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Published in: BMC Geriatrics 1/2012

Open Access 01-12-2012 | Correspondence

Improving recognition of delirium in clinical practice: a call for action

Authors: Andrew Teodorczuk, Emma Reynish, Koen Milisen

Published in: BMC Geriatrics | Issue 1/2012

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Abstract

Background

The purpose of this correspondence article is to report opinion amongst experts in the delirium field as to why, despite on-going training for all health professionals, delirium continues to be under recognised. Consensus was obtained by means of two conference workshops and an online survey of members of the European Delirium Association.
Major barriers to recognition at an individual level include ignorance about the benefit of treating delirium. At an organisational level, reflecting socio-cultural attitudes, barriers include a low strategic and financial priority and the fact that delirium is an orphan condition falling between specialties.
Literature
1.
go back to reference Lindesay J, Rockwood K, Rolfson D: The epidemiology of delirium. Delirium in Old Age. Edited by: Lindesay J, Rockwood K, Macdonald A. 2000, Oxford University, New York, 27-50. Lindesay J, Rockwood K, Rolfson D: The epidemiology of delirium. Delirium in Old Age. Edited by: Lindesay J, Rockwood K, Macdonald A. 2000, Oxford University, New York, 27-50.
2.
go back to reference Von Gunten A, Mosimann U: Delirium upon admission to Swiss nursing homes: a cross-sectional study. Swiss Med Wkly. 2010, 26 (140): 376-381. Von Gunten A, Mosimann U: Delirium upon admission to Swiss nursing homes: a cross-sectional study. Swiss Med Wkly. 2010, 26 (140): 376-381.
3.
go back to reference Marcantonio E, Kiely D, Simon S, John Orav E, Jones R, Murphy K, Bergmann M: Outcomes of older people admitted to postacute facilities with delirium. J Am Geriatr Soc. 2005, 53 (6): 963-969. 10.1111/j.1532-5415.2005.53305.x.CrossRefPubMed Marcantonio E, Kiely D, Simon S, John Orav E, Jones R, Murphy K, Bergmann M: Outcomes of older people admitted to postacute facilities with delirium. J Am Geriatr Soc. 2005, 53 (6): 963-969. 10.1111/j.1532-5415.2005.53305.x.CrossRefPubMed
4.
go back to reference Inouye SK: Delirium in older persons. N Engl J Med. 2006, 354 (11): 1157-1165. 10.1056/NEJMra052321.CrossRefPubMed Inouye SK: Delirium in older persons. N Engl J Med. 2006, 354 (11): 1157-1165. 10.1056/NEJMra052321.CrossRefPubMed
5.
go back to reference Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA: Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010, 304 (4): 443-451. 10.1001/jama.2010.1013.CrossRefPubMed Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA: Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010, 304 (4): 443-451. 10.1001/jama.2010.1013.CrossRefPubMed
6.
go back to reference Leslie D, Marcantonio E, Zhang Y, Leo-Summers L, Inouye S: One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008, 168 (1): 27-32. 10.1001/archinternmed.2007.4.CrossRefPubMedPubMedCentral Leslie D, Marcantonio E, Zhang Y, Leo-Summers L, Inouye S: One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008, 168 (1): 27-32. 10.1001/archinternmed.2007.4.CrossRefPubMedPubMedCentral
7.
go back to reference NICE: Delirium: diagnosis, prevention and management. 2010, Clinical guideline 103, London NICE: Delirium: diagnosis, prevention and management. 2010, Clinical guideline 103, London
8.
go back to reference Inouye SK, Bogardus ST, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM: A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999, 340 (9): 669-676. 10.1056/NEJM199903043400901.CrossRefPubMed Inouye SK, Bogardus ST, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM: A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999, 340 (9): 669-676. 10.1056/NEJM199903043400901.CrossRefPubMed
9.
go back to reference Deschodt M, Braes T, Flamaing J, Detroyer E, Broos P, Haentjens P, Boonen S, Milisen K: Preventing delirium in older adults with recent hip fracture through multidisciplinary geriatric consultation. J Am Geriatr Soc. 2012, 60 (4): 733-739. 10.1111/j.1532-5415.2012.03899.x.CrossRefPubMed Deschodt M, Braes T, Flamaing J, Detroyer E, Broos P, Haentjens P, Boonen S, Milisen K: Preventing delirium in older adults with recent hip fracture through multidisciplinary geriatric consultation. J Am Geriatr Soc. 2012, 60 (4): 733-739. 10.1111/j.1532-5415.2012.03899.x.CrossRefPubMed
10.
go back to reference MacLullich A, Hall R: Who Understands Delirium?. Age Ageing. 2011, 40: 412-414. 10.1093/ageing/afr062.CrossRefPubMed MacLullich A, Hall R: Who Understands Delirium?. Age Ageing. 2011, 40: 412-414. 10.1093/ageing/afr062.CrossRefPubMed
11.
go back to reference Milisen K, Lemiengre J, Braes T, Foreman M: Multicomponent intervention strategies for managing delirium in hospitalized older people: systematic review. J Adv Nurs. 2005, 52 (1): 79-90. 10.1111/j.1365-2648.2005.03557.x.CrossRefPubMed Milisen K, Lemiengre J, Braes T, Foreman M: Multicomponent intervention strategies for managing delirium in hospitalized older people: systematic review. J Adv Nurs. 2005, 52 (1): 79-90. 10.1111/j.1365-2648.2005.03557.x.CrossRefPubMed
12.
go back to reference Wong C, Holyroyd-Leduc J, Simel D, Straus S: Does this patient have delirium?: Value of Bedside Instruments. JAMA. 2010, 304: 779-786. 10.1001/jama.2010.1182.CrossRefPubMed Wong C, Holyroyd-Leduc J, Simel D, Straus S: Does this patient have delirium?: Value of Bedside Instruments. JAMA. 2010, 304: 779-786. 10.1001/jama.2010.1182.CrossRefPubMed
14.
go back to reference Lemiengre J, Nelis T, Joosten E, Braes T, Foreman M, Gastmans C, Milisen K: Detection of delirium by bedside nurses using the confusion assessment method. J Am Geriatr Soc. 2006, 54 (4): 685-10.1111/j.1532-5415.2006.00667.x.CrossRefPubMed Lemiengre J, Nelis T, Joosten E, Braes T, Foreman M, Gastmans C, Milisen K: Detection of delirium by bedside nurses using the confusion assessment method. J Am Geriatr Soc. 2006, 54 (4): 685-10.1111/j.1532-5415.2006.00667.x.CrossRefPubMed
15.
go back to reference Fick D, Foreman M: Consequences of not recognizing delirium superimposed on dementia in hospitalized elderly individuals. J Gerontol Nurs. 2000, 26 (1): 30-40.CrossRefPubMed Fick D, Foreman M: Consequences of not recognizing delirium superimposed on dementia in hospitalized elderly individuals. J Gerontol Nurs. 2000, 26 (1): 30-40.CrossRefPubMed
16.
go back to reference Kales HC, Kamholz BA, Visnic SG, Blow FC: Recorded delirium in a national sample of elderly inpatients: potential implications for recognition. J Geriatr Psychiatry Neurol. 2003, 16 (1): 32-38. 10.1177/0891988702250535.CrossRefPubMed Kales HC, Kamholz BA, Visnic SG, Blow FC: Recorded delirium in a national sample of elderly inpatients: potential implications for recognition. J Geriatr Psychiatry Neurol. 2003, 16 (1): 32-38. 10.1177/0891988702250535.CrossRefPubMed
17.
go back to reference Milisen K, Foreman M, Wouters B, Driesen R, Godderis J, Abraham I, Broos P: Documentation of delirium in elderly patients with hip fracture. J Gerontol Nurs. 2002, 28 (11): 23-29.CrossRefPubMed Milisen K, Foreman M, Wouters B, Driesen R, Godderis J, Abraham I, Broos P: Documentation of delirium in elderly patients with hip fracture. J Gerontol Nurs. 2002, 28 (11): 23-29.CrossRefPubMed
18.
go back to reference Davis D, MacLullich A: Understanding barriers to delirium care: a multicentre survey of knowledge and attitudes amongst UK junior doctors. Age Ageing. 2009, 38 (5): 559-563. 10.1093/ageing/afp099.CrossRefPubMed Davis D, MacLullich A: Understanding barriers to delirium care: a multicentre survey of knowledge and attitudes amongst UK junior doctors. Age Ageing. 2009, 38 (5): 559-563. 10.1093/ageing/afp099.CrossRefPubMed
19.
go back to reference Irving K, Detroyer E, Foreman M, Milisen K: The virtual gateway: opening doors in delirium teaching and learning. Int Rev Psychiatry. 2009, 21 (1): 15-19. 10.1080/09540260802674752.CrossRefPubMed Irving K, Detroyer E, Foreman M, Milisen K: The virtual gateway: opening doors in delirium teaching and learning. Int Rev Psychiatry. 2009, 21 (1): 15-19. 10.1080/09540260802674752.CrossRefPubMed
20.
go back to reference Detroyer E, Debonnaire D, Dobbels F, Gommers J, Irving K, Joosten E, Milisen K: The effect of a delirium e-learning program on nurses’ knowledge of delirium. European Delirium Association Annual Scientific Congress. 2011, Umea, Sweden Detroyer E, Debonnaire D, Dobbels F, Gommers J, Irving K, Joosten E, Milisen K: The effect of a delirium e-learning program on nurses’ knowledge of delirium. European Delirium Association Annual Scientific Congress. 2011, Umea, Sweden
21.
go back to reference Teodorczuk A, Welfare M, Corbett S, Mukaetova-Ladinska E: Education, hospital staff and the confused older patient. Age and Ageing. 2009, 38: 252-253.CrossRefPubMed Teodorczuk A, Welfare M, Corbett S, Mukaetova-Ladinska E: Education, hospital staff and the confused older patient. Age and Ageing. 2009, 38: 252-253.CrossRefPubMed
22.
go back to reference Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI: Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990, 113 (12): 941-948.PubMed Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI: Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990, 113 (12): 941-948.PubMed
23.
go back to reference Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, Speroff T, Gautam S, Bernard GR, Inouye SK: Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001, 29 (7): 1370-1379. 10.1097/00003246-200107000-00012.CrossRefPubMed Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, Speroff T, Gautam S, Bernard GR, Inouye SK: Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001, 29 (7): 1370-1379. 10.1097/00003246-200107000-00012.CrossRefPubMed
24.
go back to reference Schuurmans MJ, Shortridge-Baggett LM, Duursma SA: The Delirium Observation Screening Scale: a screening instrument for delirium. Res Theory Nurs Pract. 2003, 17 (1): 31-50. 10.1891/rtnp.17.1.31.53169.CrossRefPubMed Schuurmans MJ, Shortridge-Baggett LM, Duursma SA: The Delirium Observation Screening Scale: a screening instrument for delirium. Res Theory Nurs Pract. 2003, 17 (1): 31-50. 10.1891/rtnp.17.1.31.53169.CrossRefPubMed
Metadata
Title
Improving recognition of delirium in clinical practice: a call for action
Authors
Andrew Teodorczuk
Emma Reynish
Koen Milisen
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2012
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/1471-2318-12-55

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