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

The Effects of Hypochlorite-Oxidation on the Physico-Chemical Properties of Starch Obtained from Tacca Involucrata

Tacca involucrata tubers are a staple source of starch in the Middle belt region of Nigeria. In this study, hypochlorite oxidation is utilized as a means of improving the physicochemical properties of the starch, to obviate problems posed by high moisture absorbing capacity (risk of microbial contamination) and poor flow properties, etc. Samples of the starch were treated with calcium hypochlorite to provide an oxidative concentration of 10 g per litre of active chlorine, for times ranging from 15 minutes to 2 hours at 28 °C and pH 9. Suitable properties of the bleached starches: particle size, relative viscosities, true and loose densities, gelatinization temperature and equilibrium moisture content, were assessed in relation to the native unoxidized starch. The results indicate that oxidation produces starch of whiter colour and optically clearer mucilage. It causes depolymerisation of the starch, hereby yielding lower viscosity grades with lower molecular weights. The process produces starch with smaller grain particles due to structural breakdown along fissure lines. The gelatinization temperature became lowered on oxidation. The moisture absorbing capacity and hence risk of microbial attack was also reduced, but starch of slightly poorer flow was produced.Keywords: Tacca involucrata; starch; modification; hypochlorite; oxidation physiochemicalNigerian Journal of Pharmaceutical Research, Vol. 8 No 1 pp. 270 - 280 (September 2010