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. 2018 Feb 23;13(2):e0193034.
doi: 10.1371/journal.pone.0193034. eCollection 2018.

Predisposing and precipitating factors for delirium in community-dwelling older adults admitted to hospital with this condition: A prospective case series

Emmanuelle Magny  1 , Hélène Le Petitcorps  2 , Maria Pociumban  3 , Zineb Bouksani-Kacher  3 , Éric Pautas  2   4 , Joël Belmin  1   3   4 , Sylvie Bastuji-Garin  5 , Carmelo Lafuente-Lafuente  1   3   4
Affiliations

Predisposing and precipitating factors for delirium in community-dwelling older adults admitted to hospital with this condition: A prospective case series

Emmanuelle Magny et al. PLoS One. .

Abstract

Background: Factors associated with delirium among community-dwelling older adults have been poorly studied. Our aim was to describe the prevalence of predisposing and precipitating factors for delirium among patients admitted for delirium and to assess whether these factors were appropriately recognized at the first patient assessment at hospital.

Methods: Consecutive community-dwelling individuals admitted to three geriatric acute care units with a confirmed initial diagnosis of delirium were prospectively included. An independent investigator recorded, using a predefined form, any acute medical condition considered by the attending geriatrician to be a precipitating factor, at the first patient assessment and at the end of his stay in acute care.

Results: A total of 208 patients were included, 80.0% had a pre-existing cognitive or neurological disorder, or both. The most frequent precipitating factor found were infections (49.0% of all patients, mainly lung and urinary tract infections), followed by drugs (30.8%), dehydration (26.4%) and electrolytic disturbances (18.7%, mostly hyponatremia). 91% of patients had a cerebral imagery, but acute neurological conditions were found in only 18.3%. Fewer precipitating factors were found at first than at final assessment (1.4 (95%CI 1.3-1.6) versus 1.9 (95%CI 1.8-2.0) respectively, p<0.001). This difference was significant for all main categories of precipitating factors.

Conclusions: Infections, followed by drugs and hydro-electrolytic disorders seem to be the most frequent precipitating factors for delirium in community-dwelling elderly individuals. Early diagnostic and management of precipitating factors in these patients should be improved, as a significant number of them are missed at the initial assessment.

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Conflict of interest statement

Competing Interests: Pr Pautas received travel grants and speaker honoraria from Bayer Healthcare, Merck, BMS, GSK, Boerhinger Daïchi and Sanofi-Aventis. None of them was related to the present work or supported it. Pr Belmin received travel grants and speaker honoraria from Amgen, Ipsen, Novartis, Novo Nordisk, Sanofi Pasteur MSD and Servier. None of them was related to the present work or supported it. Dr Lafuente-Lafuente received travel grants and speaker honoraria from Bayer Healthcare and BMS. None of them was related to the present work or supported it. Dr Magny, Dr Pociumban, Dr Lepetitcorps, Dr Bouksani-Kacher and Pr Bastuji-Garin have no conflict of interest to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Inclusion of patients.
Fig 2
Fig 2. Number of precipitating factors found at first and final assessment.
See this image and copyright information in PMC

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