Diagnosis and Risk Factors for Delirium in Elderly Patients in the Emergency Rooms and Intensive Care Unit of the National Geriatric Hospital Emergency Department: A Cross-Sectional Observational Study

Abstract

Nguyen Ngoc Tran,1 Thi Phuong Nam Hoang,2,3 Thi Kim Thanh Ho4 1Department of Psychiatry, Ha Noi Medical University, Ha Noi, VietNam; 2Department Geriatrics, Hanoi Medical University, Ha Noi, VietNam; 3National Geriatric Hospital, Ha Noi, VietNam; 4Department of Family Medicine, Ha Noi Medical University, Ha Noi, VietNamCorrespondence: Thi Phuong Nam HoangDepartment Geriatrics, Hanoi Medical University, Ha Noi, VietNamEmail [email protected]: To diagnose delirium and identify risk factors for its development in elderly patients in the emergency department (ED) and intensive care units (ICU) at the National Geriatric Hospital (Vietnam).Patients and Methods: A cross-sectional observational study was conducted with a convenience sample of non-surgical patients admitted to ED and ICU at Hanoi National Geriatric Hospital in Vietnam. In total, 163 patients met the selection criteria and were included in the study. Screening involved using the Confusion Assessment Method (CAM) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). The diagnosis was established according to the DSM-5 and ICD-10 codes.Results: Delirium was found in a total of 106 (63.1%) patients. The factors significantly affecting its development were vision impairment (OR, 3.3; 95% CI, 1.5 to 7.4, P=0.003), hearing impairment (OR, 3.6; 95% CI, 1.77 to 7.36, P=0.0001), acute or chronic kidney failure (OR, 7.1; 95% CI, 2.05 to 6.39, P< 0.001), respiratory disorders (OR, 2.7; 95% CI, 1.4 to 5.2, P=0.004), and malnutrition (OR, 9.17; 95% CI, 3.43– 24.5, P=0.0001). The list also include the fall risk factors (OR, 12.2; 95% CI, 4.1– 36.3, P=0.0001), frailty (OR, 8.35; 95% CI, 3.4– 20.6, P=0.0001), activities of daily living (OR, 8.35; 95% CI, 3.4– 20.6, P=0.0001), hyponatremia (OR, 2.48; 95% CI, 1.07 to 5.75, P=0.001), hypernatremia (OR, 13.1; 95% CI, 1.67 to 2.5, P=0.001), and treatment interventions. In addition, delirium was linked to the duration of ICU admission (OR, 6.53; 95% CI, 4.5– 25.5, P < 0.0001).Conclusion: The CAM/CAM-ICU diagnostic algorithm makes it possible to diagnose delirium successfully. The present study confirmed the role of several premorbid and triggering factors in the occurrence of delirium in elderly patients in ED and ICU. There is a need for further research into risk factors for delirium in elderly patients.Keywords: delirium, diagnosis, elderly adult patients, emergency department, risk factors

Keywords

• delirium
• diagnosis
• elderly adult patients
• emergency department
• risk factors