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Delirium in the hospitalised elderly: An audit of NCHD prescribing practice

Published online by Cambridge University Press:  13 June 2014

Odile Hally  and
Colm Cooney
Colm Cooney
Affiliation:
Department of Old Age Psychiatry, St Vincent's Hospital, Elm Park, Dublin 4, Ireland
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Abstract

Objectives: This study was carried out to determine the prescribing of psychotropic medication of non-consultant hospital doctors in the management of delirium and to compare this with best practice guidelines.

Method: A structured questionnaire was forwarded to all non-consultant hospital doctors (n = 95) working at St Vincent's University Hospital and data was collected over a six month period. The questionnaire addressed type, dose and route of psychotropic medication use in delirium as well as adjunctive measures used to manage delirium.

Results: There was a 55% response rate (n = 52). Haloperidol and lorazepam were the two most frequently prescribed psychotropic agents used and over one third of respondents (n = 20) reported the use of risperidone. There was wide variation in doses used and a substantial proportion of NCHDs used higher than recommended starting doses for elderly patients with delirium. In addition, the intramuscular route was reported as the commonest route of administration with a majority of respondents reporting infrequent intravenous route of administration.

Conclusions: The drug choice reported by respondents followed best practice guidelines. However, the wide variation in drug doses used and frequency of parenteral route of administration (particularly intramuscular) indicate the need for increasing awareness of best practice international guidelines. Guidance and clarification regarding the use of atypical antipsychotic medication is required following concerns about their use in dementia.

Keywords

DeliriumElderlyPrescribing
Type
Audit
Information
Irish Journal of Psychological Medicine , Volume 22 , Issue 4 , December 2005 , pp. 133 - 136
Copyright
Copyright © Cambridge University Press 2005

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References

1.World Health Organisation. The ICD-10 classification of mental and behavioural disorders. Diagnostic criteria for research. Geneva: WHO, 1992.Google Scholar
2.Bucht, G, Gustafson, Y, Sandberg, O. Epidemiology of Dementia. Dementia Geriatric Cognitive Discord 1999; 10(5): 315–8.CrossRefGoogle Scholar
3.Levkoff, S, Cleary, P, Liptzin, B, Evans, DA. Epidemiology of delirium: an overview of research issues and findings. Int Psychogeriatr 1991; 3(2): 149–67.CrossRefGoogle ScholarPubMed
4.Lipowski, . Delirium. JAMA 1987; 258:1789–792.CrossRefGoogle ScholarPubMed
5.Koponen, T, Stenback, U, Matila, E. Delirium among elderly admitted to psychiatric hospital and one year follow up. Acta Psychiatric Scand 1989; 70: 579–85.CrossRefGoogle Scholar
6.Francis, J, Kapoor, Wn. Delirium in the hospitalised elderly. J Gen Intern Med 1990; 5: 65–79.CrossRefGoogle Scholar
Weddington, WW. The mortality of delirium an under appreciated problem. Psychosomatics 1982; 23:1232–1235CrossRefGoogle Scholar
7.Jarrett, PG, Rockwood, K, Carver, D, Stolee, P, Cosway, S. Illness presentation in elderly patients. Arch Int Medicine 1995; 155: 1060–1064CrossRefGoogle ScholarPubMed
8.McCusker, J, Cole, M, Abrahamowicz, M, Primeau, F, Belzile, E. Delirium predicts 12 month mortality. Arch Int Med 2002; 162: 457–63.CrossRefGoogle ScholarPubMed
9.Rabins, PV, Folstein, MRDelirium and Dementia diagnostic criteria and fatality rates. Br J Psychiatry 1982; 140:149–53.CrossRefGoogle ScholarPubMed
10.O' Keefe, S, Lavan, J. The prognostic significance of delirium in older hospitalised patients. J Am Ger Soc 1997; 45:174–8.CrossRefGoogle Scholar
11.Inouye, S, Horowitz, R, Tinetti, M, Berkman, L. Acute confusional states in hospitalised elderly incidence risk factors and complications. Clin Res 1989; 37: 524.Google Scholar
12.Rockwood, K. The occurrence and duration of symptoms in elderly patients with delirium. J Gerontol 1993; 48: 162–166.CrossRefGoogle ScholarPubMed
13.Lipowski, ZJ. Delirium: Acute Confusional States. New York: Oxford University Press, 1990.Google Scholar
14.Ross, CA, Peyser, CE, Shapiro, I. Delirium: phenomenologie and etiologie subtypes. Int Psychogeriat 1991; 3: 135–47.CrossRefGoogle Scholar
15.O' Keefe, ST. Clinical subtypes of delirium in the elderly. Dem Ger Cog Dis 1999; 10: 380–85.Google Scholar
16.Meagher, DJ. Delirium Optimising Management. BMJ 2001; 322: 144–49.CrossRefGoogle ScholarPubMed
17.Meagher, DJ. Delirium: The role of Psychiatry. Ad Psych Treatment 2001; 7; 433–43.CrossRefGoogle Scholar
18.Schor, J, Levkoff, S, Lipitz, et al.Risk factors for delirium in the hospitalised elderly. JAMA 1992; 267:827–31.CrossRefGoogle Scholar
19.Lewis, LM, Miller, DK, Morely, JE. Unrecognised delirium in emergency department geriatric patients. Am J Emerg Med (year) 13: 142–45.CrossRefGoogle Scholar
20.APA. Practice Guidelines for the Treatment of Patients with Delirium. Washington DC: APA, 1999.Google Scholar
21.Young, L, George, J. Guidelines for the diagnosis and management of delirium in the elderly. London: British Geriatric Society, 1995.Google Scholar
22.Inoyue, SK, Bogardus, ST, Charpentier, PA, Leo-Summers, , Acompora, D, Holford, TR and Cooney, LM. A multicomponent intervention to prevent delirium in hospitalised older patients. NEIM 1999; 340: 669–76.Google Scholar
23.Robertson, B. Assessment scales in delirium. Dem Geriatr Cog Dis 1999; 10: 368–79.CrossRefGoogle Scholar
24.www.cochrane.org/reviews Cochrane Collaborative Review Group for Dementia and Cognitive ImpairmentGoogle Scholar
25.Schwartz, TL, Masard, PS. The role of atypical antipsychotics in the treatment of delirium. Psychosomatics 2002; 43(3):171–74.CrossRefGoogle ScholarPubMed
26.O' Keefe, ST, Tormey, WP, Glasgow, R, Lavan, JN. Thiamine deficiency in hospitalised elderly patients. Gerontol 1994; 40: 18–24.CrossRefGoogle Scholar
27.Rockwood, K. Educational interventions in delirium. Dem Geriatr Cog Dis 1999; 10: 426–29.CrossRefGoogle ScholarPubMed
28. Committee on Safety of Medicines: www.mca.gov/uk/antipsystroke_9304.htm.Google Scholar