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. 2018 Feb 2;18(1):39.
doi: 10.1186/s12877-018-0733-3.

Clinical characteristics associated with the onset of delirium among long-term nursing home residents

Evelyn Ning Man Cheung  1 , Sophiya Benjamin  2 , George Heckman  3   4 , Joanne Man-Wai Ho  5   3   6 , Linda Lee  6   7 , Samir K Sinha  8 , Andrew P Costa  5   3   6   9
Affiliations

Clinical characteristics associated with the onset of delirium among long-term nursing home residents

Evelyn Ning Man Cheung et al. BMC Geriatr. .

Abstract

Background: Nursing home residents are frail, have multiple medical comorbidities, and are at high risk for delirium. Most of the existing evidence base on delirium is derived from studies in the acute in-patient population. We examine the association between clinical characteristics and medication use with the incidence of delirium during the nursing home stay.

Methods: This is a retrospective cohort study of 1571 residents from 12 nursing homes operated by a single care provider in Ontario, Canada. Residents were over the age of 55 and admitted between February 2010 and December 2015 with no baseline delirium and a minimum stay of 180 days. Residents with moderate or worse cognitive impairment at baseline were excluded. The baseline and follow-up characteristics of residents were collected from the Resident Assessment Instrument-Minimal Data Set 2.0 completed at admission and repeated quarterly until death or discharge. Multivariate logistic regression was used to identify characteristics and medication use associated with the onset of delirium.

Results: The incidence of delirium was 40.4% over the nursing home stay (mean LOS: 32 months). A diagnosis of dementia (OR: 2.54, p < .001), the presence of pain (OR: 1.64, p < .001), and the use of antipsychotics (OR: 1.87, p < .001) were significantly associated with the onset of delirium. Compared to residents who did not develop delirium, residents who developed a delirium had a greater increase in the use of antipsychotics and antidepressants over the nursing home stay.

Conclusions: Dementia, the presence of pain, and the use of antipsychotics were associated with the onset of delirium. Pain monitoring and treatment may be important to decrease delirium in nursing homes. Future studies are necessary to examine the prescribing patterns in nursing homes and their association with delirium.

Keywords: Delirium; Nursing homes; Pain.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval was granted through the Hamilton Integrated Research Ethics Board. Written consent was not obtained from participants given that the study solely used existing electronic clinical records (i.e., secondary use of health information). These same assessment records (i.e., MDS 2.0, MDS 3.0, and interRAI LTCF) are in common use in North America, Europe, and the Pacific Rim for public reporting, quality measurement, case mix and reimbursement, as well as research. As such, these data have been extensively studied for their psychometric properties (some of which we cite). Specific to our study, we have met all of the requirements for the secondary use of health information outlined in our provincial legislation (Province of Ontario Personal Health Information Protection Act, 2004, S.O. 2004, c. 3, Sched. A). Under the provisions set out in the legislation as well as research ethics, our study received full clearance from the Hamilton Integrated Research Ethics Board (project 0739D), which is the research ethics board for McMaster University, St. Joseph’s Healthcare Hamilton and Hamilton Health Sciences.

Consent for publication

Not applicable.

Competing interests

This work and any views expressed within it are solely those of the authors. The funders and collaborating organizations had no role in the study design, analysis, interpretation, or writing of the manuscript. No other relationships or activities that could appear to have influenced the submitted work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Laurila JV, Laakkonen ML, Timo SE, Reijo TS. Predisposing and precipitating factors for delirium in a frail geriatric population. J Psychosom Res. 2008;65:249–254. doi: 10.1016/j.jpsychores.2008.05.026. - DOI - PubMed
    1. Cole MG, McCusker J, Voyer P, Monette J, Champoux N, Ciampi A, Vu M, Belzile E. The course of Subsyndromal delirium in older long-term care residents. Am J Geriatr Psychiatr. 2013;21:289–296. doi: 10.1016/j.jagp.2012.12.008. - DOI - PubMed
    1. Cole MG, Mc Cusker J, Voyer P, Monette J, Champoux N, Ciampi A, Vu M, Belzile E. The course of delirium in older long-term care residents. Int J Geriatr Psychiatry. 2012;27:1291–1297. doi: 10.1002/gps.3782. - DOI - PubMed
    1. De Lange E, PFM V, Van Der Meer K. Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: a review. Int J Geriatr Psychiatry. 2013;28:127–134. doi: 10.1002/gps.3814. - DOI - PubMed
    1. Andrew MK, Freter SH, Rockwood K. Prevalence and outcomes of delirium in community and non-acute care settings in people without dementia: a report from the Canadian study of health and aging. BMC Med. 2006;4:15. - PMC - PubMed

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