Regular Research Article
A Longitudinal Study on Delirium in Nursing Homes

https://doi.org/10.1016/j.jagp.2013.01.003Get rights and content

Objective

To investigate the evolution of delirium of nursing home (NH) residents and their possible predictors.

Design

Post-hoc analysis of a prospective cohort assessment.

Setting

Ninety NHs in Switzerland.

Participants

Included 14,771 NH residents.

Measurements

The Resident Assessment Instrument Minimum Data Set and the Nursing Home Confusion Assessment Method were used to determine follow-up of subsyndromal or full delirium in NH residents using discrete Markov chain modeling to describe long-term trajectories and multiple logistic regression analyses to determine predictors of the trajectories.

Results

We identified four major types of delirium time courses in NH. Increasing severity of cognitive impairment and of depressive symptoms at the initial assessment predicted the different delirium time courses.

Conclusion

More pronounced cognitive impairment and depressive symptoms at the initial assessment are associated with different subsequent evolutions of delirium. The presence and evolution of delirium in the first year after NH admission predicted the subsequent course of delirium until death.

Section snippets

Subjects

All NH residents in the three Swiss cantons Aargau, Basel-City, and Solothurn (corresponding to 13.5% of the total Swiss population)17 receive a Resident Assessment Instrument Minimum Data Set (RAI-MDS) assessment at 6-month intervals.18 We obtained the authorization of the Qualitäts-Systeme Aktiengesellschaft (Q-Sys AG; Systeme zur Qualitäts- und Kostensteuerung im Gesundheitswesen), that pools all RAI data, as well as of all directors of the NHs involved in this study to use these data for

Residents' Characteristics

The residents' characteristics per NHCAM group at the time of their first assessment are shown in Table 1.

In short, most variables are significantly different depending on the NHCAM status, but the effect size is often trivial to low. Low to moderate effect size was apparent for hearing and visual impairment, continence, mobility, new drugs, number of diseases, BADL, pain, whereas moderate to high effect size was observed for depression and CPS.

Types of Delirium Trajectories

Four delirium trajectories were identified, that

Discussion

Both subsyndromal and full delirium are highly prevalent in subjects living in NHs with an average of 38.1% of all residents of this study showing at least some signs of delirium and 5.4% presenting with full delirium at their initial assessment. These figures are within the range of those reported in the literature that vary, however, between nearly a quarter and more than half of all NH residents.12, 15, 32

A number of variables are associated with NHCAM status at the first assessment, but the

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