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Use of nurse-observed symptoms of delirium in long-term care: effects on prevalence and outcomes of delirium

Published online by Cambridge University Press:  30 September 2010

Jane McCusker ,
Martin G. Cole ,
Philippe Voyer ,
Johanne Monette ,
Nathalie Champoux ,
Antonio Ciampi ,
Minh Vu  and
Eric Belzile
Jane McCusker*
Affiliation:
Department of Clinical Epidemiology and Community Studies, St Mary's Hospital, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
Martin G. Cole
Affiliation:
Department of Psychiatry, St Mary's Hospital, Montreal, Quebec, Canada Department of Psychiatry, McGill University, Montreal, Quebec, Canada
Philippe Voyer
Affiliation:
Faculty of Nursing Sciences, Laval University, Montreal, Quebec, Canada
Johanne Monette
Affiliation:
Division of Geriatric Medicine, Jewish General Hospital, Montreal, Quebec, Canada
Nathalie Champoux
Affiliation:
Institut Universitaire de Gériatrie de Montréal; Département de médecine familiale, Université de Montréal, Quebec, Canada
Antonio Ciampi
Affiliation:
Department of Clinical Epidemiology and Community Studies, St Mary's Hospital, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
Minh Vu
Affiliation:
Division of Geriatric Medicine, Centre Hospitalier de l'Université de Montréal and Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
Eric Belzile
Affiliation:
Department of Clinical Epidemiology and Community Studies, St Mary's Hospital, Montreal, Quebec, Canada
*
Correspondence should be addressed to: Dr. J. McCusker, Department of Clinical Epidemiology and Community Studies, St Mary's Hospital Center, 3830 Avenue Lacombe, Montreal, Quebec, H3T 1M5, Canada. Phone: +1 514-435-3511-5062; Fax: +1 514-734-2652. Email: jane.mccusker@mcgill.ca.
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Abstract

Background: Previous studies have reported that nurse detection of delirium has low sensitivity compared to a research diagnosis. As yet, no study has examined the use of nurse-observed delirium symptoms combined with research-observed delirium symptoms to diagnose delirium. Our specific aims were: (1) to describe the effect of using nurse-observed symptoms on the prevalence of delirium symptoms and diagnoses in long-term care (LTC) facilities, and (2) to compare the predictive validity of delirium diagnoses based on the use of research-observed symptoms alone with those based on research-observed and nurse-observed symptoms.

Methods: Residents aged 65 years and over of seven LTC facilities were recruited into a prospective study. Using the Confusion Assessment Method (CAM), research assistants (RAs) interviewed residents and nurses to assess delirium symptoms. Delirium symptoms were also abstracted independently from nursing notes. Outcomes measured at five month follow-up were: death, the Hierarchic Dementia Scale (HDS), the Barthel ADL scale, and a composite outcome measure (death, or a 10-point decline in either the HDS or the ADL score).

Results: The prevalence of delirium among 235 LTC residents increased from 14.0% (using research-observed symptoms only) to 24.7% (using research- and nurse-observed symptoms). The relative risks (and 95% confidence intervals) for prediction of the composite outcome, after adjustment for covariates, were: 1.43 (0.88, 1.96) for delirium using research-observed symptoms only; 1.77 (1.13, 2.28) for delirium using research- and nurse-observed symptoms, in comparison with no delirium.

Conclusions: The inclusion of delirium symptoms observed by nurses not only increases the detection of delirium in LTC facilities but improves the prediction of outcomes.

Keywords

deliriumdetectionnursing homelong-term care
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 4 , May 2011 , pp. 602 - 608
Copyright
Copyright © International Psychogeriatric Association 2010

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