Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Prevalence of low back pain and associated risk factors among nurses in National Hospital, Abuja, Nigeria

Objective: The objective of this study was to determine the prevalence and associated risk factors of Low Back Pain (LBP) among nurses in National Hospital, Abuja, Nigeria.Design: A cross-sectional study.Methods: The study was carried out to determine the prevalence and risk factors for LBP among nurses in National Hospital, Abuja, Nigeria. A departmentto- department enquiry was conducted using a self-structured questionnaire.Results: Two hundred and seventy three respondents who included 30 (11.0%) males and 243 (89.0%) females participated in the study. The mean age was 37.4+8.0 (37.8+7.5 years among the males and 37.4+8.1 years among the females. Results showed that 193 (70.7%) respondents were either overweight or obese and only 69 (25.3%) were of normal weight. The 12 month prevalence of low back pain was 72.1%. About 179 (80.0%) of the nurses attributed their low back pain to work related issues. The incidence of LBP was more among female nurses (129, 53.1%) than the male nurses (13, 43.3%).Conclusion: Occupational exposure to factors constituting physical loads (frequently carrying patients, availability of porters) and a previous history of back trauma were significant independent predictors of low back pain among nurses. However, LBP was not a major cause of absenteeism from work.Keywords: Low back pain, Risk factors, Prevalence, Nurse