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18 records – page 1 of 2.

The course of delirium in older long-term care residents.

https://arctichealth.org/en/permalink/ahliterature125088
Source
Int J Geriatr Psychiatry. 2012 Dec;27(12):1291-7
Publication Type
Article
Date
Dec-2012
Author
Martin G Cole
Jane McCusker
Philippe Voyer
Johanne Monette
Nathalie Champoux
Antonio Ciampi
Minh Vu
Eric Belzile
Author Affiliation
Department of Psychiatry, St Mary's Hospital Center and McGill University, Montreal, Quebec, Canada. martin.cole@ssss.gouv.qc.ca
Source
Int J Geriatr Psychiatry. 2012 Dec;27(12):1291-7
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Canada - epidemiology
Delirium - epidemiology - physiopathology
Disease Progression
Female
Humans
Incidence
Long-Term Care - statistics & numerical data
Male
Prospective Studies
Regression Analysis
Abstract
The purpose of this study was to determine the course of delirium in older long-term care (LTC) residents.
A prospective cohort study of 279 residents in seven LTC facilities in Montreal and Quebec City, Canada, was conducted. The Mini Mental State Examination (MMSE), Confusion Assessment Method (CAM), Delirium Index (DI), Hierarchic Dementia Scale, Barthel Index, and Cornell Scale for Depression were completed at baseline. The MMSE, CAM, and DI were repeated weekly for 6 months. Information on medical problems and medication was abstracted from resident charts. Data were analyzed using descriptive statistics, Cox proportional hazard regression, and logistic regression.
Of the 279 residents, 41 (14.7%) had 61 CAM-defined incident episodes of delirium: 28 (10%) had one episode and 13 (4.7%) had two or more episodes. Episode duration was 7-63 days, mean, 11.3 (SD, 10.1) days. The mean episode DI score was 11.5 (SD, 3.5). Rates of recovery at 1, 2, 4, and 24 weeks were 57.4%, 67.2% 77.1%, and 80.3%, respectively. Most episodes were preceded or followed by one or more CAM core symptoms of delirium, sometimes lasting many weeks.
Confusion Assessment Method-defined incident episodes of delirium in older LTC residents appear to last longer than episodes in acute care hospital patients, but rates of recovery at 4 and 24 weeks are similar. Notably, most episodes were preceded or followed by one or more CAM core symptoms of delirium. These findings have implications for clinical practice and research in LTC settings.
PubMed ID
22517219 View in PubMed
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Detection of delirium and its symptoms by nurses working in a long term care facility.

https://arctichealth.org/en/permalink/ahliterature135768
Source
J Am Med Dir Assoc. 2012 Mar;13(3):264-71
Publication Type
Article
Date
Mar-2012
Author
Philippe Voyer
Sylvie Richard
Jane McCusker
Martin G Cole
Johanne Monette
Nathalie Champoux
Antonio Ciampi
Eric Belzile
Author Affiliation
Faculty of Nursing Sciences, Laval University, Quebec City, Canada. philippe.voyer@fsi.ulaval.ca
Source
J Am Med Dir Assoc. 2012 Mar;13(3):264-71
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Clinical Competence
Delirium - diagnosis - physiopathology
Female
Humans
Male
Nurse's Role
Nursing Homes
Prospective Studies
Quebec
Abstract
To investigate the ability of nurses to recognize delirium and its symptoms and to investigate the factors associated with undetected delirium.
A prospective, observational study with repeated measurements over a 6-month period.
Seven long term care settings in Montreal and Quebec City, Canada.
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.
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.
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.
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.
PubMed ID
21450220 View in PubMed
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Development of a delirium risk screening tool for long-term care facilities.

https://arctichealth.org/en/permalink/ahliterature126672
Source
Int J Geriatr Psychiatry. 2012 Oct;27(10):999-1007
Publication Type
Article
Date
Oct-2012
Author
Jane McCusker
Martin G Cole
Philippe Voyer
Antonio Ciampi
Johanne Monette
Nathalie Champoux
Minh Vu
Eric Belzile
Author Affiliation
St Mary's Research Centre, St Mary's Hospital, Montreal, Quebec, Canada. jane.mccusker@mcgill.ca
Source
Int J Geriatr Psychiatry. 2012 Oct;27(10):999-1007
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cohort Studies
Delirium - diagnosis
Female
Humans
Long-Term Care
Male
Mass Screening - methods
Quebec
Risk factors
Abstract
The aim of this study is to develop a delirium risk screening tool for use in long-term care (LTC) facilities.
The sample comprised residents aged 65?years and over of seven LTC facilities in Montreal and Quebec City, Canada, admitted for LTC. Primary analyses were conducted among residents without delirium at baseline. Incident delirium was diagnosed using multiple data sources during the 6-month follow-up. Risk factors, all measured at or prior to baseline, included the following six groups: sociodemographic, medical, cognitive status, physical function, agitated behavior, and symptoms of depression. Variables were analyzed individually and by group using Cox regression models. Clinical judgment was used to select the most feasible among similarly performing factors.
The cohort comprised 206 residents without delirium at baseline; 69 cases of incident delirium were observed (rate 7.6 per 100 person weeks). The best-performing screening tool comprised five items, with an overall area under the curve of 0.82 (95% CI 0.76, 0.88). These items included brief measures of cognitive status, physical function, behavioral, and emotional problems. Using cut-points of 2 (or 3) over 5, the scale has a sensitivity of 90% (63%), specificity of 59% (85%), and positive predictive value of 52% (66%).
This brief screening tool allows nurses to identify LTC residents at increased risk for delirium. These residents can be targeted for closer monitoring and preventive interventions.
PubMed ID
22367973 View in PubMed
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Source
J Am Geriatr Soc. 2003 Nov;51(11):1539-46
Publication Type
Article
Date
Nov-2003
Author
Jane McCusker
Martin G Cole
Nandini Dendukuri
Eric Belzile
Author Affiliation
Departments of Clinical Epidemiology and Community Studies Psychiatry, St Mary's Hospital, Montreal, Quebec. jane.mccusker@mcgill.ca
Source
J Am Geriatr Soc. 2003 Nov;51(11):1539-46
Date
Nov-2003
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cohort Studies
Delirium - diagnosis - epidemiology
Female
Geriatric Assessment
Humans
Length of Stay - statistics & numerical data
Linear Models
Male
Prospective Studies
Quebec - epidemiology
Severity of Illness Index
Abstract
To determine the effects of prevalent and incident delirium on length of hospital stay.
Prospective cohort study, comparing (1). length of stay after admission in cases of prevalent delirium versus controls without prevalent delirium with (2). length of stay after diagnosis in cases of incident delirium versus controls matched by day of diagnosis.
The medical services of a primary, acute care hospital.
Medical admissions of patients aged 65 and older from the emergency department with delirium diagnosed during the first week in hospital. Patients admitted to intensive care or oncology and those with a primary diagnosis of stroke were excluded. A sample of those without delirium was also enrolled.
Delirium was diagnosed using the Confusion Assessment Method. Data on length of stay and diagnosis-related groups (DRGs) were abstracted from administrative data. Measures of covariates included the Informant Questionnaire on Cognitive Decline in the Elderly, the Delirium Index, the instrumental activities of daily living questionnaire from the Older American Resources and Services project, the Charlson Comorbidity Index, the Clinical Severity Scale, and the Acute Physiology Score.
The study sample comprised 359 patients: 204 with prevalent delirium, 37 with incident delirium, and 118 without delirium. After controlling for covariates, prevalent delirium was not associated with a significantly longer hospital stay, but incident delirium was associated with an excess stay after diagnosis of 7.78 days (95% confidence interval=3.07, 12.48). Similar results were obtained using log-transformed or DRG-adjusted estimates of length of stay.
In older medical inpatients, incident but not prevalent delirium is an important predictor of longer hospital stay. Interventions to prevent incident delirium may reduce length of stay.
PubMed ID
14687382 View in PubMed
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Does depression in older medical inpatients predict mortality? A systematic review.

https://arctichealth.org/en/permalink/ahliterature161163
Source
Gen Hosp Psychiatry. 2007 Sep-Oct;29(5):425-30
Publication Type
Article
Author
Martin G Cole
Author Affiliation
Department of Psychiatry, St. Mary's Hospital Center, McGill University, Montreal, Quebec, Canada. martin.cole@ssss.gouv.qc.ca
Source
Gen Hosp Psychiatry. 2007 Sep-Oct;29(5):425-30
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Depression
Female
Forecasting
Humans
Inpatients - psychology
Male
Middle Aged
Mortality - trends
Quebec - epidemiology
Abstract
To determine whether depression in older medical inpatients predicts mortality.
Medline, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews were searched for potentially relevant articles; the bibliographies of relevant articles were searched for additional references. Retrieved studies were screened to meet five inclusion criteria. Validity of studies was assessed according to four criteria adapted from the Evidence-Based Medicine Working Group. Data were abstracted from each study and tabulated. Data synthesis involved a qualitative meta-analysis.
Many of the studies had methodological limitations. Six reported that depression predicted increased mortality, five reported that depression did not predict mortality, and one reported that depression predicted decreased mortality when there was a history of prior depression. Unadjusted risk ratios for death ranged from 0.60 to 12.6; adjusted risk ratios ranged from 0.42 to 7.4. The disparate findings may be explained in part by differences in the proportions of young older patients and men enrolled in the different studies.
The evidence that depression in older medical inpatients predicts mortality is inconclusive. There is a need for further studies that pay attention to design, populations enrolled, and analysis.
PubMed ID
17888809 View in PubMed
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Environmental factors predict the severity of delirium symptoms in long-term care residents with and without delirium.

https://arctichealth.org/en/permalink/ahliterature114783
Source
J Am Geriatr Soc. 2013 Apr;61(4):502-11
Publication Type
Article
Date
Apr-2013
Author
Jane McCusker
Martin G Cole
Philippe Voyer
Minh Vu
Antonio Ciampi
Johanne Monette
Nathalie Champoux
Eric Belzile
Alina Dyachenko
Author Affiliation
St. Mary's Research Centre, St. Mary's Hospital, Montreal, Quebec, Canada. jane.mccusker@mcgill.ca
Source
J Am Geriatr Soc. 2013 Apr;61(4):502-11
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Canada
Cohort Studies
Confusion - epidemiology
Delirium - epidemiology
Female
Health status
Humans
Long-Term Care
Male
Mental Health - statistics & numerical data
Prospective Studies
Residential Facilities - organization & administration
Risk factors
Severity of Illness Index
Social Environment
Abstract
To identify potentially modifiable environmental factors (including number of medications) associated with changes over time in the severity of delirium symptoms and to explore the interactions between these factors and resident baseline vulnerability.
Prospective, observational cohort study.
Seven long-term care (LTC) facilities.
Two hundred seventy-two LTC residents aged 65 and older with and without delirium.
Weekly assessments (for up to 6 months) of the severity of delirium symptoms using the Delirium Index (DI), environmental risk factors, and number of medications. Baseline vulnerability measures included a diagnosis of dementia and a delirium risk score. Associations between environmental factors, medications, and weekly changes in DI were analyzed using a general linear model with correlated errors.
Six potentially modifiable environmental factors predicted weekly changes in DI (absence of reading glasses, aids to orientation, family member, and glass of water and presence of bed rails and other restraints) as did the prescription of two or more new medications. Residents with dementia appeared to be more sensitive to the effects of these factors.
Six environmental factors and prescription of two or more new medications predicted changes in the severity of delirium symptoms. These risk factors are potentially modifiable through improved LTC clinical practices.
PubMed ID
23581909 View in PubMed
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Health services use for mental health problems by community-living seniors with depression.

https://arctichealth.org/en/permalink/ahliterature161025
Source
Int Psychogeriatr. 2008 Jun;20(3):554-70
Publication Type
Article
Date
Jun-2008
Author
Martin G Cole
Jane McCusker
Maida Sewitch
Antonio Ciampi
Alina Dyachenko
Author Affiliation
Department of Psychiatry, St. Mary's Hospital Center and McGill University, Montreal, Canada. martin.cole@ssss.gouv.qc.ca
Source
Int Psychogeriatr. 2008 Jun;20(3):554-70
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada - epidemiology
Catchment Area (Health)
Community Mental Health Services - utilization
Cross-Sectional Studies
Demography
Depressive Disorder, Major - epidemiology - therapy
Female
Health Services for the Aged - utilization
Humans
Male
Mental Disorders - therapy
Rural Population - statistics & numerical data
Urban Population - statistics & numerical data
Abstract
The literature on health services (HS) use for mental health problems by community-living seniors with depression is sparse. This study aimed to characterize patterns of HS use for mental health problems by seniors with depressive disorders and symptoms during the previous 12 months.
The study used data from the Canadian Community Health Survey Cycle 1.2: Mental Health and Well-Being (N = 7736). Information was collected on demographic, social, mental, physical and functional variables and HS use for mental health problems. We obtained simple univariate and bivariate descriptions of the data and developed multivariate predictive models for each of the HS utilization variables.
Rates of any HS use for mental health problems ranged from 1.8% for those with no depressive symptoms to 31.1% for those with major depression. Variables predicting increased HS use were: depressive disorder or symptoms, clinically significant distress or impairment, age 65-84, single, post-secondary education, religiousness, disability, co-morbid mental disorder and fewer friends and positive social interactions. Variables predicting HS use among depressed seniors were physical health, psychiatric co-morbidity and activity limitation.
Community-living seniors with major depression, co-morbid major depression and depressive symptoms were more likely to use psychiatrist, family physician, other professional and self-help services for mental health problems but less than a third actually did so.
PubMed ID
17908347 View in PubMed
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Prevalence and incidence of delirium in long-term care.

https://arctichealth.org/en/permalink/ahliterature137520
Source
Int J Geriatr Psychiatry. 2011 Nov;26(11):1152-61
Publication Type
Article
Date
Nov-2011
Author
Jane McCusker
Martin G Cole
Philippe Voyer
Johanne Monette
Nathalie Champoux
Antonio Ciampi
Minh Vu
Eric Belzile
Author Affiliation
Department of Clinical Epidemiology and Community Studies, St Mary's Hospital, Montreal, Quebec, Canada. jane.mccusker@mcgill.ca
Source
Int J Geriatr Psychiatry. 2011 Nov;26(11):1152-61
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cognition Disorders - epidemiology
Delirium - epidemiology
Dementia - epidemiology
Depressive Disorder - epidemiology
Female
Humans
Incidence
Long-Term Care - statistics & numerical data
Male
Multivariate Analysis
Prevalence
Prospective Studies
Quebec - epidemiology
Risk factors
Abstract
(1) To describe the prevalence and 6-month incidence of delirium in long-term care facility (LTCF) residents age 65 and over; (2) To describe differences in these measures by resident baseline characteristics.
A multisite, prospective observational study was conducted in seven LTCFs in the province of Quebec, Canada. Residents of age 65 and over were recruited into two cohorts: Cohort A with a Mini-Mental State Examination (MMSE) score of 10 or more and Cohort B with an MMSE score of less than 10. Baseline resident measurements were obtained from research resident assessments, nurse interviews, and chart review. Weekly resident assessments for up to 24 weeks included the Confusion Assessment Method (CAM).
Two hundred seventy-nine residents were recruited and completed baseline delirium assessments: 204 in Cohort A and 75 in Cohort B. The prevalence of delirium at baseline was 3.4% in Cohort A and 33.3% in Cohort B. The incidence of delirium among those without delirium at baseline (per 100 person-weeks of follow-up) was 1.6 in Cohort A and 6.9 in Cohort B. In multivariate analyses, a diagnosis of dementia, moderate to severe cognitive impairment, and depressive symptoms at baseline were associated with a greater prevalence and incidence of delirium.
Delirium is an important clinical problem in LTCF residents, particularly among those with moderate to severe cognitive impairment at baseline.
PubMed ID
21274904 View in PubMed
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The prevalence and phenomenology of auditory hallucinations among elderly subjects attending an audiology clinic.

https://arctichealth.org/en/permalink/ahliterature190327
Source
Int J Geriatr Psychiatry. 2002 May;17(5):444-52
Publication Type
Article
Date
May-2002
Author
Martin G Cole
Lorna Dowson
Nandini Dendukuri
Eric Belzile
Author Affiliation
Department of Psychiatry, St-Mary's Hospital, Montreal, Canada.
Source
Int J Geriatr Psychiatry. 2002 May;17(5):444-52
Date
May-2002
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Audiometry
Cross-Sectional Studies
Female
Hallucinations - epidemiology
Hearing Loss - complications
Humans
Male
Prevalence
Quebec - epidemiology
Abstract
Studies of auditory hallucinations are scant.
To determine the prevalence and phenomenology of auditory hallucinations among elderly subjects with hearing impairment.
We surveyed 125 men and women aged 65 years and over referred to the Audiology department of a university-affiliated primary acute-care hospital.
The prevalence of auditory hallucinations was 32.8% (95% confidence interval (CI) 24.7-41.8). These hallucinations represented a spectrum of phenomenology from elementary personal impressions to complex percepts. The types of auditory hallucinations included humming or buzzing (35.9%), shushing (12.8%), beating or tapping (10.6%), ringing (7.7%), other individual sounds (15.4%), multiple sounds (12.6%), voices (2.5%) or music (2.5%). Subjects with any type of hallucination were younger and had poorer discrimination scores in the left ear and impaired binaural discrimination with lip-reading. Subjects with hallucinations that had more qualities of a true percept heard different types of sounds and had lower reflex thresholds and better air conduction in the right ear.
Auditory hallucinations are frequent in elderly subjects with hearing impairment and seem to be associated with younger age and asymmetrical hearing impairment.
PubMed ID
11994933 View in PubMed
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Prodrome of delirium among long-term care residents: what clinical changes can be observed in the two weeks preceding a full-blown episode of delirium?

https://arctichealth.org/en/permalink/ahliterature123922
Source
Int Psychogeriatr. 2012 Nov;24(11):1855-64
Publication Type
Article
Date
Nov-2012
Author
Philippe Voyer
Jane McCusker
Martin G Cole
Johanne Monette
Nathalie Champoux
Antonio Ciampi
Eric Belzile
Sylvie Richard
Author Affiliation
Laval University, Quebec, Quebec, Canada. philippe.voyer@fsi.ulaval.ca
Source
Int Psychogeriatr. 2012 Nov;24(11):1855-64
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Aged
Canada - epidemiology
Case-Control Studies
Delirium - diagnosis - epidemiology - etiology - psychology
Dementia - complications - diagnosis - psychology
Early Diagnosis
Female
Geriatric Assessment - methods - statistics & numerical data
Homes for the Aged - statistics & numerical data
Humans
Intelligence Tests
Long-Term Care - methods - psychology - statistics & numerical data
Male
Neuropsychological Tests
Nursing Homes - statistics & numerical data
Perception
Prodromal Symptoms
Risk Assessment - methods
Thinking
Time Factors
Abstract
Delirium among long-term care (LTC) residents is frequent and is associated with increased morbidity and mortality. Identification of clinical changes during the prodromal phase of delirium could lead to prevention of a full-blown episode and perhaps limit the deleterious consequences of this syndrome. The aim of the present study was to identify clinical changes observable in the 2-week period prior to the onset of full-blown delirium.
Long-term care (LTC) residents aged 65 years and over, with or without dementia were eligible for this nested case-control study. Delirium was assessed weekly over a 6-month period using the Confusion Assessment Method. Cases with incident delirium were matched by time since enrollment to one or more controls without delirium.
When compared to the controls, LTC residents who developed delirium (cases = 85) were more likely to have new-onset perceptual disturbances (OR = 4.75; 95% CI 1.65-13.66) and disorganized thinking (OR = 3.09; 95% CI 1.33-7.19) and a worsening of the Mini-Mental State Examination (MMSE) item measuring registration (OR = 2.59; 95% CI 1.24-5.41) during the preceding 2 weeks. However, the frequency of these changes was low. Residents with at least 3 clinical changes were more likely to develop delirium than those without any clinical change (OR = 2.52; 95% CI 1.08-5.87).
This study provides evidence of clinical changes during the prodromal phase of delirium among LTC residents. More studies are needed to further explore the role and relevance of these clinical changes as warning signs of imminent delirium.
PubMed ID
22647266 View in PubMed
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18 records – page 1 of 2.