This was a cross-sectional study to investigate predisposing factors associated with delirium among demented long-term-care residents and to assess the cumulative effect of these factors on the likelihood of having delirium. Of the 155 participants, 109 (70.3%) were found delirious according to the confusion assessment method. Among these individuals, age (OR = 1.07; 95% CI = 1.05-1.10) and severity of dementia (OR = 1.05; 95% CI = 1.03-1.07) were the most associated factors of delirium. The likelihood of being in delirium increased with the number of associated predisposing factors present (OR = 1.67; 95% CI = 1.11-2.51). Associated factors identified were level of functional autonomy, pain, depression, behavioral disturbances, number of medications, dehydration, fever, and malnutrition. Identification of predisposing factors will help nurses in detecting those residents in long-term care settings who are at high-risk for delirium, as well as in designing preventive intervention strategies for delirium, based on these factors.
Alexopoulos, G.S., Abrams, R.C., Young, R.C., & Shamoian, C.A. (1988). Cornell Scale for depression in dementia. Biological psychiatry, 23, 271-284.
2.
Ballard, C., O'Brien, J., Gray, A., Cormack, F., Ayre, G., Rowan, E., et al. (2001). Attention and fluctuating attention in patients with dementia with Lewy bodies and Alzheimer disease. Archives of Neurology, 58, 977-982.
3.
Bastien, C.H., Vallieres, A., & Morin, C.M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2, 297-307.
4.
Bentley, D.W., Bradley, S., High, K., Schoenbaum, S., Taler, G., & Yoshikawa, T.T. (2000). Practice guideline for evaluation of fever and infection in long-term care facilities. Clinical Infectious Diseases, 31, 640-653.
5.
Bickel, H. (1996). The Hierarchic Dementia Scale: Usage. International Psychogeriatrics/ IPA, 8, 213-224.
6.
Cacchione, P.Z., Culp, K., Dyck, M.J., & Laing, J. (2003). Risk for acute confusion in sensory-impaired, rural, long-term-care elders. Clinical Nursing Research, 12, 340-355.
7.
Cacchione, P.Z., Culp, K., Laing, J., & Tripp-Reimer, T. (2003). Clinical profile of acute confusion in the long-term care setting. Clinical Nursing Research, 12, 145-158.
8.
Camus, V., Schmitt, L., Ousset, P.J., & Micas, M. (1995). Depression and dementia: Contribution to the French validation of 2 depression scales: The Cornell Scale for Depression in Dementia and the Dementia Mood Assessment Scale. Encephale, 21, 201-208.
9.
Charlson, M.E., Pompei, P., Ales, K.L., & MacKenzie, C.R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation . Journal of Chronic Diseases, 40, 373-383.
10.
Cole, M.G., & Dastoor, D.P. (1987). A new hierarchic approach to the measurement of dementia. Accurate results within 15 to 30 minutes. Psychosomatics , 28, 298-301, 304.
11.
Collins, M.J., & Bakheit, A.M. (1997). Does pulse oximetry reliably detect aspiration in dysphagic stroke patients? Stroke: A Journal of Cerebral Circulation, 28, 1773-1775.
12.
Culp, K., Tripp-Reimer, T., Wadle, K., Wakefield, B., Akins, J., Mobily, P., et al. (1997). Screening for acute confusion in elderly long-term care residents. Journal of Neuroscience Nursing , 29(2), 86-88, 95-100.
13.
Davis, K.L., Mohs, R.C., Marin, D., Purohit, D.P., Perl, D.P., Lantz, M., et al. (1999). Cholinergic markers in elderly patients with early signs of Alzheimer disease. Journal of the American Medical Association, 281, 1401-1406.
14.
Demonet, J.F., Doyon, B., Ousset, P.J., Puel, M., Mahagne, M.H., Cardebat, D., et al. (1990). Standardization of a modular and hierarchic cognitive evaluation scale applicable to dementia. A French version of the Hierarchic Dementia Scale. Revue Neurologique, 146, 490-501.
15.
Desrosiers, J., Bravo, G., Hebert, R., & Dubuc, N. (1995). Reliability of the revised functional autonomy measurement system (SMAF) for epidemiological research. Age and Ageing, 24, 402-406.
16.
Fick, D.M., Agostini, J.V., & Inouye, S.K. (2002). Delirium superimposed on dementia: A systematic review. Journal of the American Geriatrics Society, 50, 1723-1732.
17.
Firth, D. (1993). Bias reduction of Maximum Likelihood Estimates . Biometrika, 80(1), 27-38.
18.
Francis, J., Martin, D., & Kapoor, W.N. (1990). A prospective study of delirium in hospitalized elderly. Journal of the American Medical Association, 263, 1097-1101.
19.
Guigoz, Y., & Vellas, B.J. (1997). Malnutrition in the elderly: The Mini Nutritional Assessment (MNA). Therapeutische Umschau, 54, 345-350.
20.
Hadjistavropoulos, T., Voyer, P., Sharpe, D., Verreault, R., & Aubin, M. (2008). Assessing pain in dementia patients with comorbid delirium and/or depression. Pain Management Nursing, 9(2), 48-54.
21.
Hebert, R., Carrier, R., & Bilodeau, A. (1988). The Functional Autonomy Measurement System (SMAF): Description and validation of an instrument for the measurement of handicaps . Age and Ageing, 17, 293-302.
22.
Inouye, S.K., & Charpentier, P.A. (1996). Precipitating factors for delirium in hospitalized elderly persons: Predictive model and interrelationship with baseline vulnerability. Journal of the American Medical Association, 275, 852-857.
23.
Inouye, S.K., Rushing, J.T., Foreman, M.D., Palmer, R.M., & Pompei, P. (1998). Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. Journal of General Internal Medicine, 13, 234-242.
24.
Inouye, S.K., van Dyck, C.H., Alessi, C.A., Balkin, S., Siegal, A.P., & Horwitz, R.I. (1990). Clarifying confusion: The confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine, 113, 941-948.
25.
Inouye, S.K., Viscoli, C.M., Horwitz, R.I., Hurst, L.D., & Tinetti, M.E. (1993). A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Annals of Internal Medicine, 119, 474-481.
26.
Kalisvaart, K.J., Vreeswijk, R., de Jonghe, J.F., van der Ploeg, T., van Gool, W.A., & Eikelenboom, P. (2006). Risk factors and prediction of postoperative delirium in elderly hip-surgery patients: Implementation and validation of a medical risk factor model. Journal of the American Geriatrics Society, 54, 817-822.
27.
Korevaar, J.C., van Munster, B.C., & de Rooij, S.E. (2005). Risk factors for delirium in acutely admitted elderly patients: A prospective cohort study. BMC Geriatrics, 5, 6.
28.
Korner, A., Lauritzen, L., Abelskov, K., Gulmann, N., Marie Brodersen, A., Wedervang-Jensen, T., et al. (2006). The Geriatric Depression Scale and the Cornell Scale for Depression in Dementia: A validity study. Nordic Journal of Psychiatry, 60, 360-364.
29.
Lemiengre, J., Nelis, T., Joosten, E., Braes, T., Foreman, M., Gastmans, C., et al. (2006). Detection of delirium by bedside nurses using the confusion assessment method. Journal of the American Geriatrics Society, 54, 685-689.
30.
Leslie, D.L., Marcantonio, E.R., Zhang, Y., Leo-Summers, L., & Inouye, S.K. (2008). One-year health care costs associated with delirium in the elderly population. Archives of Internal Medicine, 168(1), 27-32.
31.
Marcantonio, E.R., Kiely, D.K., Simon, S.E., John Orav, E., Jones, R.N., Murphy, K.M., et al. (2005). Outcomes of older people admitted to postacute facilities with delirium. Journal of the American Geriatrics Society, 53, 963-969.
32.
McAvay, G.J., Van Ness, P.H., Bogardus, S.T., Jr. , Zhang, Y., Leslie, D.L., Leo-Summers , L.S., et al. (2006). Older adults discharged from the hospital with delirium: 1-year outcomes. Journal of the American Geriatrics Society, 54, 1245-1250.
33.
McAvay, G.J., Van Ness, P.H., Bogardus, S.T., Jr. , Zhang, Y., Leslie, D.L., Leo-Summers , L.S., et al. (2007). Depressive symptoms and the risk of incident delirium in older hospitalized adults. Journal of the American Geriatrics Society, 55, 684-691.
34.
Mentes, J. (2006). Oral hydration in older adults: Greater awareness is needed in preventing, recognizing, and treating dehydration. American Journal of Nursing, 106(6), 40-49.
35.
Mentes, J., Culp, K., Maas, M., & Rantz, M. (1999). Acute confusion indicators: Risk factors and prevalence using MDS data. Research in Nursing & Health, 22(2), 95-105.
36.
Norkiene, I., Ringaitiene, D., Misiuriene, I., Samalavicius, R., Bubulis, R., Baublys, A., et al. (2007). Incidence and precipitating factors of delirium after coronary artery bypass grafting. Scandinavian Cardiovascular Journal, 41, 180-185.
37.
Parrott, A.C. (1989). Transdermal scopolamine: A review of its effects upon motion sickness, psychological performance, and physiological functioning . Aviation, Space, and Environmental Medicine, 60(1), 1-9.
38.
Pisani, M.A., Murphy, T.E., Van Ness, P.H., Araujo, K.L., & Inouye, S.K. (2007). Characteristics associated with delirium in older patients in a medical intensive care unit. Archives of Internal Medicine, 167, 1629-1634.
39.
Ray, W.A., Taylor, J.A., Lichtenstein, M.J., & Meador, K.G. (1992). The Nursing Home Behavior Problem Scale. Journal of Gerontology, 47(1), M9-16.
40.
Robertsson, B., Blennow, K., Gottfries, C.G., & Wallin, A. (1998). Delirium in dementia. International Journal of Geriatric Psychiatry, 13(1), 49-56.
41.
Schor, J.D., Levkoff, S.E., Lipsitz, L.A., Reilly, C.H., Cleary, P.D., Rowe, J.W., et al. (1992). Risk factors for delirium in hospitalized elderly. Journal of the American Medical Association, 267, 827-831.
42.
Schuurmans, M.J., Duursma, S.A., Shortridge-Baggett, L.M., Clevers, G.J., & Pel-Littel, R. (2003). Elderly patients with a hip fracture: The risk for delirium. Applied Nursing Research , 16(2), 75-84.
43.
Shapiro, S.E., Rosenfeld, A.G., Daya, M., Larson, J.L., & McCauley, L.A. (2005). Determining severe respiratory distress in older out-of-hospital patients. Prehospital Emergency Care, 9, 310-317.
44.
Voyer, P., Cole, M.G., McCusker, J., & Belzile, E. (2005). Characteristics of institutionalized older patients with delirium newly admitted to an acute care hospital. Clinical Effectiveness in Nursing, 9, 13-25.
45.
Wary, B., & Doloplus, C. (1999). Doloplus-2, a scale for pain measurement. Soins, 19, 25-27.
46.
Wei, L.A., Fearing, M.A., Sternberg, E.J., & Inouye, S.K. (2008). The confusion assessment method: A systematic review of current usage. Journal of the American Geriatrics Society, 56, 823-830.
47.
Zwakhalen, S.M., Hamers, J.P., & Berger, M.P. (2006). The psychometric quality and clinical usefulness of three pain assessment tools for elderly people with dementia. Pain, 126, 210-220.
