1. Delirium is prevalent in older hospital inpatients and associated with adverse outcomes: results of a prospective multi-centre study on World Delirium Awareness Day
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Ijeoma Obi, Simon Stapley, Farrah Bahsoon, Alice Wheeler, William McKeown, Taran Nandra, Rahul Mahida, Daniel Furmedge, Sarah Richardson, Emma Elliott, Nisha Rai, Aaron Kay, Thomas A Jackson, Olivia Evans, Dorothy Kuek, Sinead Quinn, Jane Masoli, Alex Hornsby, Ana Andrusca, Emma Astaire, Elizabeth Ellis, Alison McCulloch, Guy Tinson, James Gaywood, Eliza Griffiths, Hannah Morgan, Sanojan Bremakumar, Nedaa Haddad, Alexis Giles, Matthew Ansell, Kumudhini Giridharan, Laura Babb, Helen Chamberlain, Tamsin Critchlow, Mary Ni Lochlainn, Sejlo Koshedo, Parrthiepan Visvaratnam, Felicia Tan, Pryankaran Mithrakumar, Elizabeth Lonsdale-Eccles, Jacqueline Ibanichuka, Ahmad Alareed, Grace Fennelly, Arunkumar Annamalai, Deborah Scott, Victoria Gaunt, Esther Hindley, Elizabeth Holmes, Peter Jackson, Sneha Gurung, Huma Naqvi, Janine Valentine, Abdullah B. Khalid, Hannah Moorey, Aayenah Yunus, Adam Swietoslawski, Holly Jacques, Freya Cooper, Roisin McCormack, Alice Moseley, Zahid Subhan, Olivia Cooper, Clare Hughes, Jemima Taylor, Sohail Shakeel, Kirsty Moore, Rajeev Mishra, Ruth Willott, Georgia R. Layton, Natalie Grundmann, Ahmed Abras, Claire Copeland, Sarah B. McClelland, Natasha Christodoulides, Hannah Currie, Asiodu Nneamaka, Asma Khan, George Naish, David Saliu, Eilidh McKenzie, Emmy Abu, Nihaad Syed, Hannah Pendleton, Tammy Lee, Joanne Taylor, Simon Tetlow, Darmiga Thayabaran, Carly Welch, Frances Rickard, Saurav Bhattacharya, Wan Idoracaera Calisa Ikhwan, Oluwatosin O. Abiola, Shiv Bhakta, Martin Glasser, Kwasi Debrah, Rose Laud, Neil Henderson, Imola Bargaoanu, Awolkhier Mohammedseid-Nurhussien, Keziah Austin, Ani Tencheva, Elizabeth Deacon, Sam Cohen, Oliver Todd, James Wilcockson, Matthew Kearney, Amy Walker, Louise Beveridge, Ayoub Behbahani, Lindsay Ronan, Alex McQuillan, Adam McClean, Sureena Janagal, Emma Jay, Michael Sen, Emma Stratton, Emily Williamson, Hamza Ahmed, Roisin Healy, Katrin Hoffman, Ajay MacHarouthu, Sasha Porter-Bent, Amaka Achara, Lauren McCluskey, Hanna Waraich, Peter Nightingale, Laura Briggs, Chioma Iwu, Laurence Caines, Kara Mayor, Nader Nashed, Leeying Giet, Norman Pang, Philip Thomas, Ciaran Barlow, John Marshall, Pranav Mishra, Steve Rutter, Howell Jones, Celine Bultynck, Saad Abdullah, Tarunya Vedutla, Emily Rose, Jane Noble, Edward Bilton, Clare Hunt, Zarah Amin, Caroline Rice, Anum Cheema, Michael Haley, Natalie J. Cox, Gary Kumbun, Edward Wu, Wioletta Pyc, Emma Norman, Christopher James Miller, Olugbenro Akintade, Angela Kabia, Sherif Abdelbadiee, Karen Beharry, Riana Patel, Charlotte Chuter, Laura Jayne Beeley, Shoaib Iqbal, Mark Studley, Miriam Thake, Catherine Bryant, Stuart Winearls, Cal Doherty, Victoria Gaent, Martin Taylor-Rowan, Khai Lee Cheah, Sarah Ahmad, Thomas Pinkney, Emily Moore, Katie Houldershaw, Elaine Seymour, Zhao Xiao Bei, Victoria Clayton, Benjamin Jelley, Vincent McCormack, Daisy Wilson, Zeinab Majid, Moe Su Su San, John Frewen, Bilquis Ahmed, Rory Durcan, Lucy Porter, James Speed, Ghazal Hodhody, Ganapathy Bhat, Kim Kirrane, Emma Louise Cunningham, Rachel King, Megan Offer, Zainab Hussain, Jabed Ahmed, Katherine Williamson, Gladys Ofoche, Olivia B. Morrow, Ismail Kadir, Roxana Taranu, Helen McDonald, Helena Lee, Jennifer Champion, Sophie Pettler, Clementine Anderson, Abhishek Gupta, Teresa Harkin, Bethan Morgan, Shonit Nagumantry, Bushra Khizar, Sharan Ramakrishna, Ayesha Aamir, Harriet Brown, Isabelle Nicholls, Andre Le Poideven, Rodric Jenkin, Isabel Greaves, James Dove, Kelli Torsney, Emily Bowen, Charlotte Bell, Christian Chourot, Robbie Horton, Claire Wilkes, Anna Lewis, Rachael Bygate, Anjli Krishan, George E. Chapman, Muhammad Adam, Jamal Bhatti, Daniel Davis, Katie Ball, James Reid, Karthika Velusamy, Natalie Gaskell, Puja Jatti, Jonathan Treml, Abolfazl Behbahani, Luke Wynne, Jasmine Hart, Nathan Ingamells, Angharad Chilton, James Allen, Emma Mumtaz, Megan Parkinson, Terrence Quinn, Helen Bowden, Laura Jones, Paapa A-Odame, Bogna A Drozdowska, Emma Fisken, Vishnu Prasad, Sam Mills, Kate Foster, Paul Croft, Valerie J. Page, Sandra Darko, and Pedro Vila De Mucha
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Male ,medicine.medical_specialty ,Adverse outcomes ,lcsh:Medicine ,behavioral disciplines and activities ,03 medical and health sciences ,0302 clinical medicine ,mental disorders ,medicine ,Prevalence ,Humans ,030212 general & internal medicine ,Prospective Studies ,Multi centre ,Aged ,Aged, 80 and over ,Inpatients ,Frailty ,business.industry ,lcsh:R ,Delirium ,General Medicine ,Collaboration ,nervous system diseases ,Hospitalization ,Older adults ,Emergency medicine ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Background Delirium is a common severe neuropsychiatric condition secondary to physical illness, which predominantly affects older adults in hospital. Prior to this study, the UK point prevalence of delirium was unknown. We set out to ascertain the point prevalence of delirium across UK hospitals and how this relates to adverse outcomes. Methods We conducted a prospective observational study across 45 UK acute care hospitals. Older adults aged 65 years and older were screened and assessed for evidence of delirium on World Delirium Awareness Day (14th March 2018). We included patients admitted within the previous 48 h, excluding critical care admissions. Results The point prevalence of Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5) delirium diagnosis was 14.7% (222/1507). Delirium presence was associated with higher Clinical Frailty Scale (CFS): CFS 4–6 (frail) (OR 4.80, CI 2.63–8.74), 7–9 (very frail) (OR 9.33, CI 4.79–18.17), compared to 1–3 (fit). However, higher CFS was associated with reduced delirium recognition (7–9 compared to 1–3; OR 0.16, CI 0.04–0.77). In multivariable analyses, delirium was associated with increased length of stay (+ 3.45 days, CI 1.75–5.07) and increased mortality (OR 2.43, CI 1.44–4.09) at 1 month. Screening for delirium was associated with an increased chance of recognition (OR 5.47, CI 2.67–11.21). Conclusions Delirium is prevalent in older adults in UK hospitals but remains under-recognised. Frailty is strongly associated with the development of delirium, but delirium is less likely to be recognised in frail patients. The presence of delirium is associated with increased mortality and length of stay at one month. A national programme to increase screening has the potential to improve recognition.
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- 2019