Research Summaries

Researchers Find Better Way to Identify Older Adults with Delirium in Emergency Room

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Delirium is sudden and serious confusion that makes it hard to pay attention or think clearly. Older adults are more likely to become delirious than younger people are. They are also more likely to develop delirium more quickly than younger adults.

Older people with delirium are also more likely to be hospitalized, develop complications, and spend time in Intensive Care.  In serious cases, delirium can lead to death.  That’s why it’s very important that healthcare providers identify and treat older patients with delirium as soon as possible. The earlier it is treated, the better the outcome.

A number of things can make an older adult more likely to have delirium. These include: infections, surgery, certain medications, depression, poor vision, hearing loss, poor nutrition, dementia, and dehydration (not getting enough water or other liquids). As many as one in every 10 older patients who go to an Emergency Department (ED) has delirium. But on average, busy ED doctors diagnose delirium in only one of every six people with delirium in EDs, according to studies conducted over the past 20 years and that were described in the March issue of the Journal of the American Geriatrics Society (JAGS). As a result, some of these patients may not be diagnosed and treated early – when treatment is most effective.  This can cause complications for the patient, and may, in serious cases, contribute to death.

New Research in the Journal of the American Geriatrics Society

To help prevent that, researchers at Beth Israel Deaconess Medical Center in Boston decided to look for a way to identify older adults who are more likely to develop delirium in the ED. That way, emergency staff could focus on diagnosing and treating those adults as early as possible.

The researchers studied more than 700 adults who were 65 or older and who came to the ED for medical care. The researchers collected specific information about each patient, giving them tests of their mental abilities, including their ability to pay attention and think clearly, and then used a test called the Confusion Assessment Method (CAM) to determine if they actually had delirium. The researchers also gathered additional information about each patient – including their ages, whether they had ever had a stroke, or whether they had been diagnosed with dementia, or had an infection, among other things. 

Based on that, and other information, the researchers came up with a new way to predict whether an older adult in an emergency department is likely to be delirious. They found that certain other things increased the likelihood that an older adult would develop delirium – things such as older age, a previous stroke or “mini stroke,” dementia, certain hospitalizations, and certain infections. Based on this information the researchers were also able to come up with a “risk prediction rule” that ED staff can use to predict whether an older person is likely to have delirium, so he or she can get treatment right away.

The researchers were also able to identify which patients in the ED who would be unlikely to become delirious, and a third group with a “moderate” risk of becoming delirious. “Perhaps this (middle) group would most benefit from ... a shortened delirium screening tool that helps identify which individuals should undergo a full delirium (evaluation),” the researchers note.

“Further research is needed to streamline delirium screening for use for individuals at moderate risk of delirium,” the researchers note.” Early identification of delirium may enable physicians to implement strategies to decrease the duration of delirium or avoid inappropriate discharge of individuals with acute delirium from the ED, which could improve outcomes.”

This summary is from the full report titled, “Delirium Risk Prediction, Healthcare Use and Mortality Elderly Adults in the Emergency Department.” It appears in the March 2014 issue of the Journal of the American Geriatrics Society. The report is authored by Maura Kennedy, MD, MPH; Richard A. Enander, MS; Sarah P. Tadiri, BS; Richard Wolfe, MD, Nathan I. Shapiro, MD,MPH, and Edward R. Marcantonio, MD, SM.