Occurrence and predictors of delirium in critically ill older patients: a prospective cohort study

Autores da FMUP

• Ricardo João Cruz Correia

  Autor

• Marta João Rodrigues Da Silva

  Autor

• Andreia Sofia Costa Teixeira

  Autor

• José Artur Osório De Carvalho Paiva

  Autor

• Luís Filipe Ribeiro De Azevedo

  Autor

• Lia Paula Nogueira Sousa Fernandes

  Autor

Participantes de fora da FMUP

• Martins, R
• Martins, S
• Pinho, E
• Paulo, C
• Fontes, L
• Lopes, L

Unidades de investigação

• Ginecologia-Obstetrícia e Pediatria

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Medicina

• Medicina da Comunidade, Informação e Decisão em Saúde

• Neurociências Clínicas e Saúde Mental

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Objectives:</jats:title> <jats:p>This study aims to analyze the occurrence of delirium in critically ill older patients and to identify predictors of delirium.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>This prospective study included critically ill older patients admitted into level II units of Intensive Care Medicine Department of a University Hospital. Patients with Glasgow Coma Scale score ?11, traumatic brain injury, terminal disease, history of psychosis, blindness/deafness, or inability to understanding/speaking Portuguese were excluded. The Confusion Assessment Method-Short Form (CAM-4) was used to assess the presence of delirium.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>The final sample (n = 105) had a median age of 80 years, most being female (56.2%), widowed (49.5%), and with complete primary education (53%). Through CAM-4, 36.2% of the patients had delirium. The delirium group was more likely to have previous cognitive decline (48.6% vs 19.6%, <jats:italic toggle="yes">P</jats:italic> = .04) and severe dependency in instrumental activities of daily living (34.3% vs 14.8%, <jats:italic toggle="yes">P</jats:italic> = .032), comparing with patients without delirium. The final multiple logistic regression model explained that patients with previous cognitive decline presented a higher risk for delirium (odds ratio: 4.663, 95% confidence Interval: 1.055?20.599, <jats:italic toggle="yes">P</jats:italic> = .042).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>These findings corroborate previous studies, showing that cognitive decline is an independent predictor for delirium in older patients. This study is an important contribution for the knowledge regarding the predictors of delirium. The recognition of these factors will help to identify patients who are at high risk for this syndrome and implement early screening and prevention strategies. However, further studies with larger samples, recruited from other clinical settings as well as analyzing other potential factors for delirium, will be needed.</jats:p> </jats:sec>