Margaret A. Bergmann

Delirium Symptoms in Post-Acute Care: Prevalent, Persistent, and Associated with Poor Functional Recovery

OBJECTIVES: To determine the prevalence of delirium symptoms at the time of admission to post‐acute facilities, the persistence of delirium symptoms in this setting, and the association of delirium symptoms with functional recovery.

Outcomes of Older People Admitted to Postacute Facilities with Delirium: OUTCOMES OF DELIRIUM IN POSTACUTE CARE

Objectives: To compare outcomes of patients admitted to postacute skilled nursing facilities with delirium, subsyndromal delirium, and no delirium.

Persistent Delirium Predicts Greater Mortality

OBJECTIVES: To examine the association between persistent delirium and 1‐year mortality in newly admitted post‐acute care (PAC) facility patients with delirium who were followed regardless of residence.

Do Medical Inpatients Who Report Poor Service Quality Experience More Adverse Events and Medical Errors

Purpose:Service quality deficiencies are common in health care. However, little is known about the relationship between service quality and the occurrence of adverse events and medical errors. We hypothesized that patients who reported poor service quality were at increased risk of experiencing adverse events and medical errors. Subjects and Methods:Patients were interviewed during and after their admissions regarding problems experienced during the hospitalizations. We used this information to identify service quality deficiencies. We then performed a blinded, retrospective chart review to independently identify adverse events and errors. We used multivariable methods to analyze whether patients who reported service quality deficiencies (obtained by patient report) experienced any adverse event, close call, or low risk error (ascertained by chart review). Results:The 228 participants (mean age 63 years, 37% male) reported 183 service quality deficiencies. Of the 52 incidents identified on chart review, patients experienced 34 adverse events, 11 close calls, and 7 low risk errors. The presence of any service quality deficiency more than doubled the odds of any adverse event, close call, or low risk error (adjusted odds ratio = 2.5; 95% confidence interval = 1.2–5.4). Service quality deficiencies involving poor coordination of care (adjusted odds ratio = 4.4; 95% confidence interval = 1.4–14.0) were associated with the occurrence of adverse events and medical errors. Conclusions:Patient-reported service quality deficiencies were associated with adverse events and medical errors. Patients who report service quality incidents may help to identify patient safety hazards.

Randomized Trial of a Delirium Abatement Program for Postacute Skilled Nursing Facilities

OBJECTIVES: To determine whether a delirium abatement program (DAP) can shorten duration of delirium in new admissions to postacute care (PAC).

A Model for Management of Delirious Postacute Care Patients

Although delirium has been shown to be a common, morbid, and costly problem for hospitalized older people, evidence has mounted that it may persist for weeks or months. Therefore, concern about delirium can no longer be confined to acute care. After an acute hospitalization, many older people are discharged to postacute care (PAC) facilities—rehabilitation hospitals and skilled nursing facilities. Although several models designed to prevent delirium in the hospital setting have been described, there have been few such efforts in the PAC setting.

QUEST FOR A DETRUSOR OVERACTIVITY INDEX

PURPOSE Urge incontinence, which is the predominant type of geriatric incontinence, is generally attributed to detrusor overactivity. However, detrusor overactivity is present in up to half of continent elderly individuals. We postulated that detrusor overactivity associated with urge incontinence would be more severe but there are no established criteria for judging severity. Using urge incontinence frequency as a yardstick and controlling for nonurodynamic contributing factors we sought intrinsic lower urinary tract parameters that reflect detrusor overactivity severity. We postulated that parameters in 1 or more of 5 domains would be important, namely characteristics of uninhibited contraction, bladder capacity, bladder proprioception, detrusor contractility and sphincter adequacy. MATERIALS AND METHODS We analyzed data on 79 community dwelling incontinent individuals older than 60 years old. All subjects had urge incontinence on a 4-day voiding record and underwent multichannel videourodynamics. We examined the associations of urge incontinence frequency with the postulated key factors. RESULTS Multivariable analysis revealed that 24-hour urine output and functional bladder capacity consistently predicted urge incontinence frequency. Bladder proprioception was significant in some models. Uninhibited contraction pressure was another predictor. Surprisingly higher uninhibited contraction pressure was associated with lower urge incontinence frequency. This negative correlation was more pronounced in a subgroup with a less adequate sphincter but absent in those with good sphincter function, implying that low uninhibited contraction pressure does not necessarily indicate less severe detrusor overactivity but rather reflects sphincter inadequacy in many patients. Age was not independently associated with urge incontinence frequency. CONCLUSIONS We identified functional bladder capacity as a measure of detrusor overactivity severity. The measure commonly used, namely uninhibited contraction pressure, is inappropriate because it is severely confounded by sphincter function, especially in older individuals. Furthermore, we confirmed that urine output, and possibly bladder sensation and sphincter strength modify the clinical manifestation of detrusor overactivity.

Persistent Delirium Predicts Increased Mortality

OBJECTIVES: To examine the association between persistent delirium and 1‐year mortality in newly admitted post‐acute care (PAC) facility patients with delirium who were followed regardless of residence.

Persistent Delirium Predicts Greater Mortality: PERSISTENT DELIRIUM AND MORTALITY

OBJECTIVES: To examine the association between persistent delirium and 1‐year mortality in newly admitted post‐acute care (PAC) facility patients with delirium who were followed regardless of residence.

RESPONSE LETTER TO DR. PITKÄLÄ AND COLLEAGUES

final manuscript: KHP, TES, RST, JVL. KHP is the guarantor. Sponsor’s Role: The Finnish delirium trial was supported by the Lions Organization (Punainen SulkaFRed Feather), Helsinki University Central Hospital, Helsinki City, and the Academy of Finland (Grant 48613). The sponsors did not have any role in the study design or analysis or interpretation of data, in writing the report, or in the decision to submit this article for publication. The authors were independent researchers not associated with the funders.