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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

Published online by Cambridge University Press:  13 March 2014

Martin G. Cole ,
Jane McCusker ,
Philippe Voyer ,
Johanne Monette ,
Nathalie Champoux ,
Antonio Ciampi ,
Eric Belzile  and
Minh Vu
Martin G. Cole*
Affiliation:
Department of Psychiatry, St. Mary's Hospital Center & McGill University, Montreal, Quebec, Canada St. Mary's Research Centre, St Mary's Hospital Center, Montreal, Quebec, Canada
Jane McCusker
Affiliation:
St. Mary's Research Centre, St Mary's Hospital Center, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
Philippe Voyer
Affiliation:
Faculty of Nursing Sciences, Laval University, Quebec, Quebec, Canada
Johanne Monette
Affiliation:
Division of Geriatric Medicine, Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec, Canada Donald Berman Maimonides Geriatric Center, Montreal, Quebec, Canada
Nathalie Champoux
Affiliation:
Institut Universitaire de Gériatrie de Montréal; Département de médecine familiale, Université de Montréal, Montreal, Quebec, Canada
Antonio Ciampi
Affiliation:
St. Mary's Research Centre, St Mary's Hospital Center, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
Eric Belzile
Affiliation:
St. Mary's Research Centre, St Mary's Hospital Center, Montreal, Quebec, Canada
Minh Vu
Affiliation:
Division of Geriatric Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
*
Correspondence should be addressed to: Dr. Martin G. Cole, Department of Psychiatry, St. Mary's Hospital Center, 3830 Avenue Lacombe, Montreal, Quebec H3T 1M5, Canada. Phone: +514-345-3511; ext. 3839; Fax: +514-734-2652. Email: [email protected].
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Abstract

Background:

The immediate clinical significance of Confusion Assessment Method (CAM)-defined core symptoms of delirium not meeting criteria for delirium is unclear. This study proposed to determine if such symptoms are associated with cognitive and functional impairment, mood and behavior problems and increased Burden of Care (BOC) in older long-term care (LTC) residents.

Methods:

The study was a secondary analysis of data collected for a prospective cohort study of delirium. Two hundred and fifty-eight LTC residents aged 65 years and older in seven LTC facilities had monthly assessments (for up to six months) of CAM – defined core symptoms of delirium (fluctuation, inattention, disorganized thinking, and altered level of consciousness) and five outcome measures: Mini-Mental State Exam, Barthel Index, Cornell Scale for Depression, Nursing Home Behavioral Problems Scale, and Burden of Care. Associations between core symptoms and the five outcome measures were analyzed using generalized estimating equations.

Results:

Core symptoms of delirium not meeting criteria for delirium among residents with and without dementia were associated with cognitive and functional impairment and mood and behavior problems but not increased BOC. The associations appear to be intermediate between those of full delirium and no core symptoms and were greater for residents with than without dementia.

Conclusion:

CAM-defined core symptoms of delirium not meeting criteria for delirium appear to be associated with cognitive and functional impairment and mood and behavior problems in LTC residents with or without dementia. These findings may have implications for the prevention and management of such impairments and problems in LTC settings.

Keywords

core symptoms of deliriumsubsyndromal deliriumcognitionfunctionmoodbehavior
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 7 , July 2014 , pp. 1181 - 1189
Copyright
Copyright © International Psychogeriatric Association 2014 

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