Benny Brännström

Acute Confusional States in Elderly Patients Treated for Femoral Neck Fracture

The aims of this study were to estimate the incidence of acute confusional state (ACS), its predisposing factors and consequences in 111 consecutive patients operated for fractured neck of the femur. The incidence of ACS was 61 percent and the predicting factors were old age and dementia. Drugs with anticholinergic effect, depression, and previous stroke were factors that seemed to be associated with the development of ACS. Ninety‐two percent of the patients who had severe perioperative blood pressure drops developed ACS. The consequences of ACS were prolonged ward‐stay at the orthopedic department, a greater need for long‐term care after discharge, and poor walking ability at discharge and six months after surgery. The confused patients also had more complications, such as urinary problems, feeding problems and decubital ulcers, as compared with the nonconfused patients.

A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients

Objectives: To investigate whether an education program and a reorganization of nursing and medical care improved the outcome for older delirious patients.

Underdiagnosis and Poor Documentation of Acute Confusional States in Elderly Hip Fracture Patients

To determine the accuracy of diagnosis and documentation of acute confusional states (ACS) in the medical records of patients with hip fracture.

Delirium before and after operation for femoral neck fracture

The aim of this study was to investigate the differences between preoperative and postoperative delirium regarding predisposing, precipitating factors and outcome in older patients admitted to hospital with femoral neck fractures.

Clinical Profile of Delirium in Older Patients

OBJECTIVE: To examine the prevalence, psychiatric and behavior symptoms, differing symptom profiles, and diurnal variations of delirium in older patients.

Prevalence of dementia, delirium and psychiatric symptoms in various care settings for the elderly.

A prevalence study of psychiatric symptoms was performed in parts of a hospital catchment area in Mid-Sweden. In total 717 patients, aged 75 years and above, who were receiving care in an emergency hospital, three nursing homes, five old peoples homes and two home medical care districts were included. All patients were examined using the OBS-scale (Organic Brain Syndrome Scale). Anxiety (51%), psychomotor slowing (45%), delirium (44%), depressed mood (41%), irritability (40%) and dementia (33%) were the most prevalent psychiatric symptoms or diagnoses in the sample but there were wide differences between the four care settings. The present study shows that the prevalence of dementia, delirium and psychiatric symptoms is high in all types of care settings for the elderly. It also demonstrates the need for psychiatric medical and nursing competence in all types of care for the elderly.

Delirium in older patients admitted to general internal medicine.

Delirium on the day of admission to general internal medicine wards was studied in 400 consecutive patients aged 70 years and above regarding occurrence, associated factors, clinical profile, length of hospital stay, and mortality. The patients were assessed using the Organic Brain Syndrome Scale and the Mini-Mental State Examination, and delirium was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (4th ed) criteria. Delirium on the day of admission occurred in 31.3% of the patients and was independently associated with old age, fever on the day of admission (≥ 38°C), treatment with neuroleptics, impaired vision, male sex, and previous stroke. Delirious patients had longer hospital stay (15.4 vs 9.5 days, P < .001), a higher mortality rate during hospitalization (11/125 vs 5/275, P < .001), and a higher 1-year mortality rate (45/125 vs 55/275, P = .001). Delirium is a common complication with often easily identified causes, and it has a serious impact on outcome for older medical patients.

Symptom Profile of Delirium in Older People With and Without Dementia

Clinical profiles of delirium in 717 older people with and without dementia age 75 years and older in 4 different types of care were studied. Delirium and dementia were diagnosed according to DSM-IV criteria. Delirious demented participants (n = 135) had more often had previous delirium episodes and were more often being treated with analgesics compared to delirious participants without dementia (n = 180). The clinical profile of delirium in the participants with dementia was more frequently characterized by aggressivity, latency in reaction to verbal stimuli, restlessness and agitation, delusions, anxiousness, hallucinations, and a poorer orientation and recognition. Delirium among demented participants more often had a fluctuating course during the day and was more common in the evening and at night. In conclusion, clinical profiles of delirium in participants with and without dementia are different, which might indicate a different etiology or pathophysiology, or both, and a need for different treatment strategies. (J Geriatr Psychiatry Neurol 2007;20:166—171)

Care of the Delirious Patient

In spite of the fact that delirium is a common and often severe cognitive disturbance in the elderly, quite few intervention studies are performed. Descriptive studies of variable quality are much more common. For example, in hip fracture patients delirium is a common complication and the cause of nursing problems that cannot be explained by the fracture per se. Nursing and medical interventions have been published separately but only one study, the Piteå Program, has so far been known that combines nursing and medical knowledge. This program has been shown to reduce the incidence of delirium in elderly hip fracture patients.

Falling, Hoarding and Hiding, Eating Disturbances, and Sexual Disinhibition

Consensus concepts regarding behavioral disturbances of dementia can be useful for screening populations of patients with dementia. However, these concepts may not serve well as guidelines for treatment in clinical practice. The physician or nurse faced with a husband with dementia and his healthy wife must consider seriously all dementia-related behavioral problems, whether or not they fit within consensus concepts. It also is easier to reach a consensus on highly abstract concepts than to achieve agreement on more practical issues. Cultural differences, both between countries and within the same country, also complicate the consensus process.