Sanford, AM and Flaherty, JH (2014) Do nutrients play a role in delirium? Current Opinion in Clinical Nutrition & Metabolic Care 17, 45–50.Google ScholarPubMed
Santos, FS, Velasco, IT and Fraguas, R Jr (2004) Risk factors for delirium in the elderly after coronary artery bypass graft surgery. International Psychogeriatrics 16, 175–193.CrossRefGoogle ScholarPubMed
Scottish Intercollegiate Guidelines Network ( SIGN) (2019) Risk reduction and management of delirium. Edinburgh (SI GN Publication No. 157), March 2019. Available at: http://www.sign.ac.uk.Google Scholar
Sola-Miravete, E, Lopez, C, Martinez-Segura, E, et al. (2018) Nursing assessment as an effective tool for the identification of delirium risk in older in-patients: A case-control study. Journal of Clinical Nursing 27, 345–354.CrossRefGoogle ScholarPubMed
Voyer, P, McCusker, J, Cole, MG, et al. (2007) Factors associated with delirium severity among older patients. Journal of Clinical Nursing 16, 819–831.CrossRefGoogle ScholarPubMed
Yang, FM, Inouye, SK, Fearing, MA, et al. (2008) Participation in activity and risk for incident delirium. Journal of the American Geriatrics Society 56, 1479–1484.CrossRefGoogle ScholarPubMed