Delirium in the geriatric unit: proton-pump inhibitors and other risk factors

Abstract

Background

Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies.

Objective

Evaluate specific factors for development of delirium in a geriatric ward setting.

Methods

Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men), admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission. Comprehensive geriatric assessments including a structured interview, physical examination, geriatric functional assessment, blood sampling, ECG, abdominal ultrasound, chest X-ray, Confusion Assessment Method for diagnosis of delirium, Delirium-O-Meter to assess delirium severity, Richmond Agitation-Sedation Scale to assess sedation or agitation, visual analog scale and Doloplus-2 scale to assess pain level were performed.

Results

Multivariate logistic regression analysis revealed five independent factors associated with development of delirium in geriatric inpatients: transfer between hospital wards (odds ratio [OR] =2.78; confidence interval [CI] =1.54–5.01; P=0.001), preexisting dementia (OR =2.29; CI =1.44–3.65; P<0.001), previous delirium incidents (OR =2.23; CI =1.47–3.38; P<0.001), previous fall incidents (OR =1.76; CI =1.17–2.64; P=0.006), and use of proton-pump inhibitors (OR =1.67; CI =1.11–2.53; P=0.014).

Conclusion

Transfer between hospital wards, preexisting dementia, previous delirium incidents, previous fall incidents, and use of proton-pump inhibitors are predictive of development of delirium in the geriatric inpatient setting.

Keywords:

• delirium
• geriatric ward
• comprehensive geriatric assessment
• Confusion Assessment Method
• Delirium-O-Meter
• Richmond Agitation-Sedation Scale

Acknowledgments

This project was funded by Medical University of Silesia grants to statutory work (contracts KNW-1-059/K/3/0 and KNW-1-029/K/4/0) and graduate student research agreement (KNW-2-011/D/5/K). The funding body played no role in the formulation of the design, methods, subject recruitment, data collection, analysis, or preparation of this paper.

Author contributions

IO and JS contributed to the study conception and design, evaluation of the subjects, data collection, analysis and interpretation of data, and drafting of article. KW performed analysis and interpretation of data, drafting of article, and revising of drafts. All authors approved the final paper. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.