109THE ROLE OF THE NURSE IN THE ASSESSMENT OF DELIRIUM IN OLDER PEOPLE IN AN ACUTE HOSPITAL SETTING: A SCOPING REVIEW

Abstract

Introduction: Delirium is a serious multifactorial syndrome causing acute brain dysfunction common in older adults admitted to hospital. This is associated with negative outcomes including significantly higher mortality rates, increased length of hospital stay and discharge to institutions. Early detection and assessment is vital to managing delirium and limiting associated negative effects. Nurses are at the centre of delirium management due to their close contact with patients. In order to understand the challenges for nurses in assessing delirium in older people we undertook a scoping review. Methods: The framework for scoping reviews described by Arksey H and O'Malley L (International Journal of Social Research Methodology, 2005, 8, 19-32) was followed. Electronic databases Cinahl, Embase, MEDLINE, BNI and PsycINFO were searched systematically. Studies were included if they focused on older people >65 years, were based in acute medical departments, focused only on nursing assessment of delirium. We limited our search to the last 10 years and English language due to time and resources. Results: 262 articles were retrieved from the search. 116 titles and abstracts were screened by KW and confirmed with SC. 38 full text articles were assessed for eligibility. 30 articles were included in the review. Ten of these were clinical/research studies; the remainder were research/opinion pieces. Some of the main barriers to role of nurse in assessment of delirium are 1. Lack of knowledge; 2. The heterogeneous presentation of the condition; 3. Hypoactive delirium is particularly difficult to detect; 4. Difficulties in differentiating delirium from dementia and depression; 5. Lack of a baseline cognitive assessment to measure change. Conclusions: Key recommendations are education of nurses, providing them with the correct language to communicate behavioural and cognitive changes observed in their patient could facilitate effective assessment. These observations should be guided by a delirium assessment protocol which incorporates screening for high risk patients at the point where they present to acute hospital.