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This cross-sectional study ( N = 155) investigated precipitating factors associated with delirium among long-term-care residents with dementia and assessed their cumulative effect on the likelihood of having delirium. Use of physical restraints (odds ratio [OR] = 4.64, 95% confidence interval [CI] = 2.61–8.27) was the factor most associated, and the likelihood of being in delirium increased with the number of associated precipitating factors present (OR = 2.53, 95% CI=1.42–4.49). Given their frailty, only a few precipitating factors need be present to increase the likelihood of these residents being in delirium, hence the need for increased nurse awareness of the risks posed by use of physical restraints with respect to the cognitive function of elderly residents with dementia.

Delirium is a common cause of functional and cognitive decline, morbidity, and mortality among hospitalized elderly individuals. Several studies reveal that the prognosis of delirium is worse among elderly individuals with severe delirium. In light of these findings, it is important to identify which factors are associated with delirium severity: individual (predisposing) or environmental (precipitating) factors. This study wanted to investigate individual and environmental factors associated with delirium severity among older persons with delirium superimposed on dementia. This study is a secondary analysis of a cross-sectional study (N = 71) on delirium carried out in three long-term care facilities and one long-term care unit of a large regional hospital. Of the 29 potential risk factors considered, researchers found 6 to be significantly associated with delirium severity in univariate analysis: marital status (being married), severity of dementia, lower functional autonomy, less medication consumption, presence of behavioral problems, and inadequacy of the physical environment. In multivariate analysis, only marital status (being married) and severity of dementia remained statistically associated with delirium severity. Results of this study provide further evidence that the weakened brain functions of persons with dementia increases not only the risk of delirium but also its severity. Given the poor outcomes associated with delirium severity, nurses need to pay closer attention to the predisposing and precipitating factors of delirium severity.

The multifactorial model of delirium was developed to explain the interrelationship between predisposing and precipitating factors for delirium. Although validated among hospitalized patients, this model has never been tested among long-term care residents with dementia. We undertook this secondary data analysis to investigate the combined effect of predisposing and precipitating factors on the likelihood of having delirium among this population. Delirium was defined as meeting the Confusion Assessment Method criteria for definite or probable delirium. Risk factors considered in the study were those found significantly associated with delirium in the original study. Participants (N=155) were classified into risk groups. Prevalence of delirium for the low, moderate, and high predisposing risk groups were 32%, 78.4%, and 98.1%, respectively, and 37.9%, 67.2%, and 86.8% for the precipitating factors risk groups. When both variables were included in the same model, only predisposing factors remained statistically associated with delirium. Predisposing factors play a key role in the likelihood of having delirium among this population. Increased awareness of these factors among nurses could improve the care of these residents by targeting modifiable risk factors.

Objectives To evaluate the impact of using different diagnostic criteria on prevalence rates of delirium and subsyndromal delirium (SSD) among demented long-term care (LTC) residents. Design Descriptive study. Setting LTC settings in Quebec City, Canada. Participants Participants were 155 individuals aged 65 and older, with dementia. Measurements (1) Prevalence rates of delirium according to: (a) the Diagnostic and Statistical Manual of Mental Disorders (DSM-III, DSM-III-R, and DSM-IV) and (b) the Confusion Assessment Method (CAM) algorithms for definite and probable delirium; and (2) prevalence rates of SSD employing 2 definitions described in previous studies. Results Prevalence rates of delirium according to each set of criteria were 26.5% for DSM-III; 29% for DSM-IV-TR; 41.3% for DSM-III-R; 45.8% for CAM algorithm for definite delirium; and 70.3% for CAM algorithm for probable delirium. A total of 109 subjects (70.3%) were identified as delirious consistent with at least one classification and 37 (23.9%) met all the sets of criteria considered. Prevalence rates for SSD were 75 (48.4%) and 78 (50.3%) depending on the definition employed. Conclusion Prevalence rates for delirium are much affected by the diagnostic formulations used. The use of DSM-IV-TR among this population could result in fewer cases being identified as delirious and thus compromise proper care for those individuals. Considering that SSD was prevalent among this population, a systematic implementation of protocols targeting risk factors of delirium might be beneficial among demented LTC residents.

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.