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Latent class analysis of the multivariate Delirium Index in long-term care settings

Published online by Cambridge University Press:  03 May 2018

Antonio Ciampi ,
Chun Bai ,
Alina Dyachenko ,
Jane McCusker ,
Martin G. Cole  and
Eric Belzile
Antonio Ciampi*
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada St. Mary's Hospital Research Centre, Montreal, Quebec, Canada
Chun Bai
Affiliation:
St. Mary's Hospital Research Centre, Montreal, Quebec, Canada
Alina Dyachenko
Affiliation:
St. Mary's Hospital Research Centre, Montreal, Quebec, Canada
Jane McCusker
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada St. Mary's Hospital Research Centre, Montreal, Quebec, Canada
Martin G. Cole
Affiliation:
Department of Psychiatry, St. Mary's Hospital Center, Montreal, Quebec, Canada
Eric Belzile
Affiliation:
St. Mary's Hospital Research Centre, Montreal, Quebec, Canada
*
Correspondence should be addressed to: Antonio Ciampi, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Ave. West, Montreal, Quebec H3A 1X1, Canada. Phone: +1-514-398-1584; Fax: +1-514-398-4503. Email: antonio.ciampi@mcgill.ca.
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Abstract

Background:

A few studies examine the time evolution of delirium in long-term care (LTC) settings. In this work, we analyze the multivariate Delirium Index (DI) time evolution in LTC settings.

Methods:

The multivariate DI was measured weekly for six months in seven LTC facilities, located in Montreal and Quebec City. Data were analyzed using a hidden Markov chain/latent class model (HMC/LC).

Results:

The analysis sample included 276 LTC residents. Four ordered latent classes were identified: fairly healthy (low “disorientation” and “memory impairment,” negligible other DI symptoms), moderately ill (low “inattention” and “disorientation,” medium “memory impairment”), clearly sick (low “disorganized thinking” and “altered level of consciousness,” medium “inattention,” “disorientation,” “memory impairment” and “hypoactivity”), and very sick (low “hypoactivity,” medium “altered level of consciousness,” high “inattention,” “disorganized thinking,” “disorientation” and “memory impairment”). Four course types were also identified: stable, improvement, worsening, and non-monotone. Class order was associated with increasing cognitive impairment, frequency of both prevalent/incident delirium and dementia, mortality rate, and decreasing performance in ADL.

Conclusion:

Four ordered latent classes and four course types were found in LTC residents. These results are similar to those reported previously in acute care (AC); however, the proportion of very sick residents at enrolment was larger in LTC residents than in AC patients. In clinical settings, these findings could help identify participants with a chronic clinical disorder. Our HMC/LC approach may help understand coexistent disorders, e.g. delirium and dementia.

Keywords

deliriumlongitudinaloldlong-term careDelirium Indexhidden Markov modellatent class
Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 1: Issue Theme: Parkinson's Disease , January 2019 , pp. 59 - 72
Copyright
Copyright © International Psychogeriatric Association 2018 

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References

Adamis, D., Treloar, A., Martin, F.C. and Macdonald, A. J. (2006). Recovery and outcome of delirium in elderly medical inpatients. Archives of Gerontology and Geriatrics, 43, 289–298.Google Scholar
Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988a). Cornell scale for depression in dementia. Biological Psychiatry, 23, 271–284.Google Scholar
Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988b). Use of the Cornell scale in nondemented patients. Journal of the American Geriatrics Society, 36, 230–236.Google Scholar
American Psychiatric Association and Task Force on DSM-IV-TR (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association.Google Scholar
Beresin, E. V. (1988). Delirium in the elderly. Journal of Geriatric Psychiatry and Neurology, 1, 127–143.Google Scholar
Cattell, R. B. (1966). The scree test for the number of factors. Multivariate Behavioral Research, 1, 245–276.Google Scholar
Charlson, M. E., Pompei, P., Ales, K. L. and MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40, 373–383.Google Scholar
Ciampi, A., Dyachenko, A., Cole, M. and McCusker, J. (2011). Delirium superimposed on dementia: defining disease states and course from longitudinal measurements of a multivariate index using latent class analysis and hidden Markov chains. International Psychogeriatrics, 23, 1659–1670.Google Scholar
Ciampi, A., Bai, C., Dyachenko, A., McCusker, J., Cole, M. G. and Belzile, E. (2017). Longitudinal patterns of delirium severity scores in long-term care settings. International Psychogeriatrics, 29, 11–17.Google Scholar
Cole, M. G. and McCusker, J. (2016). Delirium in older adults: a chronic cognitive disorder? International Psychogeriatrics, 28, 1229–1233.Google Scholar
Cole, M. G., Ciampi, A., Belzile, E. and Zhong, L. (2009). Persistent delirium in older hospital patients: a systematic review of frequency and prognosis. Age and Ageing, 38, 19–26.Google Scholar
Cole, M. G., McCusker, J., Ciampi, A. and Dyachenko, A. (2007). An exploratory study of diagnostic criteria for delirium in older medical inpatients. The Journal of Neuropsychiatry and Clinical Neurosciences, 19, 151–156.Google Scholar
Cole, M. et al. (2012). The course of delirium in older long-term care residents. International Journal of Geriatric Psychiatry, 27, 1291–1297.Google Scholar
Dosa, D., Intrator, O., McNicoll, L., Cang, Y. and Teno, J. (2007). Preliminary derivation of a nursing home confusion assessment method based on data from the minimum data set. Journal of the American Geriatrics Society, 55, 1099–1105.Google Scholar
Elie, M., Cole, M. G., Primeau, F. J. and Bellavance, F. (1998). Delirium risk factors in elderly hospitalized patients. Journal of General Internal Medicine, 13, 204–212.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Hagenaars, J. A. and McCutcheon, A. L. (2002). Applied Latent Class Analysis. Cambridge, NY: Cambridge University Press.Google Scholar
Hosmer, D. W. Jr., Lemeshow, S. and Sturdivant, R. X. (2013). Applied Logistic Regression. NewYork: John Wiley & Sons.Google Scholar
Inouye, S. K. and Charpentier, P. A. (1996). Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA, 275, 852–857.Google Scholar
Inouye, S. K., Viscoli, C. M., Horwitz, R. I., Hurst, L. D. and Tinetti, M. E. (1993). A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Annals of Internal Medicine, 119, 474–481.Google Scholar
Inouye, S. K., VanDyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P. and Horwitz, R. I. (1990). Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine, 113, 941–948.Google Scholar
Inouye, S. K., Zhang, Y., Jones, R. N., Kiely, D. K., Yang, F. and Marcantonio, E. R. (2007). Risk factors for delirium at discharge: development and validation of a predictive model. Archives of Internal Medicine, 167, 1406–1413.Google Scholar
Kiely, D. K., Jones, R. N., Bergmann, M. A., Murphy, K. M., Orav, E. J. and Marcantonio, E. R. (2006). Association between delirium resolution and functional recovery among newly admitted postacute facility patients. The Journals of Gerontology, Series A, Biological Sciences and Medical Sciences, 61, 204–208.Google Scholar
Levkoff, S. E. et al. (1994). Progression and resolution of delirium in elderly patients hospitalized for acute care. The American Journal of Geriatric Psychiatry, 2, 230–238.Google Scholar
Mahoney, F. I. and Barthel, D. W. (1965). Functional evaluation: the Barthel Index. Maryland State Medical Journal, 14, 61–65.Google Scholar
Marcantonio, E. R., Simon, S. E., Bergmann, M. A., Jones, R. N., Murphy, K. M. and Morris, J. N. (2003). Delirium symptoms in post-acute care: prevalent, persistent, and associated with poor functional recovery. Journal of the American Geriatrics Society, 51, 4–9.Google Scholar
McCusker, J., Cole, M. G., Dendukuri, N. and Belzile, E. (2004). The Delirium Index: a measure of the severity of delirium: new findings on reliability, validity and responsiveness. Journal of the American Geriatrics Society, 52, 1744–1749.Google Scholar
McCusker, J., Cole, M. G., Abrahamowicz, M., Han, L., Podoba, J. E. and Ramman-Haddad, L. (2001). Environmental risk factors for delirium in hospitalized older people. Journal of the American Geriatrics Society, 49, 1327–1334.Google Scholar
McCusker, J., Cole, M. G., Dendukuri, N., Han, L. and Belzile, E. (2003). The course of delirium in older medical inpatients: a prospective study. Journal of General Internal Medicine, 18, 696–704.Google Scholar
McCusker, J. et al. (2011a). Prevalence and incidence of delirium in long-term care. International Journal of Geriatric Psychiatry, 26, 1152–1161.Google Scholar
McCusker, J. et al. (2011b). Use of nurse-observed symptoms of delirium in long-term care: effects on prevalence and outcomes of delirium. International Psychogeriatrics, 23, 602–608.Google Scholar
Murrell, P. (2011). R Graphics. Boca Raton, FL: Chapman & Hall/CRC.Google Scholar
O'Keeffe, S. and Lavan, J. (1997). The prognostic significance of delirium in older hospital patients. Journal of the American Geriatrics Society, 45, 174–178.Google Scholar
Pitkala, K. H., Laurila, J. V., Strandberg, T. E. and Tilvis, R. S. (2006). Multicomponent geriatric intervention for elderly inpatients with delirium: a randomized, controlled trial. The Journals of Gerontology, Series A, Biological Sciences and Medical Sciences A, 61, 176–181.Google Scholar
Raftery, A. E. (1995). Bayesian model selection in social research. In Marsden, P. (ed.), Sociological Methodology (pp. 111–196). Cambridge, MA, USA: Blackwells.Google Scholar
Rockwood, K. (1993). The occurrence and duration of symptoms in elderly patients with delirium. Journal of Gerontology, 48, M162–M166.Google Scholar
Rudberg, M. A., Pompei, P., Foreman, M. D., Ross, R. E. and Cassel, C. K. (1997). The natural history of delirium in older hospitalized patients: a syndrome of heterogeneity. Age and Ageing, 26, 169–174.Google Scholar
Schwarz, G. (1978). Estimating the dimension of a model. The Annals of Statistics, 6, 461–464.Google Scholar
Siddiqi, N., House, A. O. and Holmes, J. D. (2006). Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age and Ageing, 35, 350–364.Google Scholar
Sylvestre, M. P., McCusker, J., Cole, M., Regeasse, A., Belzile, E. and Abrahamowicz, M. (2006). Classification of patterns of delirium severity scores over time in an elderly population. International Psychogeriatrics, 18, 667–680.Google Scholar
Treloar, A. J. and Macdonald, A. J. D. (1997). Outcome of delirium: part 1: outcome of delirium diagnosed by DSM-III-R, ICD-10 and CAMDEX and derivation of the reversible cognitive dysfunction scale among acute geriatric inpatients. International Journal of Geriatric Psychiatry, 12, 609–613.Google Scholar
Vermunt, J. K. and Magidson, J. (2013). Technical Guide for Latent GOLD 5.0: Basic, Advanced, and Syntax. Belmont, MA: Statistical Innovations.Google Scholar
von Gunten, A., Mosimann, U. P. and Antonietti, J. P. (2013). A longitudinal study on delirium in nursing homes. American Journal of Geriatric Psychiatry, 21, 963–972.Google Scholar
Voyer, P., Richard, S., Doucet, L. and Carmichael, P. H. (2009). Detecting delirium and subsyndromal delirium using different diagnostic criteria among demented long-term care residents. Journal of the American Medical Directors Association, 10, 181–188.Google Scholar
Witlox, J., Eurelings, L. S., de Jonghe, J. F., Kalisvaart, K. J., Eikelenboom, P. and van Gool, W. A. (2010). Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA, 304, 443–451.Google Scholar