Original StudyDetection of Delirium and Its Symptoms by Nurses Working in a Long Term Care Facility
Section snippets
Design, Study Settings, and Selection of Participants
This study was a prospective, observational, multisite cohort study of LTCF residents conducted at 7 facilities located in Montreal and Quebec City, Canada. All residents aged 65 and older admitted to long term care (not respite care) and able to communicate in English or French, were eligible for the study. Two cohorts of residents were enrolled in separately funded studies that used the same staff and methods. Cohort A included residents without severe dementia (defined as a score of 10 or
Outcome
Delirium as measured with the CAM was the outcome in this study. The CAM is an established and widely used instrument to help in the detection of delirium.17, 18 The tool assesses the 9 criteria for delirium specified in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (similar to DSM-IV criteria): (1) acute onset and fluctuation of symptoms over the course of the day; (2) inattention; (3) disorganized thinking; (4) altered level of consciousness; (5)
Results
Of the 1484 residents considered for inclusion in the study, 928 (62.6%) were eligible for enrollment (Figure 1). Consent was obtained for 283 residents: 108 (49%) of the 221 competent residents and 175 (25%) of the 707 incompetent residents. Three residents died before baseline assessment, leaving a total of 280 residents for the study. Of these, only residents with at least 1 monthly assessment of delirium conducted on the same day by the RA and bedside nurse over the 6-month period were
Discussion
The purpose of this study was to investigate bedside nurses’ ability to recognize delirium and its symptoms among long term care residents, with or without dementia, and to investigate the factors associated with undetected delirium. Although recognition of delirium by bedside nurses has been studied frequently in acute care settings, this issue has scarcely been investigated in LTCFs. Moreover, to the authors’ knowledge, this study is the first one using a prospective design with repeated
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2014, Journal of Pain and Symptom ManagementCitation Excerpt :Clinical practice guidelines2,3,17 affirm that timely recognition of patients' delirium is pivotal to implementing ongoing assessment, support, and treatment, including identifying and treating the cause, reducing the impact of the delirium experience and risk of related negative outcomes. Yet delirium is often poorly recognized, documented, and followed up by clinicians across inpatient settings18–21—including palliative care22,23—leading to inconsistent delivery of appropriate interventions to delirious patients. Delirium underrecognition is linked to a range of factors, including clinician delirium knowledge gaps24–26 that exist alongside the complexity of delirium phenomenology: widely differing presentations, with fluctuating symptoms, ranging degrees of severity, and manifestations of change to cognitive and psychomotor activity.27,28
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2014, Journal of the American Medical Directors AssociationCitation Excerpt :Delirium has been found to occur in 18% of NH residents who develop an acute illness.60 The use of confusion assessment methodology by nurses in the NH resulted in 60% of delirium being missed.61 Subacute facilities are required to conduct a comprehensive evaluation of the new patient, including an assessment for delirium, within 14 days.
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The authors thank the Canadian Institute of Health Research and The Canadian Alzheimer Society for their financial support to this project. Funding for this paper was also through an Investigator Award to Philippe Voyer from the Quebec Health Research Funds (Fonds de la recherche en santé du Québec) and the Quebec Nursing Research Funds (Fonds de la recherche en sciences infirmières du Québec).