Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-19T04:58:33.415Z Has data issue: false hasContentIssue false
  • English
  • Français

Assessment of inattention in the context of delirium screening: one size does not fit all!

Published online by Cambridge University Press:  23 March 2016

Philippe Voyer ,
Nathalie Champoux ,
Johanne Desrosiers ,
Philippe Landreville ,
Johanne Monette ,
Maryse Savoie ,
Pierre-Hugues Carmichael ,
Sylvie Richard  and
Annick Bédard
Philippe Voyer*
Affiliation:
Faculty of Nursing Sciences, Laval University, Quebec City, Quebec, Canada Centre for Excellence in Aging-Research Unit, Quebec City, Quebec, Canada
Nathalie Champoux
Affiliation:
Department of Family Medicine, Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montreal, Quebec, Canada
Johanne Desrosiers
Affiliation:
Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
Philippe Landreville
Affiliation:
School of Psychology, Laval University, Quebec City, Quebec, Canada
Johanne Monette
Affiliation:
Division of Geriatric Medicine, Jewish General Hospital and Donald Berman Maimonides Geriatric Center, Montreal, Quebec, Canada
Maryse Savoie
Affiliation:
Ste. Anne Hospital, Ste-Anne de Bellevue, Quebec, Canada
Pierre-Hugues Carmichael
Affiliation:
Centre for Excellence in Aging-Research Unit, Quebec City, Quebec, Canada
Sylvie Richard
Affiliation:
Centre for Excellence in Aging-Research Unit, Quebec City, Quebec, Canada
Annick Bédard
Affiliation:
Centre for Excellence in Aging-Research Unit, Quebec City, Quebec, Canada
*
Correspondence should be addressed to: Dr P. Voyer, Faculty of Nursing Sciences, Laval University, Pavillon Ferdinand-Vandry, room 3445, 1050, rue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada. Phone: +1-418-656-2131, Ext.: 8799; Fax: +1-418-656-7747. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Despite its high prevalence and deleterious consequences, delirium often goes undetected in older hospitalized patients and long-term care (LTC) residents. Inattention is a core symptom of this syndrome. The aim of this study was to explore the usefulness of ten simple and objective attention tests that would enable efficient delirium screening among this population.

Methods:

This was a secondary analysis (n = 191) of a validation study conducted in one acute care hospital (ACH) and one LTC facility among older adults with, or without, cognitive impairment. The attention test tasks (n = 10) were drawn from the Concentration subscale the Hierarchic Dementia Scale (HDS). Delirium was defined as meeting the criteria for DSM-5 delirium. The Confusion Assessment Method (CAM) was used to determine the presence of delirium symptoms.

Results:

The Months of the Year Backward (MOTYB) test, which 57% of participants completed successfully, showed the best balance between sensitivity and specificity (82.6%; 95% CI [61.2–95.0], and 62.5%; 95% CI [54.7–69.8] respectively) for the entire group. Subgroup analyses revealed that no test had both sensitivity and specificity over 50% in participants with cognitive impairment indicated in their medical chart.

Conclusions:

Our results revealed that these tests varied greatly in performance and none can be earmarked to become a single-item screening tool for delirium among older patients and residents with, or without, cognitive impairment. The presence of premorbid cognitive impairment may necessitate more extensive assessments of delirium, especially when a change in general status or mental state is observed.

Keywords

deliriumattentionscreeningelderlylong-term careacute carecognitive impairment
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 8 , August 2016 , pp. 1293 - 1301
Copyright
Copyright © International Psychogeriatric Association 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adamis, D., Sharma, N., Whelan, P. J. and Macdonald, A. J. (2010). Delirium scales: a review of current evidence. Aging and Mental Health, 14, 543–555.Google Scholar
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.Google Scholar
Bellelli, G. et al. (2014). Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age and Ageing, 43, 496–502.Google Scholar
Bickel, H. (1996). The hierarchic dementia scale: usage. International Psychogeriatrics, 8, 213–224.Google Scholar
Bravo, G., Dubois, M. F., Hebert, R., De Wals, P. and Messier, L. (2002). A prospective evaluation of the Charlson comorbidity index for use in long-term care patients. Journal of the American Geriatrics Society, 50, 740–745.Google Scholar
Brummel, N. E., Vasilevskis, E. E., Han, J. H., Boehm, L., Pun, B. T. and Ely, E. W. (2013). Implementing delirium screening in the ICU: secrets to success. Critical Care Medicine, 41, 2196–2208.Google Scholar
Buntinx, F., Niclaes, L., Suetens, C., Jans, B., Mertens, R. and Van den Akker, M. (2002). Evaluation of Charlson's comorbidity index in elderly living in nursing homes. Journal of Clinical Epidemiology, 55, 1144–1147.Google Scholar
Charlson, M. E., Pompei, P., Ales, K. L. and MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40, 373–383.Google Scholar
Cole, M. G. and 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.Google Scholar
Cole, M. G. et al. (2014). Core symptoms not meeting criteria for delirium are associated with cognitive and functional impairment and mood and behavior problems in older long-term care residents. International Psychogeriatrics, 26, 1181–1189.CrossRefGoogle Scholar
Desrosiers, J., Bravo, G., Hebert, R. and Dubuc, N. (1995). Reliability of the revised functional autonomy measurement system (SMAF) for epidemiological research. Age and Ageing, 24, 402–406.Google Scholar
Engelborghs, S. et al. (2006). Neuropsychological and behavioural correlates of CSF biomarkers in dementia. Neurochemistry International, 48, 286–295.Google Scholar
Flaherty, J. H. et al. (2007). Delirium is a serious and under-recognized problem: why assessment of mental status should be the sixth vital sign. Journal of the American Medical Directors Association, 8, 273–275.Google Scholar
Hébert, R., Carrier, R. and 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.Google Scholar
Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P. and Horwitz, R. I. (1990). Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine, 113, 941–948.CrossRefGoogle Scholar
Inouye, S. K., Westendorp, R. G. and Saczynski, J. S. (2014). Delirium in elderly people. Lancet, 383, 911–922.Google Scholar
Kolanowski, A. M., Fick, D. M., Yevchak, A. M., Hill, N. L., Mulhall, P. M. and McDowell, J. A. (2012). Pay attention! the critical importance of assessing attention in older adults with dementia. Journal of Gerontological Nursing, 38, 23–27.Google Scholar
Landreville, P., Voyer, P. and Carmichae, P. H. (2013). Relationship between delirium and behavioral symptoms of dementia. International Psychogeriatrics, 25, 635–643.Google Scholar
O'Regan, N. A. et al. (2014). Attention! A good bedside test for delirium?. Journal of Neurology, Neurosurgery, and Psychiatry, 85, 1122–1131.CrossRefGoogle ScholarPubMed
Rizzo, J. A., Bogardus, S. T. Jr., Leo-Summers, L., Williams, C. S., Acampora, D. and Inouye, S. K. (2001). Multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value?. Medical Care, 39, 740–752.Google Scholar
Ronnberg, L. and Ericsson, K. (1994). Reliability and validity of the Hierarchic dementia scale. International Psychogeriatrics, 6, 87–94.Google Scholar
Voyer, P. et al. (2015). Recognizing acute delirium as part of your routine [RADAR]: a validation study. BMC Nursing, 14, 19.Google Scholar
Wei, L. A., Fearing, M. A., Sternberg, E. J. and Inouye, S. K. (2008). The confusion assessment method: a systematic review of current usage. Journal of the American Geriatrics Society, 56, 823–830.Google Scholar
Witlox, J., Eurelings, L. S., de Jonghe, J. F., Kalisvaart, K. J., Eikelenboom, P. and van Gool, W. A. (2010). Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. Journal of the American Medical Association, 304, 443–451.Google Scholar
Wong, C. L., Holroyd-Leduc, J., Simel, D. L. and Straus, S. E. (2010). Does this patient have delirium?: value of bedside instruments. Journal of the American Medical Association, 304, 779–786.Google Scholar