Delirium in the geriatric unit : proton-pump inhibitors and other risk factors

Abstract

Background: Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for imple- mentation of preventive strategies. Objective: Evaluate specific factors for development of delirium in a geriatric ward setting. Methods: Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men), admitted to the subacute geriatric ward of a mul- tiprofile university hospital after exclusion of 113 patients treated with antipsychotic medica- tion because of behavioral disorders before admission. Comprehensive geriatric assessments including a structured interview, physical examination, geriatric functional assessment, blood sampling, ECG, abdominal ultrasound, chest X-ray, Confusion Assessment Method for diag- nosis of delirium, Delirium-O-Meter to assess delirium severity, Richmond Agitation-Sedation Scale to assess sedation or agitation, visual analog scale and Doloplus-2 scale to assess pain level were performed. Results: Multivariate logistic regression analysis revealed five independent factors associated with development of delirium in geriatric inpatients: transfer between hospital wards (odds ratio [OR] =2.78; confidence interval [CI] =1.54–5.01; P=0.001), preexisting dementia (OR =2.29; CI =1.44–3.65; P,0.001), previous delirium incidents (OR =2.23; CI =1.47–3.38; P,0.001), previous fall incidents (OR =1.76; CI =1.17–2.64; P=0.006), and use of proton-pump inhibitors (OR =1.67; CI =1.11–2.53; P=0.014). Conclusion: Transfer between hospital wards, preexisting dementia, previous delirium inci- dents, previous fall incidents, and use of proton-pump inhibitors are predictive of development of delirium in the geriatric inpatient setting. Keywords: delirium, geriatric ward, comprehensive geriatric assessment, Confusion Assess- ment Method, Delirium-O-Meter, Richmond Agitation-Sedation Scale