Predictors of Delirium in Octogenarian Patients Hospitalized for a Hip Fracture
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed.; American Psychiatric Publishing: Washington, DC, USA, 2013. [Google Scholar]
- Girard, T.D.; Thompson, J.L.; Pandharipande, P.P.; Brummel, N.E.; Jackson, J.C.; Patel, M.B.; Hughes, C.G.; Chandrasekhar, R.; Pun, B.T.; Boehm, L.M.; et al. Clinical phenotypes of delirium during critical illness and severity of subsequent long-term cognitive impairment: A prospective cohort study. Lancet Respir. Med. 2018, 6, 213–222. [Google Scholar] [CrossRef]
- Hayhurs, C.J.; Alvis, B.D.; Girard, T.D. Delirium. Acute Brain Dysfunction in the Critically Ill. Delirium Definition and Subtypes, 1st ed.; Hughes, C.G., Pandharipande, P.P., Ely, E.W., Eds.; Springer International Publishing: Basel, Switzerland, 2020; Chapter 1; pp. 1–12. [Google Scholar]
- Lindroth, H.; Bratzke, L.; Purvis, S.; Brown, R.; Coburn, M.; Mrkobrada, M.; Chan, M.T.V.; Davis, D.H.J.; Pandharipande, P.; Carlsson, C.M.; et al. Systematic review of prediction models for delirium in the older adult inpatient. BMJ Open 2018, 8, e019223. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Inouye, S.K.; Westendorp, R.G.J.; Saczynski, J.S. Delirium in elderly people. Lancet 2014, 383, 911–922. [Google Scholar] [CrossRef] [Green Version]
- Rizk, P.; Morris, W.Z.; Oladeji, P.; Huo, M. Review of Postoperative Delirium in Geriatric Patients Undergoing Hip Surgery. Geriatr. Orthop. Surg. Rehabil. 2016, 7, 100–105. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Maldonado, J.R. Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure. Int. J. Geriatr. Psychiatry 2017, 33, 1428–1457. [Google Scholar] [CrossRef] [PubMed]
- Maldonado, J.R. Neuropathogenesis of Delirium: Review of Current Etiologic Theories and Common Pathways. Am. J. Geriatr. Psychiatry 2013, 21, 1190–1222. [Google Scholar] [CrossRef] [PubMed]
- Marcantonio, E.R. Delirium in Hospitalized Older Adults. N. Engl. J. Med. 2017, 377, 1456–1466. [Google Scholar] [CrossRef] [PubMed]
- Gutiérrez-Valencia, M.; Martínez-Velilla, N. Prevenciónfarmacológica del delirium: Un largo caminoporrecorrer. Rev. Esp. Geriatr. Gerontol. 2018, 53, 185–187. [Google Scholar]
- Dylan, F.; Byrne, G.; Mudge, A.M. Delirium risk in non-surgical patients: Systematic review of predictive tools. Arch. Gerontol. Geriatr. 2019, 83, 292–302. [Google Scholar] [CrossRef]
- Persico, I.; Cesari, M.; Morandi, A.; Haas, J.; Mazzola, P.; Zambon, A.; Annoni, G.; Bellelli, G. Frailty and Delirium in Older Adults: A Systematic Review and Meta-Analysis of the Literature. J. Am. Geriatr. Soc. 2018, 66, 2022–2030. [Google Scholar] [CrossRef]
- Marra, A.; Kotfis, K.; Hosie, A.; MacLullich, A.M.J.; Pandharipande, P.P.; Ely, E.W.; Pun, B.T. Delirium Monitoring: Yes or No? That Is The Question. Am. J. Crit. Care 2019, 28, 127–135. [Google Scholar] [CrossRef]
- Aldecoa, C.; Bettelli, G.; Bilotta, F.; Sanders, R.D.; Audisio, R.; Borozdina, A.; Cherubini, A.; Jones, C.; Kehlet, H.; MacLullich, A.; et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur. J. Anaesthesiol. 2017, 34, 192–214. [Google Scholar] [CrossRef] [PubMed]
- Inouye, S.K.; Van Dyck, C.H.; Alessi, C.A.; Balkin, S.; Siegal, A.P.; Horwitz, R.I. Clarifying Confusion: The Confusion Assessment Method. Ann. Intern. Med. 1990, 113, 941–948. [Google Scholar] [CrossRef] [PubMed]
- González-Montalvo, J.I.; Pérez, P.G.; Vega, A.M.; Alarcón, T.A.; De Linera, J.L.M.; Álvarez; Gil Garay, E.; Cimbrelo, E.G.; Biarge, J.A. The acute orthogeriatric unit. Assessment of its effect on the clinical course of patients with hip fractures and an estimate of its financial impact. Rev. Esp. Geriatr. Gerontol. 2011, 46, 193–199. (In Spanish) [Google Scholar] [CrossRef]
- Jiménez-Mola, S.; Calvo-Lobo, C.; Idoate-Gil, J.; Seco-Calvo, J. Functionality, comorbidity, complication & surgery of hip fracture in older adults by age distribution. Rev. Assoc. Med. Bras. 2018, 64, 420–427. [Google Scholar] [CrossRef] [PubMed]
- Fields, A.C.; Dieterich, J.D.; Buterbaugh, K.; Moucha, C.S. Short-term complications in hip fracture surgery using spinal versus general anaesthesia. Injury 2015, 46, 719–723. [Google Scholar] [CrossRef]
- Ahmed, S.; Leurent, B.; Sampson, E.L. Risk factors for incident delirium among older people in acute hospital medical units: A systematic review and meta-analysis. Age Ageing 2014, 43, 326–333. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- American Psychiatric Publishing. Textbook of Consultation-Liaison Psychiatry, 2nd ed.; American Psychiatric Publishing: Washington, DC, USA, 2002; pp. 259–274. [Google Scholar]
- Wang, Y.-Y.; Yue, J.-R.; Xie, D.-M.; Carter, P.; Li, Q.-L.; Gartaganis, S.L.; Chen, J.; Inouye, S.K. Effect of the Tailored, Family-Involved Hospital Elder Life Program on Postoperative Delirium and Function in Older Adults. JAMA Intern. Med. 2020, 180, 17. [Google Scholar] [CrossRef]
- Kotfis, K.; Szylińska, A.; Listewnik, M.; Strzelbicka, M.; Brykczyński, M.; Rotter, I.; Żukowski, M. Early delirium after cardiac surgery: An analysis of incidence and risk factors in elderly (≥ 65 years) and very elderly (≥ 80 years) patients. Clin. Interv. Aging 2018, 13, 1061–1070. [Google Scholar] [CrossRef] [Green Version]
- Oh, E.S.; Sieber, F.E.; Leoutsakos, J.M.; Inouye, S.K.; Lee, H.B. Sex Differences in Hip Fracture Surgery: Preoperative Risk Factors for Delirium and Postoperative Outcomes. J. Am. Geriatr. Soc. 2016, 64, 1616–1621. [Google Scholar] [CrossRef] [Green Version]
- Young, J.; Inouye, S.K. Delirium in older people. BMJ 2007, 334, 842–846. [Google Scholar] [CrossRef] [PubMed]
- Mulkey, M.A.; Hardin, S.R.; Olson, D.M.; Munro, C.L. Pathophysiology Review. Clin. Nurse Spéc. 2018, 32, 195–211. [Google Scholar] [CrossRef] [PubMed]
- Díez-Manglano, J.; Palazón-Fraile, C.; Diez-Massó, F.; Martínez-Álvarez, R.; Del Corral-Beamonte, E.; Carreño-Borrego, P.; Pueyo-Tejedor, P.; Gomes-Martín, J. Factors Associated With Onset of Delirium Among Internal Medicine Inpatients in Spain. Nurs. Res. 2013, 62, 445–449. [Google Scholar] [CrossRef] [PubMed]
- Thein, M.Z.A.; Pereira, J.V.; Nitchingham, A.; Caplan, G.A. A call to action for delirium research: Meta-analysis and regression of delirium associated mortality. BMC Geriatr. 2020, 20, 1–12. [Google Scholar] [CrossRef]
- Heidari, M.E.; Irvani, S.S.N.; Dalvand, P.; Khadem, M.; Eskandari, F.; Torabi, F.; Shahsavari, H. Prevalence of depression in elderly hip fracture: A systematic review and meta-analysis. Int. J. Orthop. Trauma Nurs. 2020, 100813, 100813. [Google Scholar] [CrossRef]
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Factor | Description of Patients with Delirium | Contrast Test | R2 | Univariate Logistic Regression | |||||
---|---|---|---|---|---|---|---|---|---|
Valor | p | OR | 95% CI | Wald | p | R2 | |||
BARTHEL | |||||||||
Total dependency | 47.8% (11) | 3.19 NS | 0.363 | 0.011 | 2.10 | 0.88/5.00 | 2.78 † | 0.096 | 0.015 |
Severe dependency | 37.1% (13) | 1.35 | 0.64/2.85 | 0.62 NS | 0.430 | -- | |||
Moderate dependency | 31.8% (7) | 1.07 | 0.42/2.74 | 0.02 NS | 0.893 | -- | |||
Slight dependency | 30.4% (63) | 1 | -- | -- | -- | -- | |||
Independent | 31.4% (83) | 1 | -- | -- | -- | -- | |||
DEAMBULATION | |||||||||
Does not walk | 50.0% (7) | 2.92 NS | 0.403 | 0.010 | 2.10 | 0.70/6.27 | 1.78 NS | 0.183 | 0.014 |
Needs a lot of help | 39.1% (9) | Ht | 1.35 | 0.55/3.30 | 0.44 NS | 0.509 | -- | ||
Walker/two canes | 28.4% (19) | 1.20 | 0.65/2.22 | 0.34 NS | 0.558 | -- | |||
Independent/one cane | 32.2% (59) | 1 | -- | -- | -- | -- | |||
Does not walk/A lot of help | 43.2% (16) | 2.12 NS | 0.145 | 0.007 | 1.68 | 0.83/3.39 | 2.09 NS | 0.148 | 0.010 |
Walker/Independent | 31.2% (78) | 1 | -- | -- | -- | -- | |||
Walker/Independent | 50.0% (7) | 1.99 NS | 0.159 | 0.007 | 2.14 | 0.73/6.28 | 1.91 NS | 0.167 | 0.009 |
Does walk (with help) | 31.9% (87) | 1 | -- | -- | -- | -- | |||
PLACE OF RESIDENCE | |||||||||
Nursing home | 37.3% (31) | 1.25 NS | 0.535 | 0.004 | 1.40 | 0.77/2.55 | 1.23 NS | 0.268 | 0.006 |
Lives with family | 32.2% (29) | 1.12 | 0.62/2.03 | 0.14 NS | 0.713 | -- | |||
Lives alone | 29.8% (34) | 1 | -- | -- | -- | -- | |||
COGNITIVE DETERIORATION | |||||||||
Severe | 7.1% (1) | 26.44 ** | 0.000 | 0.092 | 0.23 | 0.03/1.81 | 1.96 NS | 0.162 | 0.123 |
Moderate | 57.8% (37) | 4.08 | 2.20/7.56 | 19.89 ** | 0.000 | ||||
Mild | 31.0% (18) | 1.34 | 0.69/2.61 | 0.73 NS | 0.392 | ||||
No deterioration | 25.2% (38) | 1 | -- | -- | -- | -- | |||
Slight/no deterioration | 26.8% (56) | 1 | -- | -- | -- | -- |
Factor | Description of Patients with Delirium | Contrast Test | R2 | Univariate Logistic Regression | |||||
---|---|---|---|---|---|---|---|---|---|
Valor | p | OR | 95% CI | Wald | p | R2 | |||
CARDIOPATHY | |||||||||
Yes | 32.1% (67) | 0.17 NS | 0.681 | 0.001 | 0.89 | 0.51/1.54 | 0.17 NS | 0.681 | 0.001 |
No | 34.6% (27) | 1 | -- | -- | -- | -- | |||
HIGH BLOOD PRESSURE (HBP) | |||||||||
Yes | 30.5% (61) | 1.52 NS | 0.218 | 0.005 | 0.72 | 0.42/1.22 | 1.51 NS | 0.218 | 0.007 |
No | 37.9% (33) | 1 | -- | -- | -- | -- | |||
DEPRESSION | |||||||||
Yes | 35.5% (33) | 0.47 NS | 0.495 | 0.002 | 1.20 | 0.71/2.02 | 0.47 NS | 0.495 | 0.002 |
No | 31.4% (61) | 1 | -- | -- | -- | -- | |||
DEMENTIA | |||||||||
Yes | 46.7% (35) | 8.92** | 0.003 | 0.031 | 2.27 | 1.32/3.91 | 8.71** | 0.003 | 0.041 |
No | 27.8% (59) | 1 | -- | -- | -- | -- | |||
ATRIAL FIBRILLATION | |||||||||
Yes | 35.3% (24) | 0.26 NS | 0.609 | 0.001 | 1.16 | 0.66/2.06 | 0.26 NS | 0.609 | 0.001 |
No | 32.0% (70) | 1 | -- | -- | -- | -- | |||
ARTHROSIS | |||||||||
Yes | 29.9% (20) | 0.33 NS | 0.563 | 0.001 | 0.84 | 0.46/1.52 | 0.33 NS | 0.563 | 0.002 |
No | 33.6% (74) | 1 | -- | -- | -- | -- | |||
DIABETES | |||||||||
Yes | 31.8% (21) | 0.03 NS | 0.854 | 0.000 | 0.95 | 0.52/1.70 | 0.03 NS | 0.854 | 0.000 |
No | 33.0% (73) | 1 | -- | -- | -- | -- | |||
CHANGES IN VISION | |||||||||
Yes | 44.8% (26) | 4.81 * | 0.028 | 0.017 | 1.92 | 1.07/3.47 | 4.72 * | 0.030 | 0.022 |
No | 29.7% (68) | 1 | -- | -- | -- | -- | |||
TYPE OF TREATMENT | |||||||||
Bipolar partial prostheses | 37.0% (27) | 3.28 NS | 0.512 | 0.012 | 1.37 | 0.75/2.49 | 1.07 NS | 0.302 | 0.017 |
Total prosthesis | 50.0% (8) | 2.33 | 0.82/6.63 | 2.53 NS | 0.112 | ||||
Monopolar prosthesis | 33.3% (7) | 1.17 | 0.44/3.10 | 0.10 NS | 0.757 | ||||
Screws | 28.6% (4) | 0.93 | 0.28/3.14 | 0.01 NS | 0.911 | ||||
Nails | 30.0% (42) | 1 | -- | -- | -- | -- | |||
EMERGENCY SURGERY | |||||||||
Yes | 34.4% (88) | 2.83 † | 0.092 | 0.008 | 2.18 | 0.86/5.52 | 2.72 † | 0.099 | 0.015 |
No | 19.4% (6) | ||||||||
AMERICAN SOCIETY OF ANESTHESIOLOGISTS(ASA) | |||||||||
3–4 | 36.3% (77) | 4.69 * | 0.030 | 0.016 | 1.95 | 1.06/3.58 | 4.60 * | 0.032 | 0.024 |
1–2 | 22.7% (17) | ||||||||
ANESTHESIA | |||||||||
Spinal | 33.8% (78) | 0.16 NS | 0.693 | 0.001 | 1.17 | 0.53/2.59 | 0.16 NS | 0.693 | 0.001 |
General | 30.3% (10) |
Factor | Description of Patients with Delirium | Contrast Test | R2 | Univariate Logistic Regression | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Valor | p | OR | 95% CI | Wald | p | R2 | ||||
ANEMIA | ||||||||||
Yes | 30.5% (76) | 4.25 * | 0.039 | 0.015 | 0.48 | 0.24/0.98 | 4.13 * | 0.042 | 0.020 | |
No | 47.4% (18) | 1 | -- | -- | -- | -- | ||||
TRANSFUSION | ||||||||||
Yes | 29.4% (32) | 0.94 NS | 0.338 | 0.003 | 0.78 | 0.46/1.30 | 0.92 NS | 0.338 | 0.004 | |
No | 34.8% (62) | 1 | -- | -- | -- | -- | ||||
CONSTIPATION | ||||||||||
Yes | 37.3% (28) | 0.97 NS | 0.325 | 0.003 | 1.32 | 0.76/2.29 | 0.96 NS | 0.326 | 0.005 | |
No | 31.1% (66) | 1 | -- | -- | -- | -- | ||||
RESPIRATION | ||||||||||
Yes | 40.4% (19) | 1.50 NS | 0.220 | 0.005 | 1.49 | 0.78/2.84 | 1.49 NS | 0.222 | 0.007 | |
No | 31.3% (75) | 1 | -- | -- | -- | -- | ||||
ALT. RENAL FUNCTION | ||||||||||
Yes | 40.9% (18) | 1.57 NS | 0.210 | 0.005 | 1.52 | 0.79/2.94 | 1.56 NS | 0.212 | 0.007 | |
No | 31.3% (78) | 1 | -- | -- | -- | -- | ||||
URINARY TRACT INFECTION (UTI) | ||||||||||
Yes | 63.4% (26) | 20.42 ** | 0.000 | 0.071 | 4.54 | 2.27/9.08 | 18.23 ** | 0.000 | 0.090 | |
No | 27.6% (68) | 1 | -- | -- | -- | -- | ||||
MALNUTRITION | ||||||||||
Yes | 32.4% (12) | 0.00 NS | 0.965 | 0.000 | 0.98 | 0.47/2.06 | 0.02 NS | 0.965 | 0.000 | |
No | 32.8% (82) | 1 | -- | -- | -- | -- | ||||
RENAL ARTERIAL OCCLUSION (RAO) | ||||||||||
Yes | 58.1% (18) | 10.11 ** | 0.001 | 0.035 | 3.28 | 1.53/7.03 | 9.33 ** | 0.002 | 0.045 | |
No | 29.7% (76) | 1 | -- | -- | -- | -- | ||||
CHRONIC HEART FAILURE (CHF) | ||||||||||
Yes | 44.8% (13) | 2.14 NS | 0.144 | 0.007 | 1.78 | 0.82/3.86 | 2.09 NS | 0.148 | 0.010 | |
No | 31.4% (81) | 1 | -- | -- | -- | -- | ||||
ISCHEMIC CARDIOPATHY | ||||||||||
Yes | 25.0% (7) | 0.85 NS | .357 | 0.003 | 0.66 | 0.27/1.61 | 0.84 NS | 0.360 | 0.004 | |
No | 33.6% (87) | 1 | -- | -- | -- | -- |
B | Wald | p | R2 Partial | R2 Accumulated | OR | 95% CI the OR | |
---|---|---|---|---|---|---|---|
Moderate cognitive impairment | 1.35 | 17.47 ** | 0.000 | 0.098 | 0.098 | 3.85 | 2.05/7.25 |
Urinary tract infection | 1.34 | 12.05 ** | 0.001 | 0.066 | 0.164 | 3.82 | 1.79/8.16 |
Changes in vision | 0.74 | 5.03 * | 0.025 | 0.019 | 0.185 | 2.09 | 1.10/4.00 |
Emergency intervention | 1.18 | 4.62 * | 0.032 | 0.024 | 0.209 | 3.25 | 1.11/9.51 |
Number of drugs | −0.18 | 9.29 ** | 0.002 | 0.022 | 0.237 | 0.84 | 0.75/0.94 |
Factor | Description of Patients with Delirium | Contrast Test | R2 | Univariate Logistic Regression | |||||
---|---|---|---|---|---|---|---|---|---|
Valor | p | OR | 95% CI | Wald | p | R2 | |||
ANTIHYPERTENSIVE | |||||||||
Yes | 29.8% (62) | 2.55 NS | 0.110 | 0.009 | 0.64 | 0.37/1.11 | 2.53 NS | 0.111 | 0.012 |
No | 39.7% (31) | 1 | -- | -- | -- | -- | |||
BENZODIAZEPINES | |||||||||
Yes | 32.5% (38) | 0.00 NS | 0.991 | 0.000 | 1 | 0.60/1.65 | 0.00 NS | 0.991 | 0.000 |
No | 32.5% (55) | 1 | -- | -- | -- | -- | |||
ANTIDEPRESSANT | |||||||||
Yes | 33.3% (33) | 0.02 NS | 0.879 | 0.000 | 1.04 | 0.62/1.75 | 0.02 NS | 0.879 | 0.000 |
No | 32.4% (61) | 1 | -- | -- | -- | -- | |||
PROTON PUMP INHIBITORS | |||||||||
Yes | 37.9% (33) | 1.45 NS | 0.228 | 0.005 | 1.38 | 0.82/2.34 | 1.45 NS | 0.229 | 0.007 |
No | 30.7% (61) | 1 | -- | -- | -- | -- | |||
ANTIAGREGANTS | |||||||||
Yes | 29.2% (21) | 0.56 NS | 0.454 | 0.002 | 0.80 | 0.45/1.43 | 0.56 NS | 0.454 | 0.003 |
No | 34.0% (73) | 1 | -- | -- | -- | -- | |||
ANTICOAGULANTS | |||||||||
Yes | 34.4% (22) | 0.10 NS | 0.754 | 0.000 | 1.10 | 0.61/1.98 | 0.10 NS | 0.754 | 0.000 |
No | 32.3% (72) | 1 | -- | -- | -- | -- | |||
ORAL ANTIDIABETICS | |||||||||
Yes | 28.3% (15) | 0.58 NS | 0.445 | 0.002 | 0.77 | 0.40/1.49 | 0.58 NS | 0.445 | 0.003 |
No | 33.8% (79) | 1 | -- | -- | -- | -- | |||
ANALGESIA | |||||||||
Yes | 30.6% (159 | 0.12 NS | 0.726 | 0.000 | 0.89 | 0.46/1.73 | 0.12 NS | 0.726 | 0.02 |
No | 33.2% (79) | 1 | -- | -- | -- | -- |
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Plaza-Carmona, M.; Requena-Hernández, C.; Jiménez-Mola, S. Predictors of Delirium in Octogenarian Patients Hospitalized for a Hip Fracture. Int. J. Environ. Res. Public Health 2020, 17, 7467. https://doi.org/10.3390/ijerph17207467
Plaza-Carmona M, Requena-Hernández C, Jiménez-Mola S. Predictors of Delirium in Octogenarian Patients Hospitalized for a Hip Fracture. International Journal of Environmental Research and Public Health. 2020; 17(20):7467. https://doi.org/10.3390/ijerph17207467
Chicago/Turabian StylePlaza-Carmona, María, Carmen Requena-Hernández, and Sonia Jiménez-Mola. 2020. "Predictors of Delirium in Octogenarian Patients Hospitalized for a Hip Fracture" International Journal of Environmental Research and Public Health 17, no. 20: 7467. https://doi.org/10.3390/ijerph17207467