Diagnosis and Risk Factors for Delirium in Elderly Patients in the Emergency Rooms and Intensive Care Unit of the National Geriatric Hospital Emergency Department: A Cross-Sectional Observational Study

Figures & data

Table 1 Demographic and Medical Information Regarding Patients with Delirium (n=106)

Variable	Patients (n=106)
Age:
60–69	25 (23.6%)
70–79	28 (26.4%)
80–89	36 (34.0%)
≥ 90	17 (16.0%)
± SD (years old)	78.3 ± 10.9
Sex:
Male	50 (47.2%)
Female	56 (52.8%)
Marital status:
Single	3 (2.8%)
Married	46 (43.4%)
Divorced	3 (2.8%)
Widowed	54 (51.0%)
Living conditions:
Living with Family (Wives/Husbands/Children)	73 (68.9%)
Living with caregivers	24 (22.6%)
Living alone	7 (6.6%)
Living in a nursing home	2 (1.9%)
Past medical history associated with delirium:
Vision impairment	93 (87.7%)
Hearing impairment	86 (81.1%)
Smoking	29 (27.4%)
Alcohol consumption	75 (70.8%)

Figure 1 Study scheme.

Table 2 Manifestations of Delirium in Patients (n=106)

Features		Patients (n=106)
Attention impairment:
Impairment in focusing attention		86 (81.1%)
Impairment in maintaining attention		65 (61.3%)
Impairment in shifting attention		24 (22.6%)
Orientation disorder:
Disorientation to time		95 (89.6%)
Disorientation to space		95 (89.6%)
Disorientation to self		59 (55.7%)
Disorientation to person		24 (22.6%)
Memory disorders:
Immediate memory loss		52 (49.1%)
Loss of short-term memory		95 (89.6%)
Loss of long-term memory		8 (7.5%)
Psychomotor disorder:
Rapidly flactuating symptoms		52 (49.1%)
Increased reaction time		35 (33.0%)
Increased or decreased language proficiency		62 (58.5%)
Increased startle responses		53 (50.0%)
Sleep disorders:
Without sleep disorder		5 (4.7%)
Mild sleep disorder at night and sleepy at daytime		39 (36.8%)
Moderate disturbance of sleep-wake cycle		28 (26.4%)
Severe disturbance of sleep-wake cycle (oversleeping or serious insomnia)		8 (7.5%)
Sleep-wake inversion		26 (24.5%)
Emotional disorders:
Depression		35 (33%)
Anxiety		49 (45,2%)
Emotionless/shocked, bewildered		22 (20.8%)
Types of delirium:
Hyperactive delirium		36 (34.0%)
Hypoactive delirium		52 (49.0%)
Mixed delirium		18 (17.0%)
Subclinical symptoms:
Plasma natrium	Hypernatremia	16 (15.1%)
	Hyponatremia	35 (33.0%)
Plasma Glucose	Increase	66 (62.3%)
	Decrease	3 (2.8%)
Albumin	Increase	2 (3.7%)
	Decrease	46 (85.2%)
Reduction of blood oxidation		61 (57.5%)
Hypercapnia		6 (5.7%)
Creatinin (μmol/L)		148.3 ±59.2
Timing:
Time to onset of first symptoms after admission (hour)		17.9 ± 34.1
Duration of persistence (day)		4.9 ± 4.9

Table 3 Underlying Diseases in Patients with Delirium (n=106)

Underlying Diseases	Patients (n=106)
Heart attack	8 (7.5%)
Heart failure	29 (27.4%)
Hypertension	72 (67.9%)
COPD	13 (12.3%)
Pneumonia	69 (65.1%)
Asthma	5 (4.7%)
Lao	4 (3.8%)
Diabetes	43 (40.6%)
Stroke	44 (41.5%)
Kidney disease - kidney failure	33 (31.1%)
Chronic liver disease	11 (10.4%)
Septic shock	31 (29.2%)
Dementia	19 (17.9%)
Cancer	5 (4.7%)
Musculoskeletal disorder	4 (3.8%)
Anaemia	41 (38.7%)
Depression	3 (2.8%)
Number of underlying diseases in patients with delirium:
± SD	4.0 ± 1.8

Table 4 Association of Delirium and Risk Factors

Risk factors			With Delirium (n=106)	Without Delirium (n=57)	OR	95% CI	P
Sensory impairment, substance use history:
Vision impairment			93 (87.7%)	39 (68.4%)	3.3	1.5–7.4	0.003
Hearing impairment			86 (81.1%)	31 (54.4%)	3.6	1.77–7.36	0.0001
Smoking			29 (27.4%)	12 (21.1%)	1.4	0.3–1.5	0.37
Alcohol consumption			75 (70.8%)	39 (68.4%)	1.6	0.4–1.7	0.7
Interventions in treatment:
Nasogastric intubation			21 (19.8%)	2 (3.5%)	6.7	1.53–3.65	0.004
Urinary catheterization			60 (56.6%)	8 (24.0%)	7.7	1.61–4.29	<0.001
Endotracheal intubation			37 (34.9%)	7 (22.3%)	3.8	1.11–2.63	0.002
Tracheostomy			10 (8.9%)	0 (0%)	1.6	1.4–1.8	0.015
Invasive mechanical ventilation			34 (32.1%)	4 (7.0%)	6.3	2.05–4.48	<0.001
Electrolyte disturbance, glucose disturbance:
Plasma natrium (mmol/L)	Hyponatremia [Na] < 135		35 (33.0%)	1 (1.75%)	2.48	1.07–5.75	0.001
	Hypernatremia [Na]: > 145		16 (15.1%)	1 (1.75%)	13.1	1.67–2.5
Glucose ≤ 7.8 mmol/l			45 (42.5%)	31 (54.4%)	1	0.84–3.1	0.14
Glucose > 7.8 mmol/l			66 (62.3%)	26 (45.6%)	1.6
Nutritional status (scale MNA - SF):
12–14 points: normal nutrition			12 (11.3%)	20 (35.1%)	1	–	0.0001
8–11 points: risk of malnutrition			38 (35.8%)	27 (47.4%)	2.35	0.98–5.59
0–7 points: malnutrition			56 (52.9%)	10 (17.5%)	9.17	3.43–24.5
Mean of MNA ± SD			2.39 ± 0.73	1.82 ± 0.09
Fall Risk Factors (Stratify Scale):
0 point: low risk of fall			5 (4.7%)	18 (31.6%)	1	-	0.0001
1 point: moderate risk of fall			16 (15.1%)	14 (24.6%)	4.1	4.2–14
≥ 2 point: high risk of fall			85 (80.2%)	25 (43.8%)	12.2	4.1–36.3
Pain:
Yes			10 (9.4%)	6 (10.5%)	1	0.3–2.6	0.82
No			96 (90.6%)	51 (89.5%)	1.12
Drug use:
Benzodiazepine			13 (12.3%)	4 (7.0%)	1.9	0.1–1.7	0.3
Opioid			2 (1.9%)	0 (0%)	1.5	1.4–1.7	0.3
Corticoid			18 (17.0%)	4 (7.0%)	2.7	0.1–1.1	0.08
Total number of drugs per patient		<5	16 (15.1%)	18 (31.6%)	1	1.2–5.6	0.014
		≥5	90 (84.9%)	39 (68.4%)	2.6
Duration of admission:
Days ( ± SD)			12.7 ± 7.7	8.5 ± 4.3	5.7	0.6–2.3	<0.001
Past medical history of stroke, dementia:
Stroke			23 (21.7%)	4 (7.0%)	3.7	0.09–0.83	0.016
Dementia			16 (15.1%)	3 (5.3%)	3.2	0.09–1.12	0.62
Age:
<65 years old			14 (13.2%)	6 (10.5%)	1	0.3–2.14	0.62
≥ 65 years old			92 (86.8%)	51 (89.5%)	1.3
Gender:
Female			50 (47.2%)	29 (50.9%)	1	0.61–2.21	0.65
Male			56 (52.8%)	28 (49.1%)	1.16
Several accompanying conditions:
Acute kidney failure or chronic kidney failure			43 (40.6%)	5 (8.8%)	7.1	2.05–6.39	<0.001
Respiratory failure			67 (63.2%)	22 (40.4%)	2.7	1.4–5.2	0.004
Acute liver failure and chronic liver failure			11 (10.4%)	6 (10.5%)	1.02	0.3–2.9	0.98
Number of accompanying pathologies			4.0 ± 1.7	2.9 ± 1.3			< 0.001
Frailty Syndrome (Edmonton Frail Scale):
<5 points: without frailty syndrome			17 (16.0%)	33 (57.9%)	1	–	0.0001
6–7 points: risk of frailty syndrome			13 (12.3%)	7 (12.3%)	3.6	1.2–10.7
8–9 points: mild frailty			17 (16.0%)	6 (10.5%)	5.5	1.8–16.5
10–11 points: moderate frailty			16 (15.1%)	1 (1.8%)	3.1	3.8–25.4
12–17 points: severe frailty			43 (40.6%)	10 (17.5%)	8.35	3.4–20.6
REFS mean ± SD			9.7 ± 3.8	5.8 ± 4.3
Activities of daily living scale (IADLs):
Mean of ADL point ± SD			2.5 ± 2.1	4.2 ± 2.1	6.53	4.5–25.5	0.0001