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. 1994 Oct 1;151(7):965–970.

Systematic intervention for elderly inpatients with delirium: a randomized trial.

M G Cole 1, F J Primeau 1, R F Bailey 1, M J Bonnycastle 1, F Masciarelli 1, F Engelsmann 1, M J Pepin 1, D Ducic 1
PMCID: PMC1337283  PMID: 7922932

Abstract

OBJECTIVE: To assess a systematic intervention in cases of delirium in elderly inpatients. DESIGN: Randomized, controlled trial. SETTING: University-affiliated, primary acute care hospital. PATIENTS: Patients aged 75 years or over admitted to the medical department. They were screened within 24 hours after admission, and 88 patients with delirium (according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, third revised edition) were detected and enrolled in the trial. The patients were randomly allocated to the treatment group (42) or the control group (46); all were followed up until the end of the study. INTERVENTION: Patients were assessed on enrolment and 1, 2, 4 and 8 weeks later. Those in the treatment group received a consultation by a geriatric internist or psychiatrist and follow-up by a liaison nurse. Those in the control group received regular medical care. OUTCOME MEASURES: Short Portable Mental Status Questionnaire (SPMSQ), Crichton Geriatric Behavioural Rating Scale (CGBRS), use of restraints, length of hospital stay, discharge to a setting providing more care than was needed before admission and mortality rate. RESULTS: Two weeks after admission, patients in the treatment group showed an improvement in their mean SPMSQ scores, from 8.2 (standard deviation [SD] 1.9) to 7.9 (SD 2.5), whereas the control group showed a deterioration, from 8.4 (SD 1.7) to 9.1 (SD 1.1); this difference had disappeared by the end of the 8-week period (p < 0.05). Mean CGBRS scores were higher in the treatment group (32.0 [SD 8.6]) than the control group (28.5 [SD 9.4]) on enrolment and had improved more markedly by the end of the 8-week period (to 23.9 [SD 7.8] v. 25.0 [SD 7.0], p = 0.06). There was no statistically significant difference between the groups in use of restraints, length of hospital stay, discharge to a setting providing more care than was needed before admission or mortality rate. CONCLUSION: The beneficial effects of systematic detection and intervention in cases of delirium in elderly inpatients were small.

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Selected References

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  1. Altman D. G. Statistics and ethics in medical research: III How large a sample? Br Med J. 1980 Nov 15;281(6251):1336–1338. doi: 10.1136/bmj.281.6251.1336. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Beresin E. V. Delirium in the elderly. J Geriatr Psychiatry Neurol. 1988 Jul-Sep;1(3):127–143. doi: 10.1177/089198878800100302. [DOI] [PubMed] [Google Scholar]
  3. Bergmann K., Eastham E. J. Psychogeriatric ascertainment and assessment for treatment in an acute medical ward setting. Age Ageing. 1974 Aug;3(3):174–188. doi: 10.1093/ageing/3.3.174. [DOI] [PubMed] [Google Scholar]
  4. Cole M. G. Assessing the effectiveness of geriatric services: a proposed methodology. Canadian Task Force on the Periodic Health Examination. CMAJ. 1993 Mar 15;148(6):939–944. [PMC free article] [PubMed] [Google Scholar]
  5. Cole M. G., Fenton F. R., Engelsmann F., Mansouri I. Effectiveness of geriatric psychiatry consultation in an acute care hospital: a randomized clinical trial. J Am Geriatr Soc. 1991 Dec;39(12):1183–1188. doi: 10.1111/j.1532-5415.1991.tb03572.x. [DOI] [PubMed] [Google Scholar]
  6. Cole M. G. Inter-rater reliability of the Crichton Geriatric Behavioural Rating Scale. Age Ageing. 1989 Jan;18(1):57–60. doi: 10.1093/ageing/18.1.57. [DOI] [PubMed] [Google Scholar]
  7. Cole M. G., Primeau F. J. Prognosis of delirium in elderly hospital patients. CMAJ. 1993 Jul 1;149(1):41–46. [PMC free article] [PubMed] [Google Scholar]
  8. Erkinjuntti T., Sulkava R., Wikström J., Autio L. Short Portable Mental Status Questionnaire as a screening test for dementia and delirium among the elderly. J Am Geriatr Soc. 1987 May;35(5):412–416. doi: 10.1111/j.1532-5415.1987.tb04662.x. [DOI] [PubMed] [Google Scholar]
  9. FLINT F. J., RICHARDS S. M. Organic basis of confusional states in the elderly. Br Med J. 1956 Dec 29;2(5008):1537–1539. doi: 10.1136/bmj.2.5008.1537. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Francis J., Kapoor W. N. Prognosis after hospital discharge of older medical patients with delirium. J Am Geriatr Soc. 1992 Jun;40(6):601–606. doi: 10.1111/j.1532-5415.1992.tb02111.x. [DOI] [PubMed] [Google Scholar]
  11. Francis J., Martin D., Kapoor W. N. A prospective study of delirium in hospitalized elderly. JAMA. 1990 Feb 23;263(8):1097–1101. [PubMed] [Google Scholar]
  12. Inouye S. K., van Dyck C. H., Alessi C. A., Balkin S., Siegal A. P., Horwitz R. I. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990 Dec 15;113(12):941–948. doi: 10.7326/0003-4819-113-12-941. [DOI] [PubMed] [Google Scholar]
  13. Jitapunkul S., Pillay I., Ebrahim S. Delirium in newly admitted elderly patients: a prospective study. Q J Med. 1992 Apr;83(300):307–314. [PubMed] [Google Scholar]
  14. Kolbeinsson H., Jónsson A. Delirium and dementia in acute medical admissions of elderly patients in Iceland. Acta Psychiatr Scand. 1993 Feb;87(2):123–127. doi: 10.1111/j.1600-0447.1993.tb03342.x. [DOI] [PubMed] [Google Scholar]
  15. Levkoff S. E., Evans D. A., Liptzin B., Cleary P. D., Lipsitz L. A., Wetle T. T., Reilly C. H., Pilgrim D. M., Schor J., Rowe J. Delirium. The occurrence and persistence of symptoms among elderly hospitalized patients. Arch Intern Med. 1992 Feb;152(2):334–340. doi: 10.1001/archinte.152.2.334. [DOI] [PubMed] [Google Scholar]
  16. Murray A. M., Levkoff S. E., Wetle T. T., Beckett L., Cleary P. D., Schor J. D., Lipsitz L. A., Rowe J. W., Evans D. A. Acute delirium and functional decline in the hospitalized elderly patient. J Gerontol. 1993 Sep;48(5):M181–M186. doi: 10.1093/geronj/48.5.m181. [DOI] [PubMed] [Google Scholar]
  17. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975 Oct;23(10):433–441. doi: 10.1111/j.1532-5415.1975.tb00927.x. [DOI] [PubMed] [Google Scholar]
  18. ROBINSON R. A. Some problems of clinical trials in elderly people. Gerontol Clin (Basel) 1961;3:247–257. doi: 10.1159/000244693. [DOI] [PubMed] [Google Scholar]
  19. Rockwood K. Acute confusion in elderly medical patients. J Am Geriatr Soc. 1989 Feb;37(2):150–154. doi: 10.1111/j.1532-5415.1989.tb05874.x. [DOI] [PubMed] [Google Scholar]
  20. Rockwood K. The occurrence and duration of symptoms in elderly patients with delirium. J Gerontol. 1993 Jul;48(4):M162–M166. doi: 10.1093/geronj/48.4.m162. [DOI] [PubMed] [Google Scholar]
  21. Seymour D. G., Henschke P. J., Cape R. D., Campbell A. J. Acute confusional states and dementia in the elderly: the role of dehydration/volume depletion, physical illness and age. Age Ageing. 1980 Aug;9(3):137–146. doi: 10.1093/ageing/9.3.137. [DOI] [PubMed] [Google Scholar]
  22. Thomas R. I., Cameron D. J., Fahs M. C. A prospective study of delirium and prolonged hospital stay. Exploratory study. Arch Gen Psychiatry. 1988 Oct;45(10):937–940. doi: 10.1001/archpsyc.1988.01800340065009. [DOI] [PubMed] [Google Scholar]
  23. Wanich C. K., Sullivan-Marx E. M., Gottlieb G. L., Johnson J. C. Functional status outcomes of a nursing intervention in hospitalized elderly. Image J Nurs Sch. 1992 Fall;24(3):201–207. doi: 10.1111/j.1547-5069.1992.tb00719.x. [DOI] [PubMed] [Google Scholar]
  24. Williams M. A., Campbell E. B., Raynor W. J., Mlynarczyk S. M., Ward S. E. Reducing acute confusional states in elderly patients with hip fractures. Res Nurs Health. 1985 Dec;8(4):329–337. doi: 10.1002/nur.4770080405. [DOI] [PubMed] [Google Scholar]

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