Academic Emergency Medicine,
Journal Year:
2024,
Volume and Issue:
unknown
Published: June 7, 2024
Abstract
Objective
As
part
of
the
Geriatric
Emergency
Department
(ED)
Guidelines
2.0
project,
we
conducted
a
systematic
review
to
find
risk
factors
or
stratification
approaches
that
can
be
used
identify
subsets
older
adults
who
may
benefit
from
targeted
ED
delirium
screening.
Methods
An
electronic
search
strategy
was
developed
with
medical
librarian,
in
April
2021
and
November
2022.
Full‐text
studies
patients
≥65
years
assessed
for
prevalent
were
included.
Risk
bias
using
McMaster
University
Clarity
Group
tool.
Outcomes
measures
pertained
method
used.
Due
heterogeneity
patient
populations,
methods,
outcomes,
meta‐analysis
not
conducted.
Results
Our
yielded
1878
unique
citations,
which
13
Six
novel
score
without
evaluation
specific
factors,
six
evaluated
only,
one
study
an
existing
nondelirium
association
delirium.
The
most
common
factor
history
dementia,
odds
ratios
ranging
3.3
(95%
confidence
interval
[CI]
1.2–8.9)
18.33
CI
8.08–43.64).
Other
consistently
associated
increased
included
age,
use
certain
medications
(such
as
antipsychotics,
antidepressants,
opioids,
among
others),
functional
impairments.
Of
scores,
reported
area
under
curve
ranged
0.77
0.90.
Only
two
potential
impact
tool
on
screening
burden.
Conclusions
There
is
significant
heterogeneity,
but
results
suggest
such
age
over
75,
impairments
should
are
at
highest
No
implementation
patient‐oriented
outcomes.
Nursing in Critical Care,
Journal Year:
2024,
Volume and Issue:
29(6), P. 1215 - 1223
Published: Aug. 13, 2024
Delirium
is
a
common
acute
mental
disorder,
and
its
adverse
outcomes
often
cause
distress
to
both
patients
their
families.
Despite
prevalence
in
treated
emergency
departments,
delirium
frequently
overlooked.
Journal of the American Geriatrics Society,
Journal Year:
2024,
Volume and Issue:
unknown
Published: Sept. 12, 2024
Abstract
Introduction
Delirium
affects
15%
of
older
adults
presenting
to
emergency
departments
(EDs)
but
is
detected
in
only
one‐third
cases.
Evidence‐based
guidelines
for
ED
delirium
screening
exist,
are
underutilized.
Frontline
staff
perceptions
about
and
time
resource
constraints
known
barriers
uptake.
Early
adopters
can
offer
valuable
lessons
successful
implementation.
Methods
We
conducted
semi‐structured
interviews
with
clinician‐administrators
leading
initiatives
from
20
EDs
the
United
States
Canada.
Interviews
focused
on
experiences
planning
implementing
screening.
lasted
15
50
minutes
were
digitally
recorded
transcribed.
To
identify
factors
that
commonly
impacted
implementation
screening,
we
used
constructs
Consolidated
Framework
Implementation
Research
(CFIR),
an
Science
framework
widely
evaluate
healthcare
improvement
initiatives.
Results
Overall,
notable
facilitators
having
institutional
leadership
support
designated
clinical
champions
longitudinally
engage
educate
frontline
staff.
found
specific
examples
affecting
drawn
following
seven
CFIR
constructs:
(1)
intervention
complexity,
(2)
adaptability,
(3)
external
policies
incentives,
(4)
peer
pressure
other
institutions,
(5)
climate
ED,
(6)
knowledge
beliefs,
(7)
engaging
deliverers
intervention,
is,
Conclusion
Implementing
complex
requires
resources
as
well
a
sustained
fashion.
Journal of the American Geriatrics Society,
Journal Year:
2021,
Volume and Issue:
70(2), P. 341 - 351
Published: Nov. 19, 2021
Abstract
Background
Evaluating
older
adults
with
cognitive
dysfunction
in
emergency
departments
(EDs)
requires
obtaining
collateral
information
from
sources
other
than
the
patient.
Understanding
challenges
clinicians
face
can
inform
development
of
interventions
to
improve
geriatric
care
and,
more
specifically,
detection
ED
delirium.
The
objective
was
understand
clinicians'
experiences
on
dysfunction,
both
before
and
during
COVID‐19
pandemic.
Methods
From
February
May
2021,
we
conducted
semi‐structured
interviews
a
purposive
sample
22
physicians
advanced
practice
providers
two
urban
academic
hospitals
one
community
hospital
Northeast
United
States.
Interviews
lasted
10–20
min
were
digitally
recorded
transcribed.
Interview
transcripts
analyzed
for
dominant
themes
using
combined
deductive–inductive
approach.
Responses
regarding
pandemic
compared.
Results
Five
major
emerged
(1)
availability
caregivers,
(2)
reliability
sources,
(3)
language
barriers,
(4)
time
constraints,
(5)
incomplete
transfer
documentation.
Participants
perceived
all
challenges,
but
those
relating
documentation
amplified
by
Conclusion
Emergency
perspectives
efforts
support
caregiver
presence
at
bedside
develop
standardized
communication
tools
recognition
delirium
broadly,
care.
