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. 2018 Feb 6;18(1):43.
doi: 10.1186/s12877-018-0731-5.

Delirium in older hospitalized patients-signs and actions: a retrospective patient record review

Yvonne A Johansson  1   2 , Ingrid Bergh  3 , Iréne Ericsson  4 , Elisabeth Kenne Sarenmalm  5
Affiliations

Delirium in older hospitalized patients-signs and actions: a retrospective patient record review

Yvonne A Johansson et al. BMC Geriatr. .

Abstract

Background: Delirium is common in older hospitalized patients, and is associated with negative consequences for the patients, next of kin, healthcare professionals and healthcare costs. It is important to understand its clinical features, as almost 40% of all cases in hospitals may be preventable. Yet, delirium in hospitalized patients is often unrecognized and untreated. Few studies describe thoroughly how delirium manifests itself in older hospitalized patients and what actions healthcare professionals take in relation to these signs. Therefore, the aim of this study was to describe signs of delirium in older hospitalized patients and action taken by healthcare professionals, as reported in patient records.

Methods: Patient records from patients aged ≥65 (n = 286) were retrospectively reviewed for signs of delirium, which was found in 78 patient records (27%). Additionally, these records were reviewed for action taken by healthcare professionals in relation to the patients' signs of delirium. The identified text was analyzed with qualitative content analysis in two steps.

Results: Healthcare professionals responded only in part to older hospitalized patients' needs of care in relation to their signs of delirium. The patients displayed various signs of delirium that led to a reduced ability to participate in their own care and to keep themselves free from harm. Healthcare professionals met these signs with a variation of actions and the care was adapted, deficient and beyond the usual care. A systematic and holistic perspective in the care of older hospitalized patients with signs of delirium was missing.

Conclusion: Improved knowledge about delirium in hospitals is needed in order to reduce human suffering, healthcare utilization and costs. It is important to enable older hospitalized patients with signs of delirium to participate in their own care and to protect them from harm. Delirium has to be seen as a preventable adverse event in all hospitals units. To improve the prevention and management of older hospitalized patients with signs of delirium, person-centered care and patient safety may be important issues.

Keywords: Action by healthcare professionals; Neurocognitive disorders; Older hospitalized patients; Patient participation; Patient safety; Person-centered care; Qualitative content analysis; Signs of delirium.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Regional Ethical Review Board in Gothenburg (Registration number: 934–13). Declaration of Helsinki ethical principles were followed [42]. Confidentiality was ensured by collecting data where identifiers were not linked to the data. Documentation of signs as well as clinical characteristics was collected through a review of patient electronic records. Identifiers were replaced by using a serial code list. Only data without identifiers were transferred to the protocols. The code list was kept separate from the protocols. Access to information about individual patients was restricted to the researcher.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

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

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