A critical appraisal and recommendation synthesis of delirium clinical practice guidelines relevant to the care of older adults in the emergency department: An umbrella review DOI Creative Commons
Sarah Filiatreault, Jeremy Grimshaw, Sara A. Kreindler

et al.

Journal of Evaluation in Clinical Practice, Journal Year: 2023, Volume and Issue: 29(6), P. 1039 - 1053

Published: June 14, 2023

Abstract Rationale Older adults are at high risk of developing delirium in the emergency department (ED); however, it is often missed or undertreated. Improving ED care challenging part due to a lack standards guide best practice. Clinical practice guidelines (CPGs) translate evidence into recommendations improve Aim To critically appraise and synthesize CPG for relevant older patients. Methods We conducted an umbrella review retrieve CPGs. Quality CPGs their were appraised using Appraisal Guidelines, Research, Evaluation (AGREE)‐II; Guidelines Research Evaluation—Recommendations Excellence (AGREE‐REX) instruments. A threshold 70% greater AGREE‐II Rigour Development domain was used define high‐quality Delirium from meeting this included synthesis narrative analysis. Results scores ranged 37% 83%, with 5 10 predefined threshold. AGREE‐REX overall calculated 44% 80%. Recommendations grouped screening, diagnosis, reduction, management. Although none ED‐specific, many incorporated setting. There agreement that screening nonmodifiable factors important high‐risk populations, those should be screened delirium. The ‘4A's Test’ recommended tool use specifically. Multicomponent strategies its management if occurs. only area disagreement short‐term antipsychotic medication urgent situations. Conclusion This first known including critical appraisal recommendations. Researchers policymakers can inform future improvement efforts research ED. Registration study has been registered Open Science Framework registries: https://doi.org/10.17605/OSF.IO/TG7S6OSF.IO/TG7S6 .

Language: Английский

Perioperative neurocognitive disorders: A narrative review focusing on diagnosis, prevention, and treatment DOI
Hao Kong,

Long‐Ming Xu,

Dong‐Xin Wang

et al.

CNS Neuroscience & Therapeutics, Journal Year: 2022, Volume and Issue: 28(8), P. 1147 - 1167

Published: June 1, 2022

Abstract Perioperative neurocognitive disorders (NCDs) refer to abnormalities detected during the perioperative periods, including preexisting cognitive impairment, preoperative delirium, delirium occurring up 7 days after surgery, delayed recovery, and postoperative NCD. The Diagnostic Statistical Manual of Mental Disorders‐5th edition (DSM‐5) is golden standard for diagnosing NCDs. Given impracticality using DSM‐5 by non‐psychiatric practitioners, many diagnostic tools have been developed validated different clinical scenarios. etiology NCDs multifactorial includes predisposing precipitating factors. Identifying these risk factors conducive stratification reduction. Prevention should include avoiding possible contributors implementing nonpharmacologic pharmacological interventions. former generally benzodiazepines, anticholinergics, prolonged liquid fasting, deep anesthesia, cerebral oxygen desaturation, intraoperative hypothermia. Nonpharmacologic measures prehabilitation, comprehensive geriatric assessment, fast‐track combined use regional block, sleep promotion. Pharmacological dexmedetomidine, nonsteroidal anti‐inflammatory drugs, acetaminophen are found beneficial effects. Nonpharmacological treatments first‐line established still limited severely agitated or distressed patients.

Language: Английский

Citations

91
Incidence of postoperative delirium in older adults undergoing surgical procedures: A systematic literature review and meta‐analysis DOI Creative Commons
Ezinne O. Igwe, Jessica Nealon,

Pauline O’Shaughnessy

et al.

Worldviews on Evidence-Based Nursing, Journal Year: 2023, Volume and Issue: 20(3), P. 220 - 237

Published: May 2, 2023

Abstract Background With the increase in life expectancy around globe, incidence of postoperative delirium (POD) among older people (≥65 years) is growing. Previous studies showed a wide variation POD, from 4% to 53%, with lack specific evidence about POD by surgery type people. The aim this systematic review and meta‐analysis was determine within populations 65 years over. Methods Databases including PubMed, Cochrane library, Embase, CINAHL were searched until October 2020. Due relatively higher number meta‐analyses undertaken area research, streamlined proposed. Results A total 28 (comprising 284 individual studies) reviewed. Data relevant ( n = 90) extracted included current study. Studies grouped into eight types for orthopedic, vascular, spinal, cardiac, colorectal, abdominal, urologic, mixed surgeries 20%, 14%, 13%, 32%, 30%, 10%, 26%, respectively. detection instruments different across studies, Confusion Assessment Method (CAM & CAM‐ICU) being most frequently adopted. Linking Evidence Action This study that undergoing varied widely type. more complex like cardiac abdominal associated risk POD. highlights need include level complexity as factor preoperative assessments.

Language: Английский

Citations

30
Delirium prevalence in geriatric emergency department patients: A systematic review and meta-analysis DOI
Fei Chen, Libo Liu, Yetong Wang

et al.

The American Journal of Emergency Medicine, Journal Year: 2022, Volume and Issue: 59, P. 121 - 128

Published: July 1, 2022

Language: Английский

Citations

36
Understanding the association between pain and delirium in older hospital inpatients: systematic review and meta-analysis DOI Creative Commons
Nicola White, Juan Carlos Bazo‐Alvarez,

Michel Koopmans

et al.

Age and Ageing, Journal Year: 2024, Volume and Issue: 53(4)

Published: April 1, 2024

Abstract Objective Delirium and pain are common in older adults admitted to hospital. The relationship between these is unclear, but clinically important. We aimed systematically review the association (at rest, movement, severity) delirium this population. Methods PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Web of Science were searched (January 1982–November 2022) for Medical Subject Heading terms synonyms (‘Pain’, ‘Analgesic’, ‘Delirium’). Study eligibility: (1) validated measure as exposure, (2) tool an outcome; participant medical or surgical (planned/unplanned) inpatients, admission length ≥ 48 h (3) median cohort age over 65 years. quality was assessed with Newcastle Ottawa Scale. collected/calculated odds ratios (ORs) categorical data standard mean differences (SMDs) continuous conducted multi-level random-intercepts meta-regression models. This prospectively registered PROSPERO [18/5/2020] (CRD42020181346). Results Thirty studies selected: 14 reported data; 16 data. prevalence ranged from 2.2 55%. In analysis, at rest (OR 2.14; 95% confidence interval [CI] 1.39–3.30), movement 1.30; CI 0.66–2.56), categorised ‘severe’ 3.42; 2.09–5.59) increased severity when measured continuously (SMD 0.33; 0.08–0.59) associated risk. There substantial heterogeneity both (I2 = 0%–77%) analyses 85%). Conclusion An increase a higher risk developing delirium. Adequate management appropriate analgesia may reduce incidence

Language: Английский

Citations

6
Emergency Department Length of Stay Is Associated with Delirium in Older Adults DOI Creative Commons

Natalie Elder,

Katren Tyler, Bryn E. Mumma

et al.

Western Journal of Emergency Medicine, Journal Year: 2023, Volume and Issue: 24(3)

Published: May 3, 2023

Incident delirium in older patients is associated with prolonged hospitalization and mortality. A recent study suggested an association between emergency department (ED) length of stay (LOS), time ED hallways, incident delirium. In this we further evaluated the emerging LOS, number non-clinical patient moves ED.We performed retrospective cohort at a single, urban, academic medical center. All data were extracted from electronic health record. We included aged ≥65 years presenting to admitted family or internal medicine services over two-year period. Patients any other service, transferred another hospital, discharged ED, who underwent procedural sedation excluded. The primary outcome was delirium, defined as positive screen, receipt sedative medications, use physical restraints. Multivariable logistic regression models including age, gender, language, history dementia, Elixhauser Comorbidity Index, within total spent hallway, LOS fitted.We studied 5,886 age; median age 77 (69-83) years; 3,031 (52%) female, 1,361 (23%) reported dementia. Overall, 1,408 (24%) experienced multivariable models, development (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.03, per hour), while [OR 0.97, (95% CI 0.91-1.04) hallway 0.99, 0.98-1.01, hour) not delirium.In single-center study, adults, not. Health systems should systemically limit for adults.

Language: Английский

Citations

16
Association of delirium with increased short-term mortality among older emergency department patients: A cohort study DOI

Mariah L. Arneson,

Lucas Oliveira J. e Silva, Jessica A. Stanich

et al.

The American Journal of Emergency Medicine, Journal Year: 2023, Volume and Issue: 66, P. 105 - 110

Published: Jan. 26, 2023

Language: Английский

Citations

12
Therapeutic dilemma’s: antipsychotics use for neuropsychiatric symptoms of dementia, delirium and insomnia and risk of falling in older adults, a clinical review DOI Creative Commons

Netta Korkatti-Puoskari,

Miia Tiihonen, María Ángeles Caballero-Mora

et al.

European Geriatric Medicine, Journal Year: 2023, Volume and Issue: 14(4), P. 709 - 720

Published: July 26, 2023

Abstract Purpose Because of the common and increasing use antipsychotics in older adults, we aim to summarize current knowledge on causes antipsychotic-related risk falls adults. We also provide information dementia, delirium insomnia, their adverse effects an overview pharmacokinetic pharmacodynamic mechanisms associated with antipsychotic falls. Finally, clinicians for weighing benefits harms (de)prescribing. Methods A literature search was executed CINAHL, PubMed Scopus March 2022 identify studies focusing fall-related focused neuropsychiatric symptoms delirium. Results Antipsychotics increase through anticholinergic, orthostatic extrapyramidal effects, sedation, cardio- cerebrovascular system. Practical resources algorithms are available that guide assist deprescribing without indication. Conclusions Deprescribing should be considered encouraged people at falling, especially when prescribed or insomnia. If still needed, recommend reassessed within two four weeks prescription. more harm than benefit, process started.

Language: Английский

Citations

12
Precision‐based approaches to delirium in critical illness: A narrative review DOI Creative Commons
Melissa J. Ankravs, Cathrine McKenzie, Michael T. Kenes

et al.

Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy, Journal Year: 2023, Volume and Issue: 43(11), P. 1139 - 1153

Published: May 3, 2023

Delirium occurs in critical illness and is associated with poor clinical outcomes, having a longstanding impact on survivors. Understanding the complexity of delirium its deleterious outcome has expanded since early reports. culmination predisposing precipitating risk factors that result transition to delirium. Known risks range from advanced age, frailty, medication exposure or withdrawal, sedation depth, sepsis. Because multifactorial nature, different phenotypes, potential neurobiological causes, precise approach reducing requires broad understanding complexity. Refinement categorization subtypes phenotypes (i.e., psychomotor classifications) attention. Recent advances association outcomes expand our highlight potentially modifiable targets. Several biomarkers care have been examined, disrupted functional connectivity being detecting reinforce as an acute, partially modifiable, brain dysfunction, place emphasis importance mechanistic pathways including cholinergic activity glucose metabolism. Pharmacologic agents assessed randomized controlled prevention treatment trials, disappointing lack efficacy. Antipsychotics remain widely used after "negative" yet may role specific subtypes. However, antipsychotics do not appear improve outcomes. Alpha-2 agonists perhaps hold greater for current use future investigation. The thiamine appears promising, evidence. Looking forward, pharmacists should prioritize mitigation able. Future research needed within individual identify targets only duration severity, but long-term cognitive impairment.

Language: Английский

Citations

11
Racial, Ethnic, and Age-Related Disparities in Sedation and Restraint Use for Older Adults in the Emergency Department DOI

Patelle Jivalagian,

Cameron J. Gettel, Colin M. Smith

et al.

American Journal of Geriatric Psychiatry, Journal Year: 2024, Volume and Issue: unknown

Published: July 1, 2024

Language: Английский

Citations

4
Delir in der Notaufnahme – ein unerkanntes Problem DOI
Rebecca von Haken, Arnold Kaltwasser, Rolf Dubb

et al.

Geriatrie up2date, Journal Year: 2025, Volume and Issue: 07(01), P. 9 - 24

Published: Jan. 1, 2025

Mit 10,5 Millionen Aufnahmen/Jahr bewältigen die zentralen Notaufnahmen (ZNA) in Deutschland über Hälfte aller akuten Notfallpatienten 1. Zahlen aus den USA und der Schweiz zeigen, dass ein hoher Prozentsatz (66–87%) Delirien übersehen wird 2 3. Ein unerkanntes Delir kann später zu einer erhöhten Hospitalisierung mit notwendigem Pflegeheimaufenthalt führen, beim alten Patienten ZNA geht es um 30% Letalität einher 4.

Citations

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