Effects of a Medication Review on Delirium in Older Hospitalised Patients: A Comparative Retrospective Cohort Study
Tóm tắt
Delirium in older hospitalised patients is a common and serious disorder. Polypharmacy and certain medications are risk factors for developing delirium. A medication review could benefit older hospitalised patients with delirium. (1) Evaluate the effects of medication review on length of delirium, length of hospital stay, mortality, and discharge destination; and (2) describe and analyse the proposed changes to medication and its implementation by the treating physician. The study was conducted at Maastricht University Medical Centre+. We compared two cohorts of older patients with delirium: the first cohort from before introducing the medication review, and a second cohort 5 months after introduction of the medication review. Data were extracted from the patients’ digital medical records. A significant interaction effect of cohort and number of medications taken by the patient was found for duration of delirium: patients from the second cohort taking between zero and six medications had significantly shorter delirious episodes than patients in the first cohort. This effect bordered on significance for patients taking between seven and 11 medications, but disappeared for patients taking 12 or more medications. No other statistically significant differences were found between the cohorts. The proposed changes in medication were implemented for 71% of the patients. A medication review seems to significantly decrease the length of an older patient’s delirious episode. Given the clinical relevance of these findings, we advise medication reviews for all older patients who are delirious or are at risk of developing delirium.
Tài liệu tham khảo
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000.
Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–22.
Davis DH, Muniz Terrera G, Keage H, Rahkonen T, Oinas M, Matthews FE, et al. Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain. 2012;135(Pt 9):2809–16.
Krogseth M, Watne LO, Juliebo V, Skovlund E, Engedal K, Frihagen F, et al. Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients. Arch Gerontol Geriatr. 2016;64:38–44.
Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304(4):443–51.
Bail K, Goss J, Draper B, Berry H, Karmel R, Gibson D. The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study. BMC Health Serv Res. 2015;15:91. https://doi.org/10.1186/s12913-015-0743-1.
Leslie DL, Inouye SK. The importance of delirium: economic and societal costs. J Am Geriatr Soc. 2011;59(Suppl 2):S241–3.
Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008;168(1):27–32.
Weinrebe W, Johannsdottir E, Karaman M, Fusgen I. What does delirium cost? An economic evaluation of hyperactive delirium. Z Gerontol Geriatr. 2015. https://doi.org/10.1007/s00391-015-0871-6.
Inouye SK, Bogardus ST, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340(9):669–76.
Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001;49(5):516–22.
Bjorkelund KB, Hommel A, Thorngren KG, Gustafson L, Larsson S, Lundberg D. Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study. Acta Anaesthesiol Scand. 2010;54(6):678–88.
Inouye S, Robinson T, Blaum C. Postoperative delirium in older adults: best practice statement from the American Geriatrics Society. J Am Coll Surg. 2015;220(2):136–48.
Milisen K, Foreman MD, Abraham IL, De Geest S, Godderis J, Vandermeulen E, et al. A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients. J Am Geriatr Soc. 2001;49(5):523–32.
Rizk P, Morris W, Oladeji P, Huo M. Review of postoperative delirium in geriatric patients undergoing hip surgery. Geriatr Orthop Surg Rehab. 2016;7(2):100–5.
Vidan M, Serra JA, Moreno C, Riquelme G, Ortiz J. Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc. 2005;53(9):1476–82.
Ahmed S, Leurent B, Sampson EL. Risk factors for incident delirium among older people in acute hospital medical units: a systematic review and meta-analysis. Age Ageing. 2014;43:1–8. https://doi.org/10.1093/ageing/afu022.
Warnier R, van Rossum E, van Leendert J, Pijls N, Mulder W, Schols J, et al. Screening for frailty in hospitalized older adults: reliability and feasibility of the Maastricht Frailty Screening Tool for Hospitalized Patients (MFST-HP). Res Gerontol Nurs. 2016;9(5):243–51.
Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharm Ther. 2008;46(2):72–83.
Schuurmans MJ, Shortridge-Baggett LM, Duursma SA. The Delirium Observation Screening Scale: a screening instrument for delirium. Res Theory Nurs Pract. 2003;17(1):31–50.
Dasgupta M, Hillier LM. Factors associated with prolonged delirium: a systematic review. Int Psychogeriatr. 2010;22(3):373–94.
Kiely DK, Jones RN, Bergmann MA, Murphy KM, Orav EJ, Marcantonio ER. Association between delirium resolution and functional recovery among newly admitted postacute facility patients. J Gerontol A Biol Sci Med Sci. 2006;61(2):204–8.
Speciale S, Bellelli G, Lucchi E, Trabucchi M. Delirium and functional recovery in elderly patients. J Gerontol A Biol Sci Med Sci. 2007;62(1):107–8 (author reply 8).
Mc Donnell S, Timmins F. A quantitative exploration of the subjective burden experienced by nurses when caring for patients with delirium. J Clin Nurs. 2012;21(17–18):2488–98.
Day J, Higgins I, Keatinge D. Orientation strategies during delirium: are they helpful? J Clin Nurs. 2011;20(23–24):3285–94.