Proposing a Scientific and Technological Approach to the Summaries of Clinical Issues of Inpatient Elderly with Delirium: A Viewpoint

Abstract

Background/rationale: Despite mounting evidence about delirium, this complex geriatric syndrome is still not well managed in clinical contexts. The aging population creates a very demanding area for innovation and technology in healthcare. For instance, an outline of an aging-friendly healthcare environment and clear guidance for technology-supported improvements for people at delirium risk are lacking. Objective: We aimed to foster debate about the importance of technical support in optimizing healthcare professional practice and improving the outcomes for inpatients' at delirium risk. We focused on critical clinical points in the field of delirium worthy of being addressed by a multidisciplinary approach. Methods: Starting from a consensus workshop sponsored by the Management Perfectioning Course based at the Marco Biagi Foundation (Modena, Italy) about clinical issues related to delirium management still not addressed in our healthcare organizations, we developed a requirements' analysis among the representatives of different disciplines and tried to formulate how technology could support the summaries of the clinical issues. We analyzed the national and international panorama by a PubMed consultation of articles with the following keywords in advanced research: "delirium", "delirium management", "technology in healthcare", and "elderly population". Results: Despite international recommendations, delirium remains underdiagnosed, underdetected, underreported, and mismanaged in the acute hospital, increasing healthcare costs, healthcare professionals' job distress, and poor clinical outcomes. Discussion: Although all healthcare professionals recognize delirium as a severe and potentially preventable source of morbidity and mortality for hospitalized older people, it receives insufficient attention in resource allocation and multidisciplinary research. We synthesized how tech-based tools could offer potential solutions to the critical clinical points in delirium management.

Keywords: delirium; disease management; healthcare; patient care management; technology; telemedicine.

Figure 1

The wall of clinical issues about delirium. Phenomenologically, delirium shows five features: cognitive deficits, attentional deficits, circadian rhythm dysregulation, emotional dysregulation, and psychomotor dysregulation. Phenotypically, there are at least five types of delirium. Healthcare organizations may exacerbate the trigger point’s load with clinical issues that persist despite the increased academic knowledge on this hot topic.

Figure 2

Technology advances could be useful to support clinicians in their activity thanks to the application of digital devices for telemedicine or tech-based intervention for monitoring, prevention, education, and clinical management of delirium. The importance of technology application comes from the lack of biomarkers for delirium diagnosis, and this determines the underestimation and undertreatment of this impacting syndrome. Technology sprouting will guarantee overcoming logistic obstacles to an aging-friendly environment realization in the healthcare setting, reducing the stress of healthcare workers when they deal with patients developing delirium.

Figure 3

In a highly organized healthcare organization that is equipped with a delirium unit, within a well-codified PDTA (pathway for diagnosis, treatment, and assistance), delirium care management is characterized by several CCPs (critical clinical points). In the boxes, we report what the CCPs are and the criticism about what is the actual practice by suggesting possible solutions in the parentheses. At hospital admission, the lack of good documentation about the vulnerability of patients increases the risk to expose the elderly to the potential contributing factors precipitating delirium. Elderly patients with behavioral disorders are at risk of being diagnosed with dementia if personnel are not trained to recognize delirium. Sometimes, delirium occurs also in younger people, and they are managed in not-appropriate settings (delirium is mistaken for psychosis). Discharge is another critical point during the “hospital delirium journey”. In the end, people affected by delirium do have not a robust supporting network and they are lost at the follow-up. Therefore, the risk of cognitive decline is not promptly addressed.