"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

G. Bellelli, A. Morandi, Simona Gabriella Di Santo, Andrea Mazzone, Antonio Cherubini, Enrico Mossello, Mario Bo, A. Bianchetti, R. Rozzini, Ermellina Zanetti, Massimo Musicco, A. Ferrari, Nicola Ferrara, M. Trabucchi, S. Boffelli, Fabio Di Stefano, Francesco De Filippi, F. Guerini, Erik Bertoletti, Albert MarchAlessandro Margiotta, Patrizia Mecocci, Desireè Addesi, F. Fantò, Babette Dijik, Paola Porrino, A. Cotroneo, Giovanni Galli, Amalia Cecilia Bruni, B. Bernardini, C. Corsini, Annachiara Cagnin, Amedeo Zurlo, Giuseppe Barbagallo, Maria Lia Lunardelli, E. Martini, Giuseppe Battaglia, Raffaele Latella, Donatella Petritola, Elena Sinforiani, A. Cester, M. Formilan, Pasqualina Carbone, I. M. Appollonio, Diletta Cereda, Lucio Tremolizzo, E. Bottacchi, Lucio Lucchetti, Claudio Mariani, Piero Rapazzini, Giuseppe Romanelli, A. Marengoni, Giovanni Zuliani, Lara Bianchi, Teresa Suardi, Ettore Muti, Renato Bottura, Giovanni Sgrò, Antonella Mandas, Luca Serchisu, Patrizia Crippa, Claudio Ivaldi, Andrea Ungar, Daniele Villani, Clara Raimondi, Chiara Mussi, Giancarlo Isaia, Giuseppe Provenzano, Daniela Mari, P. Odetti, Fiammetta Monacelli, R. Antonelli Incalzi, Alice Pluderi, Claudio Bellamoli, Luciano Terranova, Elio Angelo Scarpini, Ferdinando D'Amico, Maria Chiara Cavallini, Gianbattista Guerrini, AnnaMaria Scotuzzi, Antonino Chiarello, A. Pilotto, Sara Tognini, Giuseppina Dell'Aquila, G. Toigo, Giuliano Ceschia, Maristella Piccinini, A. Fabbo, Marco Zoli, P. Forti, Christian Wenter, Giorgio Basile, Anna Lasagni, A. Padovani, L. Rozzini, Maria Cottino, S. Vitali, G. Tripi, Stefano Avanzi, Giorgio Annoni, Giovanni Ruotolo, Federica Boschi, Paolo Bonino, Niccolò Marchionni, Sara Fascendini, Gabriele Noro, Renato Turco, M. C. Ubezio, C. Serrati, Maria Infante, Simona Gentile, Luigi M. Pernigotti, Carlo A. Biagini, Enzo Canonico, Pietro Bonati, Pietro Gareri, Paolo Caffarra, Arcangelo Ceretti, Rosanna Castiglia, Carlo Gabelli, Mario Lo Storto, P. Putzu, Simona Di Santo

Research output: Contribution to journalArticle

Abstract

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys.

Original languageEnglish
Article number106
JournalBMC Medicine
Volume14
Issue number1
DOIs
Publication statusPublished - Jul 18 2016

Keywords

  • 4AT
  • Delirium
  • Hospital
  • Multicenter
  • Prevalence

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of '"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool'. Together they form a unique fingerprint.

  • Cite this

    Bellelli, G., Morandi, A., Di Santo, S. G., Mazzone, A., Cherubini, A., Mossello, E., Bo, M., Bianchetti, A., Rozzini, R., Zanetti, E., Musicco, M., Ferrari, A., Ferrara, N., Trabucchi, M., Boffelli, S., Stefano, F. D., Filippi, F. D., Guerini, F., Bertoletti, E., ... Santo, S. D. (2016). "Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool. BMC Medicine, 14(1), [106]. https://doi.org/10.1186/s12916-016-0649-8