"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Visual and Hearing Impairment Are Associated With Delirium in Hospitalized Patients: Results of a Multisite Prevalence Study

426noreservedObjective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 “Delirium Day” project. Setting and Participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P <.001), visual impairment (24.2% vs 15.7%; P <.01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2–2.1; P =.00] and in Model 2 (OR 1.4; CI 1.1–1.9; P =.02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6–1.2, P =.36; OR 1.1; CI 0.8–1.4; P =.42) or in Model 2 (OR 0.8, CI 0.6–1.2, P =.27; OR 1.1, CI 0.8–1.4, P =.63). Conclusions and implications: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.mixedMorandi A.; Inzitari M.; Udina C.; Gual N.; Mota M.; Tassistro E.; Andreano A.; Cherubini A.; Gentile S.; Mossello E.; Marengoni A.; Olive A.; Riba F.; Ruiz D.; de Jaime E.; Bellelli G.; Tarasconi A.; Sella M.; Auriemma S.; Paterno G.; Faggian G.; Lucarelli C.; De Grazia N.; Alberto C.; Margola A.; Porcella L.; Nardiello I.; Chimenti E.; Zeni M.; Giani A.; Famularo S.; Romairone E.; Minaglia C.; Ceccotti C.; Guerra G.; Mantovani G.; Monacelli F.; Candiani T.; Ballestrero A.; Santolini F.; Rosso M.; Bono V.; Sibilla S.; Dal Santo P.; Ceci M.; Barone P.; Schirinzi T.; Formenti A.; Nastasi G.; Isaia G.; Gonella D.; Battuello A.; Casson S.; Calvani D.; Boni F.; Ciaccio A.; Rosa R.; Sanna G.; Manfredini S.; Cortese L.; Rizzo M.; Prestano R.; Greco A.; Lauriola M.; Gelosa G.; Piras V.; Arena M.; Cosenza D.; Bellomo A.; LaMontagna M.; Gabbani L.; Lambertucci L.; Perego S.; Parati G.; Basile G.; Gallina V.; Pilone G.; Giudice C.; De F.; Pietrogrande L.; De B.; Mosca M.; Corazzin I.; Rossi P.; Nunziata V.; D'Amico F.; Grippa A.; Giardini S.; Barucci R.; Cossu A.; Fiorin L.; Distefano M.; Lunardelli M.; Brunori M.; Ruffini I.; Abraham E.; Varutti A.; Fabbro E.; Catalano A.; Martino G.; Leotta D.; Marchet A.; Dell'Aquila G.; Scrimieri A.; Davoli M.; Casella M.; Cartei A.; Polidori G.; Brischetto D.; Motta S.; Saponara R.; Perrone P.; Russo G.; Del D.; Car C.; Pirina T.; Franzoni S.; Cotroneo A.; Ghiggia F.; Volpi G.; Menichetti C.; Bo M.; Panico A.; Calogero P.; Corvalli G.; Mauri M.; Lupia E.; Manfredini R.; Fabbian F.; March A.; Pedrotti M.; Veronesi M.; Strocchi E.; Borghi C.; Bianchetti A.; Crucitti A.; DiFrancesco V.; Fontana G.; Bonanni L.; Barbone F.; Serrati C.; Ballardini G.; Simoncelli M.; Ceschia G.; Scarpa C.; Brugiolo R.; Fusco S.; Ciarambino T.; Biagini C.; Tonon E.; Porta M.; Venuti D.; DelSette M.; Poeta M.; Barbagallo G.; Trovato G.; Delitala A.; Arosio P.; Reggiani F.; Zuliani G.; Ortolani B.; Mussio E.; Girardi A.; Coin A.; Ruotolo G.; Castagna A.; Masina M.; Cimino R.; Pinciaroli A.; Tripodi G.; Cannistra U.; Cassadonte F.; Vatrano M.; Scaglione L.; Fogliacco P.; Muzzuilini C.; Romano F.; Padovani A.; Rozzini L.; Cagnin A.; Fragiacomo F.; Desideri G.; Liberatore E.; Bruni A.; Orsitto G.; Franco M.; Bonfrate L.; Bonetto M.; Pizio N.; Magnani G.; Cecchetti G.; Longo A.; Bubba V.; Marinan L.; Cotelli M.; Turla M.; Sessa M.; Abruzzi L.; Castoldi G.; LoVetere D.; Musacchio C.; Novello M.; Cavarape A.; Bini A.; Leonardi A.; Seneci F.; Grimaldi W.; Fimognari F.; Bambara V.; Saitta A.; Corica F.; Braga M.; Ettorre E.; Camellini C.; Bellelli G.; Annoni G.; Crescenzo A.; Noro G.; Turco R.; Ponzetto M.; Giuseppe L.; Mazzei B.; Maiuri G.; Costaggiu D.; Damato R.; Formilan M.; Patrizia G.; Gallucci M.; Paragona M.; Bini P.; Modica D.; Abati C.; Clerici M.; Barbera I.; NigroImperiale F.; Manni A.; Votino C.; Castiglioni C.; Di M.; Degl'Innocenti M.; Moscatelli G.; Guerini S.; Casini C.; Dini D.; D'Imporzano E.; DeNotariis S.; Bonometti F.; Paolillo C.; Riccardi A.; Tiozzo A.; DiBari M.; Vanni S.; Scarpa A.; Zara D.; Ranieri P.; Alessandro M.; Di F.; Pezzoni D.; Platto C.; D'Ambrosio V.; Ivaldi C.; Milia P.; DeSalvo F.; Solaro C.; Strazzacappa M.; Cazzadori M.; Confente S.; Grasso M.; Troisi E.; Guerini V.; Bernardini B.; Corsini C.; Boffelli S.; Filippi A.; Delpin K.; Faraci B.; Bertoletti E.; Vannucci M.; Tesi F.; Crippa P.; Malighetti A.; Bettini D.; Maltese F.; Abruzzese G.; Cosimo D.; Azzini M.; Colombo M.; Procino G.; Fascendini S.; Barocco F.; Del P.; Mazzone A.; Riva E.; Dell'Acqua D.; Cottino M.; Vezzadini G.; Avanzi S.; Brambilla C.; Orini S.; Sgrilli F.; Mello A.; Lombardi L.; Muti E.; Dijk B.; Fenu S.; Pes C.; Gareri P.; Passamonte M.; Rigo R.; Locusta L.; Caser L.; Rosso G.; Cesarini S.; Cozzi R.; Santini C.; Carbone P.; Cazzaniga I.; Lovati R.; Cantoni A.; Ranzani P.; Barra D.; Pompilio G.; Dimori S.; Cernesi S.; Ricco C.; Piazzolla F.; Capittini E.; Rota C.; Gottardi F.; Merla L.; Barelli A.; Millul A.; De G.; Morrone G.; Bigolari M.; Macchi M.; Zambon F.; Pizzorni C.; DiCasaleto G.; Menculini G.; Marcacci M.; Catanese G.; Sprini D.; DiCasalet T.; Bocci M.; Borga S.; Caironi P.; Cat C.; Cingolani E.; Avalli L.; Greco G.; Citerio G.; Gandini L.; Cornara G.; Lerda R.; Brazzi L.; Simeone F.; Caciorgna M.; Alampi D.; Francesconi S.; Beck E.; Antonini B.; Vettoretto K.; Meggiolaro M.; Garofalo E.; Notaro S.; Varutti R.; Bassi F.; Mistraletti G.; Marino A.; Rona R.; Rondelli E.; Riva I.; Scapigliati A.; Cortegiani A.; Vitale F.; Pistidda L.; D'Andrea R.; Querci L.; Gnesin P.; Todeschini M.; Lugano M.; Castelli G.; Ortolani M.; Cotoia A.; Maggiore S.; DiTizio L.; Graziani R.; Testa I.; Ferretti E.; Castioni C.; Lombardi F.; Caserta R.; Pasqua M.; Simoncini S.; Baccarini F.; Rispoli M.; Grossi F.; Cancelliere L.; Carnelli M.; Puccini F.; Biancofiore G.; Siniscalchi A.; Laici C.; Mossello E.; Torrini M.; Pasetti G.; Palmese S.; Oggioni R.; Mangani V.; Pini S.; Martelli M.; Rigo E.; Zuccala F.; Cherri A.; Spina R.; Calamai I.; Petrucci N.; Caicedo A.; Ferri F.; Gritti P.; Brienza N.; Fonnesu R.; Dessena M.; Fullin G.; Saggioro D.Morandi, A.; Inzitari, M.; Udina, C.; Gual, N.; Mota, M.; Tassistro, E.; Andreano, A.; Cherubini, A.; Gentile, S.; Mossello, E.; Marengoni, A.; Olive, A.; Riba, F.; Ruiz, D.; de Jaime, E.; Bellelli, G.; Tarasconi, A.; Sella, M.; Auriemma, S.; Paterno, G.; Faggian, G.; Lucarelli, C.; De Grazia, N.; Alberto, C.; Margola, A.; Porcella, L.; Nardiello, I.; Chimenti, E.; Zeni, M.; Giani, A.; Famularo, S.; Romairone, E.; Minaglia, C.; Ceccotti, C.; Guerra, G.; Mantovani, G.; Monacelli, F.; Candiani, T.; Ballestrero, A.; Santolini, F.; Rosso, M.; Bono, V.; Sibilla, S.; Dal Santo, P.; Ceci, M.; Barone, P.; Schirinzi, T.; Formenti, A.; Nastasi, G.; Isaia, G.; Gonella, D.; Battuello, A.; Casson, S.; Calvani, D.; Boni, F.; Ciaccio, A.; Rosa, R.; Sanna, G.; Manfredini, S.; Cortese, L.; Rizzo, M.; Prestano, R.; Greco, A.; Lauriola, M.; Gelosa, G.; Piras, V.; Arena, M.; Cosenza, D.; Bellomo, A.; Lamontagna, M.; Gabbani, L.; Lambertucci, L.; Perego, S.; Parati, G.; Basile, G.; Gallina, V.; Pilone, G.; Giudice, C.; De, F.; Pietrogrande, L.; De, B.; Mosca, M.; Corazzin, I.; Rossi, P.; Nunziata, V.; D'Amico, F.; Grippa, A.; Giardini, S.; Barucci, R.; Cossu, A.; Fiorin, L.; Distefano, M.; Lunardelli, M.; Brunori, M.; Ruffini, I.; Abraham, E.; Varutti, A.; Fabbro, E.; Catalano, A.; Martino, G.; Leotta, D.; Marchet, A.; Dell'Aquila, G.; Scrimieri, A.; Davoli, M.; Casella, M.; Cartei, A.; Polidori, G.; Brischetto, D.; Motta, S.; Saponara, R.; Perrone, P.; Russo, G.; Del, D.; Car, C.; Pirina, T.; Franzoni, S.; Cotroneo, A.; Ghiggia, F.; Volpi, G.; Menichetti, C.; Bo, M.; Panico, A.; Calogero, P.; Corvalli, G.; Mauri, M.; Lupia, E.; Manfredini, R.; Fabbian, F.; March, A.; Pedrotti, M.; Veronesi, M.; Strocchi, E.; Borghi, C.; Bianchetti, A.; Crucitti, A.; Difrancesco, V.; Fontana, G.; Bonanni, L.; Barbone, F.; Serrati, C.; Ballardini, G.; Simoncelli, M.; Ceschia, G.; Scarpa, C.; Brugiolo, R.; Fusco, S.; Ciarambino, T.; Biagini, C.; Tonon, E.; Porta, M.; Venuti, D.; Delsette, M.; Poeta, M.; Barbagallo, G.; Trovato, G.; Delitala, A.; Arosio, P.; Reggiani, F.; Zuliani, G.; Ortolani, B.; Mussio, E.; Girardi, A.; Coin, A.; Ruotolo, G.; Castagna, A.; Masina, M.; Cimino, R.; Pinciaroli, A.; Tripodi, G.; Cannistra, U.; Cassadonte, F.; Vatrano, M.; Scaglione, L.; Fogliacco, P.; Muzzuilini, C.; Romano, F.; Padovani, A.; Rozzini, L.; Cagnin, A.; Fragiacomo, F.; Desideri, G.; Liberatore, E.; Bruni, A.; Orsitto, G.; Franco, M.; Bonfrate, L.; Bonetto, M.; Pizio, N.; Magnani, G.; Cecchetti, G.; Longo, A.; Bubba, V.; Marinan, L.; Cotelli, M.; Turla, M.; Sessa, M.; Abruzzi, L.; Castoldi, G.; Lovetere, D.; Musacchio, C.; Novello, M.; Cavarape, A.; Bini, A.; Leonardi, A.; Seneci, F.; Grimaldi, W.; Fimognari, F.; Bambara, V.; Saitta, A.; Corica, F.; Braga, M.; Ettorre, E.; Camellini, C.; Bellelli, G.; Annoni, G.; Crescenzo, A.; Noro, G.; Turco, R.; Ponzetto, M.; Giuseppe, L.; Mazzei, B.; Maiuri, G.; Costaggiu, D.; Damato, R.; Formilan, M.; Patrizia, G.; Gallucci, M.; Paragona, M.; Bini, P.; Modica, D.; Abati, C.; Clerici, M.; Barbera, I.; Nigroimperiale, F.; Manni, A.; Votino, C.; Castiglioni, C.; Di, M.; Degl'Innocenti, M.; Moscatelli, G.; Guerini, S.; Casini, C.; Dini, D.; D'Imporzano, E.; Denotariis, S.; Bonometti, F.; Paolillo, C.; Riccardi, A.; Tiozzo, A.; Dibari, M.; Vanni, S.; Scarpa, A.; Zara, D.; Ranieri, P.; Alessandro, M.; Di, F.; Pezzoni, D.; Platto, C.; D'Ambrosio, V.; Ivaldi, C.; Milia, P.; Desalvo, F.; Solaro, C.; Strazzacappa, M.; Cazzadori, M.; Confente, S.; Grasso, M.; Troisi, E.; Guerini, V.; Bernardini, B.; Corsini, C.; Boffelli, S.; Filippi, A.; Delpin, K.; Faraci, B.; Bertoletti, E.; Vannucci, M.; Tesi, F.; Crippa, P.; Malighetti, A.; Bettini, D.; Maltese, F.; Abruzzese, G.; Cosimo, D.; Azzini, M.; Colombo, M.; Procino, G.; Fascendini, S.; Barocco, F.; Del, P.; Mazzone, A.; Riva, E.; Dell'Acqua, D.; Cottino, M.; Vezzadini, G.; Avanzi, S.; Brambilla, C.; Orini, S.; Sgrilli, F.; Mello, A.; Lombardi, L.; Muti, E.; Dijk, B.; Fenu, S.; Pes, C.; Gareri, P.; Passamonte, M.; Rigo, R.; Locusta, L.; Caser, L.; Rosso, G.; Cesarini, S.; Cozzi, R.; Santini, C.; Carbone, P.; Cazzaniga, I.; Lovati, R.; Cantoni, A.; Ranzani, P.; Barra, D.; Pompilio, G.; Dimori, S.; Cernesi, S.; Ricco, C.; Piazzolla, F.; Capittini, E.; Rota, C.; Gottardi, F.; Merla, L.; Barelli, A.; Millul, A.; De, G.; Morrone, G.; Bigolari, M.; Macchi, M.; Zambon, F.; Pizzorni, C.; Dicasaleto, G.; Menculini, G.; Marcacci, M.; Catanese, G.; Sprini, D.; Dicasalet, T.; Bocci, M.; Borga, S.; Caironi, P.; Cat, C.; Cingolani, E.; Avalli, L.; Greco, G.; Citerio, G.; Gandini, L.; Cornara, G.; Lerda, R.; Brazzi, L.; Simeone, F.; Caciorgna, M.; Alampi, D.; Francesconi, S.; Beck, E.; Antonini, B.; Vettoretto, K.; Meggiolaro, M.; Garofalo, E.; Notaro, S.; Varutti, R.; Bassi, F.; Mistraletti, G.; Marino, A.; Rona, R.; Rondelli, E.; Riva, I.; Scapigliati, A.; Cortegiani, A.; Vitale, F.; Pistidda, L.; D'Andrea, R.; Querci, L.; Gnesin, P.; Todeschini, M.; Lugano, M.; Castelli, G.; Ortolani, M.; Cotoia, A.; Maggiore, S.; Ditizio, L.; Graziani, R.; Testa, I.; Ferretti, E.; Castioni, C.; Lombardi, F.; Caserta, R.; Pasqua, M.; Simoncini, S.; Baccarini, F.; Rispoli, M.; Grossi, F.; Cancelliere, L.; Carnelli, M.; Puccini, F.; Biancofiore, G.; Siniscalchi, A.; Laici, C.; Mossello, E.; Torrini, M.; Pasetti, G.; Palmese, S.; Oggioni, R.; Mangani, V.; Pini, S.; Martelli, M.; Rigo, E.; Zuccala, F.; Cherri, A.; Spina, R.; Calamai, I.; Petrucci, N.; Caicedo, A.; Ferri, F.; Gritti, P.; Brienza, N.; Fonnesu, R.; Dessena, M.; Fullin, G.; Saggioro, D

Visual and Hearing Impairment Are Associated With Delirium in Hospitalized Patients: Results of a Multisite Prevalence Study

Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium

Delirium and Clusters of Older Patients Affected by Multimorbidity in Acute Hospitals.

Objectives: Delirium is commonly seen in older adults with multimorbidity, during a hospitalization, resulting from the interplay between predisposing factors such as advanced age, frailty, and dementia, and a series of precipitating factors. The association between delirium and specific multimorbidity is largely unexplored so far although of potential key relevance for targeted interventions. The aim of the study was to check for a potential association of multimorbidity with delirium in a large cohort of older patients hospitalized for an acute medical or surgical condition. Design: This is a cross-sectional study nested in the 2017 Delirium Day project. Setting and participants: The study includes 1829 hospitalized patients (age: 81.8, SD: 5.5). Of them, 419 (22.9%) had delirium. Methods: Sociodemographic and medical history were collected. The 4AT was used to assess the presence of delirium. The Charlson Comorbidity index was used to assess multimorbidity. Results: The results identified neurosensorial multimorbidity as the most prevalent, including patients with dementia, cerebrovascular diseases, and sensory impairments. In light of the highest co-occurrence of 3 neurosensorial chronic conditions, we could hypothesize that a baseline altered brain functional and neural connectivity might determine the vulnerability signature for incipient overall system disruption in presence of acute insults. Conclusions and implications: Eventually, our findings moved a step forward in supporting the key importance of routine screening for sensory impairments and cognitive status of older patients for the highest risk of in-hospital delirium. In fact, preventive interventions could be particularly relevant and effective in preventing delirium in such vulnerable populations and might help refining this early diagnosis

The relationship between frailty and delirium: insights from the 2017 Delirium Day study.

Background: although frailty and delirium are among the most frequent and burdensome geriatric syndromes, little is known about their association and impact on short-term mortality. Objective: to examine, in hospitalized older persons, whether frailty is associated with delirium, and whether these two conditions, alone or in combination, affect these patients' 30-day survival. Design: observational study nested in the Delirium Day project, with 30-day follow-up. Setting: acute medical wards (n = 118) and rehabilitation wards (n = 46) in Italy. Subjects: a total of 2,065 individuals aged 65+ years hospitalized in acute medical (1,484 patients, 71.9%) or rehabilitation (581 patients, 28.1%) wards. Methods: a 25-item Frailty Index (FI) was created. Delirium was assessed using the 4AT test. Vital status was ascertained at 30 days. Results: overall, 469 (22.7%) patients experienced delirium on the index day and 82 (4.0%) died during follow-up. After adjustment for potential confounders, each FI score increase of 0.1 significantly increased the odds of delirium (odds ratio, OR: 1.66 [95% CI: 1.45-1.90]), with no difference between the acute (OR: 1.65 [95% CI: 1.41-1.93]) and rehabilitation ward patients (OR: 1.71 [95% CI: 1.27-2.30]). The risk of dying during follow-up also increased significantly for every FI increase of 0.1 in the overall population (OR: 1.65 [95% CI: 1.33-2.05]) and in the acute medical ward patients (OR: 1.61 [95% CI: 1.28-2.04]), but not in the rehabilitation patients. Delirium was not significantly associated with 30-day mortality in either hospital setting. Conclusions: in hospitalized older patients, frailty is associated with delirium and with an increased risk of short-term mortality