Nurses' Recognition of Hospitalized Older Patients With Delirium and Cognitive Impairment Using the Delirium Observation Screening Scale: A Prospective Comparison Study (original) (raw)
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Detection of Delirium by Bedside Nurses Using the Confusion Assessment Method
Journal of the American Geriatrics Society, 2000
A prospective, descriptive study was used to assess the diagnostic validity of the Confusion Assessment Method (CAM) administered at the bedside by nurses in daily practice. Two different scoring methods of the CAM (the specific (SPEC) and sensitive (SENS) methods) were compared with a criterion standard (CAM completed by trained research nurses). During a 5-month period, all patients consecutively admitted to an acute geriatric ward of the University Hospitals of Leuven (Belgium) were enrolled in the study. The 258 elderly inpatients who were included underwent 641 paired but independent ratings of delirium by bedside and trained research nurses.
Age and ageing, 2016
screening all unscheduled older adults for delirium is recommended in national guidelines, but there is no consensus on how to perform initial assessment. to evaluate the test accuracy of five brief cognitive assessment tools for delirium diagnosis in routine clinical practice. a consecutive cohort of non-elective, elderly care (older than 65 years) hospital inpatients admitted to a geriatric medical assessment unit of an urban teaching hospital. Reference assessments were clinical diagnosis of delirium performed by elderly care physicians. Routine screening tests were: Abbreviated Mental Test (AMT-10, AMT-4), 4 A's Test (4AT), brief Confusion Assessment Method (bCAM), months of the year backwards (MOTYB) and informant Single Question in Delirium (SQiD). we assessed 500 patients, mean age 83 years (range = 66-101). Clinical diagnoses were: 93 of 500 (18.6%) definite delirium, 104 of 500 (20.8%) possible delirium and 277 of 500 (55.4%) no delirium; 266 of 500 (53.2%) were identif...
Psychosomatics, 2004
Delirium is a common and severe disorder that is often misdiagnosed. The use of screening instruments is advisable for its early detection and treatment. In this study, the authors present an adaptation of the Confusion Assessment Method in order to improve its psychometric properties. One hundred fifty-three elderly inpatients were assessed in a four-phase procedure. Interrater reliability was high (kappa.)98.0ס Sensitivity was 90%, and specificity was 100%; the value for negative predictive accuracy was 97%, and the value for positive predictive accuracy was 100%. The adaptation has convergent agreement with two other mental status tests, the Mini-Mental Status Examination and the Delirium Rating Scale. Our results suggest that the adaptation of the Confusion Assessment Method is sensitive, specific, reliable, and easy to use by clinicians.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2018
Delirium is frequent in elderly patients presenting in the emergency department (ED). Despite the severe prognosis, the majority of delirium cases remain undetected by emergency physicians (EPs). At the time of our study there was no valid delirium screening tool available for EDs in German-speaking regions. We aimed to evaluate the brief Confusion Assessment Method (bCAM) for a German ED during the daily work routine. We implemented the bCAM into practice in a German interdisciplinary high-volume ED and evaluated the bCAM's validity in a convenience sample of medical patients aged ≥ 70 years. The bCAM, which assesses four core features of delirium, was performed by EPs during their daily work routine and compared to a criterion standard based on the criteria for delirium as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Compared to the criterion standard, delirium was found to be present in 46 (16.0%) of the 288 nonsurgical patients enrol...
Singapore Medical Journal, 2016
RESULTS A total of 57 patients (28 male, 29 female) were involved in the study. Their mean age was 76.0 ± 8.7 years. The prevalence of delirium based on MMSE scores was 40.4%; 16 patients had delirium on admission while seven developed delirium during their inpatient stay. However, delirium was documented in the case notes of only 7 (30%) of the 23 patients. CDT score was better than baseline MMSE score at predicting a decline in MMSE score. CONCLUSION The prevalence of delirium in the acute medical setting is high but underdiagnosed. The CDT may be a good screening tool to identify patients at risk of delirium during their inpatient stay. Baseline cognition screening should be performed in every elderly patient admitted to hospital.
Annals of Emergency Medicine, 2013
Background-Delirium is a common form of acute brain dysfunction with prognostic significance. Health care professionals caring for older emergency department (ED) patients miss delirium approximately 75% of cases. This error results from a lack of available measures that can be performed rapidly enough to be incorporated into clinical practice. Therefore, we developed and evaluated a novel two-step approach to delirium surveillance for the ED. Methods-This prospective observational study was conducted at an academic ED in patients ≥ 65 years old. A research assistant (RA) and physician performed the Delirium Triage Screen (DTS), designed to be a highly sensitive rule-out test, and the Brief Confusion Assessment
Detection of Delirium and Its Symptoms by Nurses Working in a Long Term Care Facility
2012
Delirium detection long term care setting a b s t r a c t Objective: To investigate the ability of nurses to recognize delirium and its symptoms and to investigate the factors associated with undetected delirium. Design: A prospective, observational study with repeated measurements over a 6-month period. Setting: Seven long term care settings in Montreal and Quebec City, Canada. Participants: Residents aged 65 and older, with or without dementia, admitted to long term care (not respite care) and able to communicate in English or French. Measurements: Delirium and its symptoms were assessed using the Confusion Assessment Method. Ratings of delirium by nurses based on their observations during routine care were compared with delirium ratings by trained research assistants based on a one-time formal structured evaluation (Confusion Assessment Method and Mini Mental State Examination). This procedure was repeated for 10 delirium symptoms. Sensitivity, specificity, and positive and negative predictive values were calculated. The method of generalized estimating equations was used to identify factors associated with undetected delirium. Results: Research assistants identified delirium in 43 (21.3%) of the 202 residents. Nurses identified delirium in 51% of the cases identified by the research assistants. However, for cases without delirium according to the research assistants, nurses identified 90% of them correctly. Detection rates for delirium symptoms ranged from 25% to 66.7%. Undetected delirium was associated with lower number of depressive symptoms manifested by the resident. Conclusion: Detection of delirium is a major issue for nurses. Strategies to improve nurse recognition of delirium could well reduce adverse outcomes for this vulnerable population.
Assessing severity of delirium by the delirium observation screening scale
International Journal of Geriatric Psychiatry, 2011
Objective: Delirium is the most common acute neuropsychiatric disorder in hospitalized elderly. Assessment of the severity of delirium is important for adjusting medication. The minimal dose of medication is preferable to prevent side effects. Only few nurse based severity measures are available. The aim of this study was to validate a scale developed to assess symptoms of delirium during regular nursing care, the Delirium Observation Screening (DOS) Scale, for monitoring severity of delirium. Method: Delirious patients of 65 years and older were included. Delirium was diagnosed according to DSM-IV criteria and the Confusion Assessment Method. The DOS Scale was compared to the Dutch version of the Delirium Rating Scale-Revised-98 (DRS-R-98). Global cognitive functioning was assessed by the Informant Questionnaire Cognitive Decline in the Elderly-Short Form (IQCODE-SF) and the KATZ-ADL Scale was used for functional impairment. Results: Ninety seven delirious patients were included: 41 hip fracture patients and 56 medical patients. The correlation between total DRS-R-98 scores and DOS Scale scores was 0.67 ( p ¼ 0.01). For the cognitive impaired group (IQCODE-SF 3.9) this correlation was 0.61 ( p ¼ 0.01); for the group with no global cognitive impairment, this correlation was 0.67 ( p ¼ 0.01). Correlations between DRS-R-98 and DOS Scale for hypoactive, hyperactive and mixed delirium subtype were 0.40 ( p ¼ 0.32), 0.44 ( p ¼ 0.01) and 0.69 ( p ¼ 0.05), respectively. Conclusions: The DOS Scale is able to measure severity of delirium. In routine daily clinical practice, the DOS Scale is a time-efficient, easy to use and reliable method for measuring and monitoring severity of delirium by nurses.
Journal of clinical nursing, 2017
To evaluate the usefulness of comprehensive nursing assessment as a strategy for determining the risk of delirium in older in-patients from a model of care needs based on variables easily measured by nurses. There are many scales of assessment and prediction of risk of delirium, but they are little known and infrequently used by professionals. Recognition of delirium by doctors and nurses continues to be limited. A case-control study. A specific form of data collection was designed to include the risk factors for delirium commonly identified in the literature and the care needs evaluated from the comprehensive nursing assessment based on the Virginia Henderson model of care needs. We studied 454 in-patient units in a basic general hospital. Data were collected from a review of the records of patients' electronic clinical history. The areas of care that were significant in patients with delirium were dyspnoea, problems with nutrition, elimination, mobility, rest and sleep, self-c...