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Kumar V. Ageing in India--an overview. Indian J Med Res ; : Delirium in general practice. Inouye SK. Delirium in older persons. N Engl J Med ; : One-year health care costs associated with delirium in the elderly population. Arch Intern Med ; : Delirium in patients admitted to a cardiac intensive care unit with cardiac emergencies in a developing country: incidence, prevalence, risk factor and outcome. Gen Hosp Psychiatry ; 36 : Delirium in an intensive care unit: a study of risk factors.

Intensive Care Med ; 27 : Delirium in the intensive care unit: occurrence and clinical course in older patients.

Age of Delirium

J Am Geriatr Soc ; 51 : Predisposing factors for delirium in the surgical intensive care unit. Crit Care ; 5 : Subsyndromal delirium in the ICU: evidence for a disease spectrum. Intensive Care Med ; 33 : Implications of objective vs subjective delirium assessment in surgical intensive care patients. Am J Crit Care ; 21 : e Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis JAMA ; : Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: a review.

Int J Geriatr Psychiatry ; 28 : Partial and No Recovery from Delirium in older hospitalized adults: Frequency and baseline risk factors.


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J Am Geriatr Soc ; 63 : Costs associated with delirium in mechanically ventilated patients. Crit Care Med ; 32 : Design and methods of the Hospital Elder Life Program HELP , a multicomponent targeted intervention to prevent delirium in hospitalized older patients: efficacy and cost-effectiveness in Dutch health care.

BMC Geriatr ; 13 : Delirium in hospitalized older patients: recognition and risk factors. J Geriatr Psychiatry Neurol ; 11 : ; discussion The ICD classification of mental and behavioural disorders : Clinical descriptions and diagnostic guidelines. Geneva: WHO; Popp J. Delirium and cognitive decline: more than a coincidence. Curr Opin Neurol ; 26 : The cholinergic system and inflammation: common pathways in delirium pathophysiology.

J Am Geriatr Soc ; 60 : Clegg A, Young JB. Which medications to avoid in people at risk of delirium: a systematic review. Age Ageing ; 40 : Predisposing and precipitating factors of delirium after cardiac surgery: a prospective observational cohort study. Ann Surg ; : Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction.

Brit J Anaesth ; Suppl 1 : i Delirium: diagnosis, prevention and management. Available from: www. Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery.

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Circulation ; : Standardised frailty indicator as predictor for postoperative delirium after vascular surgery: a prospective cohort study. Eur J Vasc Endovasc Surg ; 42 : Delirium risk screening and haloperidol prophylaxis program in hip fracture patients is a helpful tool in identifying high-risk patients, but does not reduce the incidence of delirium.

BMC Geriatr ; 11 : Am J Crit Care ; 21 : J Crit Care ; 25 : Practical assessment of delirium in palliative care. J Pain Symptom Manage ; 48 : Delirium monitoring in the ICU: strategies for initiating and sustaining screening efforts. Semin Respir Crit Care Med ; 34 : A multicomponent intervention to prevent delirium in hospitalized older patients.

The Hospital Elder Life Program: A model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program. J Am Geriatr Soc ; 48 : NICE quality standard Delirium in adults. July On the other hand, if a previously unrecognized severe cognitive disorder was found, the patient probably could not consent, requiring consent from a substitute decision-maker. This study has several strong features. The study will determine the perioperative delirium prevalence, measured with I-CAM-S, for the first time in a large multicenter German sample.

Despite its high prevalence and consequences, delirium is often underdiagnosed in hospitalized older adults. In particular, this is the case for hypoactive delirium because patients with this syndrome are often not disruptive [ 8 ]. To tackle this issue, we will use the five-item I-CAM, a useful diagnostic and screening tool for ICD delirium that includes abnormal psychomotor activity and is sensitive for the detection of hypoactive delirium [ 28 ].

In addition, we will use a complementary chart review [ 31 ] to ascertain the detection of delirium beyond the established sensitivity and specificity of the I-CAM. While we cannot exclude disruptions of blinding of outcome assessors in this complex trial, we nevertheless attempted to ensure blinding of the assessors as much as was feasible in this trial. Another advantage of the study is the development of a multisector, individualized, multiprofessional and multimodal delirium and POCD prevention program.

There is now strong evidence indicating that such multicomponent interventions can prevent delirium in hospitalized patients, and indicating the importance of adequate training of the involved staff [ 16 ]. Another strength of the study is the design as a stepped-wedge cluster randomized controlled trial, which allows modeling of effects within and between sites of the delirium prevention and management program. Such evidence is of higher quality than results obtained from nonrandomized studies [ 74 ].

In addition, by using a stepped-wedge design, the intervention will be made available to all clusters by the end of the trial [ 75 ], avoiding the controversial situation in which control groups have no intervention. The study will also investigate whether the intervention is cost-effective, so that the improvement of quality of life does not involve higher costs, and the care needs are lower than without the intervention. Given that delirium is highly multifactorial and is linked to many other common geriatric syndromes, it is expected that improving its diagnosis and treatment will be a very practical and effective strategy to improve outcomes, decrease costs, and raise the quality of the healthcare system wide [ 14 ].

Finally, the results of the study are intended to be a milestone for new German guidelines for the prevention and management of delirium in surgery, and for dealing with the frequent and insufficiently diagnosed POCD. In this way, the results of an elective operation will be better, the patient safety and quality of life will be improved, and the long-term risk of dementia will be minimized. Furthermore, from an economic perspective, diagnosing cognitive deficits early and minimizing POD and POCD should be beneficial for patients, caregivers, hospitals, and healthcare insurances.

Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. Patients prone for postoperative delirium: preoperative assessment, perioperative prophylaxis, postoperative treatment. Curr Opin Anaesthesiol. Impaired olfaction and risk of delirium or cognitive decline after cardiac surgery.

Review ARTICLE

J Am Geriatr Soc. Sleep disruption at home as an independent risk factor for postoperative delirium. The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients. J Neural Transm Vienna. Alzheimers Dement. Postoperative cognitive disorders. Curr Opin Crit Care. Rundshagen I. Postoperative cognitive dysfunction.

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Dtsch Arztebl Int. The interface between delirium and dementia in elderly adults. Lancet Neurol. Predicting postoperative delirium after vascular surgical procedures. J Vasc Sur. Int J Nurs Stud. Effect of delirium and other major complications on outcomes after elective surgery in older adults. JAMA surg. Delirium in older people.


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  7. In-facility delirium prevention programs as a patient safety strategy: a systematic review. Ann Intern Med. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. Postoperative delirium in older adults: best practice statement from the American Geriatrics Society. J Am Coll Surg. Psych Up2date.

    Delirium Bibliography

    Strategies for prevention of postoperative delirium: a systematic review and meta-analysis of randomized trials. Crit Care. Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis. Participation in activity and risk for incident delirium. How to prevent perioperative delirium in the elderly? Z Gerontol Geriatr und Geriatrie.

    Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med.